This Blog Is About

This blog is about---You! Each and every post is about you. Use it to challenge your usual patterns, as a tool for self-discovery, to stimulate your thinking, to learn about yourself and to answer your questions about others.

Friday, December 30, 2011

Biggest Bang For Your Buck

How to Get The Most Out of Your Therapy Session

 The post I wrote about therapists, called The Imperfect Therapist, has received a lot of attention and continues to attract a lot of readers.   That post discusses what you should expect from a therapist.  However, there are two sides to the story.  How beneficial your therapy is depends, not only on how effective your therapist is but, also, on what you bring to the table.
If you've never been through a course of therapy, it's hard to know how to make the most of it.
How to best use therapy is actually something to be learned.  It is different from  going to other professionals such as a medical doctor or accountant, or tax preparer, or dentist or financial adviser or lawyer since these people usually do something specific to or for you.  For example, a dentist does a procedure to your teeth (oooo, we don't really want to think about that too much, do we!), a lawyer drafts a will, a doctor writes a prescription, and so forth.  So, to these professionals, you simply present your problem and they do something about it. 

The difference in working with a therapist is that it is a collaborative effort.  So the best therapist in the world can't  be very successful with you if you go to them with all your defenses up:  They can't help you move in the most productive direction for you if you lie;  if you are hiding your feelings and restricting what you share, it will be hard for the therapist to make a connection with you.  Your therapist will be trying to begin and build, a trusting, reciprocal, safe, creative relationship with you.

 ~Most therapy effectiveness studies show that the quality of the relationship with the therapist is the most significant determinant of the outcome of the therapy.~
Therefore, the first step is to carefully select your therapist.  Personal referrals are good if you are lucky enough to know someone who has a therapist they like and think would be good for you.  Otherwise, beyond the basic credentials, you want to look for someone experienced, who seems competent to you, and with whom you can feel comfortable.  I don't mean that therapy is always going to be a cake walk, just that you should feel faith in doing your personal work with this particular person.

  • Think about yourself before your session.  You may have a lot of things on your mind, but, try to feel what is foremost.  What has the most charge for you?  Bring that to your session.
  •  Leave your cell phone in the car.  It is a distraction, even on vibe.  Your therapist isn't answering the phone during your session (I hope!), nor interrupting her attention on you to glance at incoming cell calls.  Take the therapy hour as time for yourself; leave your other obligations aside for the session and devote it, uninterrupted, to yourself.              
  • Try to make it to every appointment if at all possible.  There is a psychological rhythm that gets established if you attend therapy regularly.
  • Stay focused in the session.  It doesn't mean that free association shouldn't happen---sometimes insights come up---and it is an off-shoot of your original focus.  That's all right.  In fact, that's good.  Sometimes great leaps of learning take place there.  But what isn't good is if you just go off on tangent after tangent and end up only having poured out your mind contents without achieving any in-depth understanding on any of it.  That can  be frustrating if it happens a lot.
  • Allow yourself to truly consider what suggestions your therapist might offer.  Sometimes the pent up emotionality of a topic will make it difficult for the patient to listen.  If you can't really consider it in the session, try still to take  in what your therapist says and consider it later. 
  •  Have both your feelings and your thinking in gear during your session.
  • Be forthcoming.  Be flowing rather than self-inhibiting.   The more you offer up, the more your therapist and you have to engage with and to consider.  Don't be a tightwad!  Be generous with your inner self and personal information in therapy.
  • Think about what transpired in your session afterwords.  If it is at all possible, take some time right after your visit to digest what has occurred.  It's better not to just put it away and go running off to the next task in your day.  Definitely don't spew it all out to a friend or spouse or relative.  Even if you feel a lot about some of it---excited, stirred up, puzzled, or anything else, it's better to stay with that feeling and see what evolves.  If you immediately share it with someone else, it dilutes the therapeutic effect.
 If you stay in the process, you may continue to move along in your personal growth or toward the resolution of a problem, during the time between sessions; you may have realizations that result from what occurred in the session.  This is ideal as you hope one day, to be able to grow and change on your own.  By the way, therapy does ultimately help you to become more independent and differentiated.  It can take time, and you may feel dependent on your therapist for awhile, but, eventually you will begin to discover self clarification and firmer boundaries,  more flexibility, increased consciousness, and an improved ability to make good decisions for yourself.
Therapy is not only for problem-solving; it can also serve to help you grow and mature.  It even has, sometimes, an effect of improving physical health.                                                                  
Does therapy sound effortful?  Well, yes, it is.  To get the most out of it, you have to put something into it.  But, on the other hand, in an on-going therapy relationship, there is always room for just using a session here and there, for some nurturing and understanding.  If you have been sincere and genuinely sharing with your therapist, the therapist will be able to offer you attentive listening and real compassion.  Now there's a rare and treasured life experience.

Please share your reactions and comments.

Thursday, December 22, 2011

Gift To Yourself

Practice to Nurture Your Well-Being

 "Compassion is a fundamental human trait with deep evolutionary roots.  By creating environments that foster cooperation and altruism, we nurture this positive side of human nature.

 Happiness isn't just determined by our genes.  It also develops from a learned set of skills and habits of mind that can be taught and, with practice, deepened. 

Happiness and altruism inevitably intertwine.  Doing good is an essential ingredient to being happy."

The Greater Good Science Center

Friday, December 16, 2011

Wrong Way Corrigan

How do Most People go About Selecting Their Therapist?

The wrong way, at least in the opinion of most therapists, themselves.  I have heard some pretty hot-under-the-collar declarations by therapists regarding what I am about to describe.
Most people, notably those who have never been in therapy before, seek a therapist in the following manner:  "Hmmm, I think I will call my insurance company for a list of therapists that are on their panel.  Oh, good, here's the list.  Now, let me see, who has an office that is most conveniently located to my work or home."
This isn't how a therapist wants to be selected.
A therapist seeking their own consultant does it quite differently.  (Yes, we do go to therapists ourselves and, by the way, you wouldn't want to see a therapist who didn't.  Someone who already knows it all is not in a growth process).  None of us would ever select a therapist for our own treatment or consultation using this method.

Why is that?  It seems practical, efficient and logical.  Well, because, this is a highly personal matter.  It is even more personal than your relationship with your primary care physician.  A therapist has to provide a number of things for you to be able to flourish in treatment:  They need to match your idea of professionalism, be able to make you feel reasonably comfortable, seem intelligent and knowledgeable enough for your criteria.  And that's just the beginning.  It is a highly individual and personal selection that needs to be made.

It isn't that you are looking for someone perfect but, you are looking for someone with whom you can form a bond and with whom you can think:  "I will probably be able to open up here.  I can imagine myself being able to make the changes I need to make or look at the issues I need to, with this person."  In other words, therapists are not interchangeable.  Be willing to drive a little ways for the right person.  It's worth it.

How Does the Therapist Think About You?
  You are probably more important than you realize.  Most therapists in a solo private practice, do not have more than 20 cases at a time.  They may have more than 20 people under their care as some cases may be couples or families.  But, you can see, we are talking about a range of 10 to 30 people.  So, you are not just a persona passing through.  You receive a lot of attention from your therapist:  Thought, care, planning, concern.  You are individually considered;
you are not in an assembly line.
When you start in therapy with a particular practitioner, they expect to see you on-going for awhile so, they begin by investing themselves in a relationship, in establishing a relationship with you.  This relationship is important as it is the framework within which you will work on your problems.

So, How Do You Find This Just Right For You Person?
If you are lucky enough to get a personal referral, that is ideal.  If you have a friend who is in or who has been in therapy and has someone to recommend, great.   Ask around.  Read profiles on referral services.  If a therapist writes, read what they say; how does it make you feel?  Investigate.  Most therapists in their own practice now have some sort of on-line presence, a blog, a listing, a facebook page, a website; look at these and compare.
Once you've found a few that look interesting, it wouldn't hurt to do a little mini-phone interview.
The last time I sought a therapist for myself, I thought about what were my most important criteria---here I will share those with you---lots of experience, the older the better, someone who had lived a little---these were what I wanted.

I encourage you to think about what you want.  And, also, what doesn't matter to you.  For example, I didn't care if the office was the dingiest ever, if I found someone who could meet me at my level.  But, for some people, the setting is important in feeling comfortable.  I didn't care if the therapist was a man or a woman.  This is important to some people.  Etc.  The point is to try to know what you are looking for---at least what your bottom line must-haves are.
Then I contacted a woman, out of my area, as a matter of fact, who had been the facilitator in some post-graduate training I did.  So, she knew me a little which also helped.  I asked her for recommendations, based on my criteria, outlined above.  She gave me two suggestions.  I picked one and it worked out great.

Using the 1st Discussed- Practical, Efficient Method
Once I had a parent come in with his son.  His son had been seeing a therapist for quite awhile, was connected to her, had a bit of history with her, and felt comfortable with her.   The parents' insurance through their employer had changed and the new one did not have the family's therapist listed.  So, they were looking for a replacement, someone who was on their list and not too far from home.
The son looked so sad.  I tried to say to them that they really should try to negotiate a fee with the former therapist, that the established relationship was important.
I guess you could say I was shooting myself in the foot by not just swooping them up---after all, new business for me, right?  No. Not right. That's not only not ethical, it's unkind.  The boy needed to complete the work he was doing with the therapist he knew.  It was obvious to me.
Unfortunately, the father wouldn't hear of it.  Why should he pay-in this case, the fee was $100. per session-when he could pay a co-payment of $35., he said emphatically.  The last time I talked to them, they were still looking, looking for a replacement.

The Dilemma
Sometimes someone needs therapy, has insurance that will cover part of the cost, the insurance is an HMO (list of their own providers), and they can't afford standard fees.
On the other side is the therapist who earns their living on the payments they receive from a very few patients.
Compromise sometimes has to happen.  Maybe the therapist can lower their fee a little and the patient can stretch their paying tolerance a little and a deal can be struck.  Give it a try.  I wish you the best in finding the therapist who is just right or, right enough, for you.

Your comments are welcome.

Saturday, December 10, 2011

Dialectical Behavior Therapy

Herrick Hospital psychiatry grand rounds, November 14, 2011,  DBT:  An Overview.  Mardell Gavriel, Psychologist, Psy.D. 

A theory of therapy, an offshoot of Cognitive Behavioral Therapy, which has gained some recent renown, was discussed by Dr. Gavriel who uses this method at the mental health services division of the Haight Ashbury Clinic. 
An underlying principle is that if you change one part of the triad---thinking-feeling-behavior, all will change.  This harkens back to family systems therapy theory wherein it was postulated that if one part of the system changed, all parts would have to shift.  It is like a suspended mobile:  If you touch one part, the entire mobile moves (John Bradshaw).
Any kind of emotional dysregulation  can be addressed by this type of therapy.
Goals are:  To do dialectical thinking
.                  To be a flexible problem solver.
                   To find truth in more than one position.
                   To be able to synthesize apparent contradictions.
                   To learn to seek the middle path.
                   To not get caught up in black and white thinking.
                   To learn that ambivalence is possible.
                   One person can have more than one truth.
The DBT therapist uses techniques such as Diary Cards, Homework and Skills Training.
Usually DBT can only be fully utilized in a clinic setting as it requires team strategies (the team is made up of a group of health care providers) who will consult about the patient.  However, individual practitioners can still benefit from some of the ideas and apply them in their practice.

In DBT the therapist and patient work based on a hierarchy of targets, resolving first what DBT considers to be the most serious.  These must be dealt with before moving on to the next target.  The first to be addressed is if there are any dangers-to-self behaviors, on the part of the patient.  The next is therapy interfering behaviors.  Next to be addressed is anything that lowers the quality of the therapy.  And, finally, what DBT calls life interfering behaviors-usually the problems which people come into therapy to work on.
The hoped for outcome for the patient of DBT is:
  • Enhanced capabilities
  • A more efficient life
  • Improved motivational factors
  • Ability to transfer a learned skill from one situation to another
  • Structure the environment to live more effectively
  • Eliminate self-harm behaviors
  • Increase distress tolerance
  • Emotional self regulation
  • Better interpersonal effectiveness
If you, the reader, have ever been able to partake of the therapy process, you will recognize some of the ideas outlined by Dr. Gavriel.   It isn't all new but it is newly organized.
This is not a comprehensive description of this type of therapy; it is a brief rendition of some parts of it.  For more info, see,
Please comment below -

Monday, December 5, 2011

Your Greatest Asset

Reading is brain exercise.  Reading keeps your brain healthy.  If you read my blog, you get double benefits; you get the brain exercise and you get new information and tips for making your life better!

( Anna Ferguson Hall, The Brunswick News, Ga.
Knight Ridder/Tribune Business News)
Nov. 10--Clerks at the Brunswick-Glynn County Library know Evelyn Connell well.
Like clockwork, the Brunswick resident stops by the library every other week, checking out as many books as she can carry. Last week, she signed out 14.
"I can really only carry about 12 or so in my bag, but I just stuff as many as possible in it anyway," Connell said. "There is no limit on how many you can check out, so I take advantage of that, you'd say. I read at least six books a week."
At 71, Connell is an active reader with a sharp mind. She is quick on her feet, clever and vivacious. She loves the TV trivia show "Jeopardy!" and usually knows most of the answers.
She can do several tasks at once and has a mind like a steel trap.
...Her spryness and spunk are likely due to how active she keeps her brain, she speculates.
"I do think that the more active you keep your brain, the longer you hold on to those traits of brain power you have at a younger age," Connell said.
Connell is not alone in that thinking. Overwhelming research has shown that older citizens who keep their minds sharp and active are more likely to retain a higher level of brain power as they age.
Keeping the brain active through exercises like reading regularly is vital to preventing memory loss and reduced brain function, said Janice Vickers, executive director of Alzheimer's of Glynn/ Brunswick.
"There is no question that reading can maintain a healthy brain as you age," Vickers said. "The saying is true: If you don't use it, you lose it."
An estimated 5.4 million Americans of all ages have Alzheimer's disease, the most common form of dementia, according to the National Alzheimer's Association. That's one in eight older Americans.
Vickers said the disease, though prevalent in aging citizens, can be avoided or, at the very least, delayed. Working to prevent the condition at an earlier age is key to ensuring a quick mind like Connell's, Vickers said.
That means flexing the brain as often as possible in a variety of ways.
Cracking a book or other printed work awakens many functions in the brain, including concentration, vision and comprehension, Vickers said.
Reading books, magazines and periodicals aren't the only sources individuals can lean on for stimulating brain function. Doing research online, playing trivia games and even crossword puzzles have been shown as ways to produce more brain function and prevent dementia-related diseases, Vickers said.
Reading also can be a link to diagnosing early stages of memory loss. The ability to read can slip from some patients early in the process of developing the disease. 

(-- Call reporter Anna Ferguson Hall at 265-8320 or e-mail her at to suggest literacy programs or community needs for The Literacy Project.
Distributed by MCT Information Services)


Monday, November 28, 2011

An Offer

Do you want to be in therapy with me?

Have you ever thought that you might like to try therapy?  Maybe you have been in therapy before and you now would like to see me.  You might be someone reading this blog because you want to be in therapy.
Possibly you have been looking for a therapist.
I am going to be accepting new clients at a reduced rate beginning on January 1.  Most psychotherapy fees range somewhere between $100 and $200 per session.  My standard fee is $120.  For the month of January, if you enter therapy with me, your fee per session will be $65.  

The fee will remain at this rate for one year or until there is a break in treatment of 3 months or more.
This is an opportunity to benefit from being in the process of therapy, with a very experienced therapist, in a private practice setting.
In case you are new to therapy, the sessions are about 45 to 50 minutes long and take place once a week.  To therapy you can bring a wide range of problems - for discussion, for acknowledegement,  for suggestions, and for discerning listening.
Call me now to get a January appointment.
You can contact me to arrange an appointment for this - what shall we call it?---sale, discounted fee, gift to my readers, - how about we just say, inexpensive therapy opportunity---at my office phone:  

510 724-4711.

Saturday, November 26, 2011

Your Self-Editor

Here's another way you can improve your relations with others.

The Dalai Lama is repeatedly exhorting us to be kind to each other.  Why does he have to say this over and over?  It seems like if we don't self-edit, any of us can be suddenly sorry about what was just said.
Personally I don't do that on purpose.  But, sometimes some unfortunate remark escapes from me and when I see it land, I am full of instant regret.  Yes, we all slip.  Why does that happen?  It's just the frustrations, or fatigue, or disappointment that we have absorbed, being released.

The problem is, it sometimes gets released on a person; they are innocent and suddenly they feel the sting.  If it happens, all is not lost.  You can apologize.  You can attempt to make it up to the victim.  But, oh, wouldn't it be better if it didn't happen in the first place?  Ms. Flake has a helpful post toward that end:

Cheri Augustine Flake

"...I just wanted to share the wise words that I learned from one of my mentors that I like to teach to my clients. Try to consider the following before speaking (or, I guess, writing) anyone...about anything:

Is it true?
Is it necessary?
Is it kind?

The answer to all three does not need to be 'yes' in order to express yourself, but just to have considered the questions before acting.

Mostly, I guess the lesson is, yes, think before you speak. But also, know that you don't have to say everything that you think.

Could you leave a conference knowing full well that you are "more" of an expert than the presenter without anyone else knowing it?

Or, could you listen to someone's account of their exciting trip to India and all of its glory without mentioning that you've been there 3 times before?

My husband is one of the smartest people I've ever met as well as the most humble. His closest friends don't know that he was Valedictorian of his class, or about his scholarships, degrees or honors. Even when people are speaking about topics of which I know he is an expert, he seems the most quiet.

I try model this behavior because I admire it. I mean, do people have to know all that I know???


Just my humble take on things...

Have a lovely week, y'all!"


Cheri Augustine Flake, LCSW
It would be interesting to hear your own stories related to this post.  (Comment)

Monday, November 21, 2011

Some Things Are Worth Repeating

And so you will find me saying some things more than once.

These two were working  and working hard when this photo was taken but look at the sparkle in those eyes and those full-out smiles. 

Shifting focus away from worry and toward gratitude will reduce stress.

Sunday, November 20, 2011

"From Self-Medication to Intoxication: American Culture's Addiction to No-Suffering"

Psychiatry Grand Rounds, Herrick Hospital:  A Critique of the Self-Medication Hypothesis by Anna Lembke, MD, Stanford University
Held on November 7, 2011

Since 1985, when Edward Khantzian came up with the concept of addiction being the result of self-medication (i.e., the individual doesn't feel right so they use street drugs/alcohol to experience more balance), it has been in usage by most therapists and has become commonly believed.   

The addict or substance abuser  asks for treatment of his personal problems believing this (assistance with resolution of emotional distress) will make it possible to give up the chemical use.  The assumption is that early childhood trauma or an extremely distressing life event, internal psychological suffering or psychiatric symptoms, triggered the addictive use of alcohol or drugs.  However, it turns out, according to Dr. Lembke, who has reviewed hundreds of studies, testing this hypothesis, that there is no evidence for this idea.  She proposes that the evidence shows a substance use disorder to be an independent problem.
This, despite the fact that there is a high rate of co-occurrence.  For example, those diagnosed with an anti-social personality disorder show an 80% rate of substance use disorder, those with bipolar 1 disorder have a 60% co-occurrence rate, and schizophrenics have been found to have a 50%  rate of substance use disorders, while the "regular population" has a rate of 15%.  Nonetheless, a case cannot  be made for someone using a particular substance because it addresses their specific disorder since some of the studies tested what people would do given the free option to choose and full access to mind-altering chemicals.  It turns out, we humans all like the same things.  

People, according to this presentation actually get involved with substances due to either boredom (often the case with marijuana) or to the idea that all suffering should be eliminated and that to take a pill is the way to get rid of it.  Actually, the evidence is for the  reverse; stopping substance abuse leads to healing, it turns out
Dr. Lembke suggests, as did Joan Zweben (see earlier post:, that individuals who are having trouble with the overuse of a substance, experiment with not using. She suggests  4 weeks (the amount of time needed for the brain to reach a new homeostasis) and then to follow that with an evaluation:  
What was different?  What was better?  Was anything worse?  Etc.

The best treatment targets both disorders (whatever is personally troubling the individual as well as the substance use disorder).  It should be an integrated treatment, not one in the absence of the other nor one first and then the other.  Dr. Lembke feels it is possible to help anyone and that "...self-medication is not medicinal."

(The illustration from an artwork by Michael Parkes, titled See No Evil, I chose because the problems discussed here are so hard for many people to talk about and therefore sometimes shame is felt about one's use of substances which can lead to denial)

This point of view is different from what is usually put forward on this topic; do you have any comments?

Tuesday, November 15, 2011

A Simple Way to Improve Your Health

Apply the research results that have been recently coming out and reduce your chance of disease by simply making a point of getting up every hour and walking around a bit or having a little stretch.  Such a simple new habit to establish which could make quite a difference in your future.

"Patel and others also have investigated the health dangers of sitting too long without moving around, which is called "sitting disease." 

In a study of 123,000 people, she found that the more time people spent sitting, the higher their risk of dying early. "Even among individuals who were regularly active, the risk of dying prematurely was higher among those who spent more time sitting," she says.
Even if you are doing half an hour of aerobic activity a day, you need to make sure you don't sit the rest of the day, Patel says. "You have to get up and take breaks from sitting."
Emerging research indicates that prolonged sitting also increases the risk of some types of cancer, such as colon, endometrial and ovarian cancers, Friedenreich says.
James Levine, a professor of medicine at Mayo Clinic in Rochester, Minn., says many people sit an average of seven to 9 hours a day. "If you've sat for an hour, you've probably sat too long," he says.
Friedenreich is looking into why exercise reduces cancer risk. In a study of 320 post-menopausal women, she has found that physical activity appears to decrease the risk of cancer by increasing insulin sensitivity and reducing body fat, inflammation, metabolic hormones and sex steroids hormones."
To see more of, or to subscribe, go to

Copyright 2011 USA TODAY, a division of Gannett Co. Inc.

Monday, November 7, 2011

Your Vision

                             I believe that All human beings are creative beings

"Inspiration comes from everything.  It is the spark within your soul that entices you to create, the need to leave behind something greater than yourself.  Whether you are creating works of art or designing your day, the creative soul needs a place..." or a time or the unoccupied space, to be able to emerge.
Organize your life so that there is some time for your dreams to be dreamt, your thoughts to be formed and your vision to become more and more finely tuned.
(quote from Soft Surroundings and art piece from Anthropologie)

Monday, October 31, 2011

A Healthy Diet Plan

A way to lower your weight that will promote, not compromise, your health
Feeling happy tends to go hand in hand with good food choices and an absence of overeating.  When you are happy, you are more likely to eat only when your body tells you you're (physically) hungry.  You won't be eating in an attempt to quiet emotional hungers.  This blog is full of tips for you to help yourself to create a better life and a more fulfilled you.  If you try some of the suggestions and just check in here on a regular basis, you will begin to see your own vision more clearly and be able to start manifesting it.  You can always start small.  Little changes and improvements add up to an enhanced life experience.

Friday, October 28, 2011

A New Member=A Happy Day

                             When I see a new follower appear, I am delighted
Welcome to my blog, Faaiza Haroon
                                                                 Photograph of cherry blossoms by Ping H. Chen

Tuesday, October 25, 2011

A Dark Secret

Psychiatry Grand Rounds, Herrick Hospital;  The Role of Misogyny and Homophobia in Prison Sexual Abuse by Terry A. Kupers, MD, MSP

Secretiveness is a part of some human problems:  Some examples are, the symptoms of the eating disorder Bulimia such as binging and purging, alcoholism is another, and incest can only continue if it is kept a secret.  The ending of the secret is often key to the beginning of addressing the problem in treatment. 

The extent of the sexual abuse that occurs on a regular basis in our prisons is not commonly known. The victims must keep it secret or they will be subject to retribution.  Some of the reasons for the pervasiveness of this problem are overcrowding which causes an increase in violence, that the proportion of the mentally ill being shifted to the prison system instead of being hospitalized is on the increase, and, the exaggerated dominance hierarchy that exists in prisons.
In a prison, each person, inmate and staff alike, are either the top dog or the victim.  The dominant ones, besides the guards, show "..toxic masculinity; they don't show any emotions or express feelings, they have no trust, they are very watchful, they isolate, they are tough, burly, and buffed, big and mean.  The people at the bottom of the hierarchy are labeled in the prison as, losers, weaklings, faggots, and punks (punk meaning that they are the recipients of sexual advances by the perpetrators/tough guys)."
In prison, inmates, -both men and women- are raped, some of them, repeatedly; they are trapped in a situation that is impossible to be kept safe and can't report the attacks due to the repercussions they will be subject to.  Inmates sometimes suffer "...acute psychiatric decompensation and suicide; people are murdered and are demoralized by being called names such as, hoe, bitch and being infantilized and patronized."
Almost all of the "... prisoners have been massively traumatized..." prior to committing a crime and being imprisoned.  They are then further damaged, psychologically, during the prison experience.  The result is people, when they are released, who have suffered, are damaged and have no coping skills that will be effective on the outside.  What the men tend to do, if left to their own devices is, "...isolate, turn to drugs, and blow up.  The women gain weight, isolate and do everything to try to not show anything in their overt behavior that may be interpreted as a sexual invitation."
Suffice it to say, this is a part of our population that needs help.  (And, of course, as they are helped to, first, receive less damage while incarcerated, and second, to be rehabilitated, it benefits all of us and society, in general)  In 2003, the Prison Rape Elimination Act (a bi-partisan achievement) was passed, which will offer some help.  It requires that the facilities  provide safety.  Of course, they need to have enough supervision to implement that directive. 
Newly released prisoners need assistance with healing, with making the transition, and with learning how to be a productive, good citizen.
Is there anything you can do?  If someone in this situation is one of your relatives, is in your friend group, or gains employment at your work place, what can you do to facilitate their successful transition? 
If they are in therapy, you can be supportive and encouraging of that effort. "...You can express sincere interest in them, as a person.  You can remember to try to understand what goes on in a prison. .. You can be patient."
If you are a psychotherapist reading this post and are in or near the San Francisco Bay Area, you can volunteer one session per week to see a newly released inmate for therapy by calling this number;  510 841-0974.
Dr. Kupers is, of course, working in the American courts and describing the situation in prisons here.  I know that I have readers from all over the world but, I wouldn't be surprised if the conditions he has observed here would also be found in prisons elsewhere.
If you are living with a terrible secret, speak to a trusted person about it.  A therapist would be a good choice, and so would be a doctor.  Sometimes teachers can help or, in some countries, police officers.
Secrets kept in the darkness contribute to the pathology of some  human problems, such as incest, domestic violence, drug addiction and alcoholism.   Bringing the secret out into the open allows for the possibility of a healing light to shine on it.

Thursday, October 20, 2011

A Practical Matter, Beautifully Stated

Nature is one of our most accessible and best stress reducers.

 ". . . The first in time and the first in importance of the influences upon the mind is that of nature.  Every day, the sun; and, after sunset, Night and her stars.  Ever the winds blow; ever the grass grows.  Every day, men and women, conversing---beholding and beholden."---Ralph Waldo Emerson(1803-1882) American writer and poet

Saturday, October 15, 2011

Practice Makes Perfect

Psychiatry Grand Rounds, 10-10-11:  Brain Based Psychotherapy by Lloyd Linford, PhD

"The more often you do something, the more likely you are to do it again."  If you take on a French tutor to work on learning that language, you are likely to do that again.  If you go on a drinking binge, there is a good chance you will repeat that behavior.  Patterns are created in the brain so, "...not only does biology create the mind, but the mind also creates biology."
 If you want to install a good habit in your lifestyle, do it a few times; each time you do, you reinforce that brain pattern and set yourself up to more readily repeat it.  If you want to change, we now know that psychotherapy changes the brain:  "Psychotherapy works by producing changes in gene expression that alter the strength of synaptic connections."
 Neuroplasticity informs us that the brain can change through early nurturing relationships and experiences, psychotherapy, meditation, and mindfulness.  Neuroplasticity means that our brains can form new dendrites, new synapses, improved synaptic efficiency, and perform neurogenesis.  The brain can turn stem cells into new neurons.
Neuroscience was an important field of study until 1900 when Freud published The Interpretation of Dreams.  At that point, most brain studies stopped.  Now, there is an upsurge of interest in this area of inquiry.  Now we have consilience:  Biological realities and psychotherapy are becoming connected in the thinking about human dilemmas and growth.  Once again we see the holistic approach being validated; the mind and body are connected.  As we look at the brain we see that both hemispheres, feeling and thinking are important.  So, now the field will begin moving away from the recent popularity of Cognitive-Behavioral theory to a more comprehensive view:  We do not only move from cognition to affect.  Feelings are not only caused by thoughts but also arise from body states, are a response to memory, and more.
Some of the knowledge emerging from brain studies is:
  • Psychotherapy and anti-depressant medication are about equally effective in depression treatment (info. from effectiveness research).
  • Specialized methods of psychotherapy are not as important as the alliance between the patient and the therapist.  In addition, the outcome of therapy is due to what the patient brings to the table, 40%, to the therapist, 20%, to the technique/type of therapy, only 5%
  • There are gender differences in the brains of females and males.
  • The brain begins with a surplus of neurons; those that are stimulated and used live, the others are subject to apostosis;  "Use it or lose it."
  • Brain development is dependent upon both nature (temperament and genetics) as well as nurture (attachment experience).
  • Attachment=emotional regulation.  A secure caretaker of a child produces a secure adult; attachment leads to healthy autonomy.  Secure attachment leads to lower cortisol levels.
  • 40% of adults are insecure
For more information  on this new current in the theory of therapy, look to the book on evidence based treatment for everyday practice, Brain Based Psychotherapy by Dr. Linford.

You are welcome to comment on this post.

Tuesday, October 11, 2011


What quality of yours is most important to you?  What personality trait or characteristic?

"I suppose if you had to choose just one quality to have that would be it:  vitality."
John F. Kennedy

Friday, October 7, 2011


How do you find a top-notch helping professional?

 "If you lose confidence in your financial adviser, all is lost."  Mike Weintraub (find a story about him in the post titled, Paying It Forward and Benefactors).  When I heard this statement from my friend, right away I began thinking about how true this is for so many people who are in some sort of service or helping position with each of us.  It isn't just your financial adviser you want to feel confidence in; it is your doctor, your tax preparer, your dentist, your secretary if you have one, your chiropractor, physical therapist, broker, electrician, and your therapist. 

How do you develop confidence in one of these or in other types of service providers you might employ?  I have been thinking about those  I have come to trust and trying to define why that is and how that happened.  There are also some in whom I was not able to place my confidence.  What's the difference I've been asking myself.  And do the qualities of those I do feel I can rely on generalize to all?

These are the characteristics and experiences I've noticed with the 'keepers' in my life.  Do you have anything to add?  I'd really be interested in your comments.

  • Someone who explains in a way I can understand and who does not become impatient with sometimes having to clarify or repeat something.  
  • A person who, when in their professional role, is calm.
  • It helps if they don't appear rushed or, at least, not all the time.
  • Honesty is critically important but difficult to determine.
  • Reliable:  They do what they say they are going to do.
  • They can show a human side (like a sense of humor, or a personal anecdote here and there), and still retain their professionalism.
  • Pay attention:  They seem to be careful and thorough.  They either have prepared for their work with you or they are very attentive at the time of the work together.
  • What you bring up is attended to as being important.
  • They listen and address, in some way, your presenting problem or questions.  Your concerns are not dismissed in favor of their own agenda.
  • You can feel their regard for you as a complete person, not just another money-generating appointment.                                                                                                      
  • Hopefully the transaction, whatever it is, is successful for you.  But even if it somehow isn't, you come away with the conviction that the effort was sincere.
These are the experiences I've had with a variety of kinds of professionals that led me to have faith in them as opposed to those who were disappointing. Can you add anything to this list?
It seems to me that looking for criteria such as these could help a person rest easy when another individual is dealing with their personal business.

Monday, October 3, 2011

Between a Rock and a Hard Place

Help with difficult decisions

 Simple + useful=elegant.
There are so many decisions to make as we traverse our own life path.  Some are real dilemmas---difficult; sometimes they are so unclear that we get immobilized.  We can't move, can't choose, and so we stay stuck.  Here is a simple assist, courtesy of my colleague, Charlton Hall.
if you have a thorny problem, try out this simple method as a way to begin sorting it out.

"I have a tool I use, called a 'Cost-Benefit Analysis.' When a client has a decision to make, we do a 'CBA Sheet.' This is a sheet of paper divided into four quadrants. The quadrants are: 1. Costs of doing this; 2. Benefits of doing this; 3. Costs of not doing this, and 4. Benefits of not doing this."
We try to cover all possible ramifications in session. That way I avoid giving them advice by presenting them with all the options and letting them decide. It becomes a great way to dialogue about what goals they, themselves really have for their own lives.
Here's a link to the actual worksheet I use":

Charlton Hall, MMFT, LMFT
Did you try this or something like it?  Please share your comment.

Monday, September 26, 2011

"It's A Big Job Being Me!"

Is there a way to make it easier?

This week I've had 2 adult male patients, in very different stages of life say almost the same thing.  The other one was:  "Why does it have to be so hard?"
             (artist, image on right, Daniel Healey, 2008)

It does, in fact take thought and conscious effort to be you---all that you were meant to be or all that you want to be.  At this stage in human development, a happy fulfilled life is not automatic.  In fact, people who shun self-reflection and do expect a good life without doing any personal work are usually the most unhappy, after all.  An uncomplicated example:  If you simply take the first job you land in, after school, get enamored of the money coming in and don't try to discover what work would be meaningful to you, you can find yourself, years later, a misfit.
One thing    that is much more available now to more people is, choice.  You make many choices and decisions along the way that can be life-altering.  Without some time spent searching inwardly and thinking about your choices, your life can fall off course.
Here are some simple strategies you can begin right away that can start you in the right direction:
  1. Highlight your positive experiences
  2. Substitute gratitude for worry and also, for tension
  3. Try to make someone in your family happier
  4. Contribute some volunteer time to your community
  5. Improve your psychological well-being by practicing forgiveness
Two ways that a therapist can help you feel better are to offer a safe place to re-visit some of your past painful  experiences and, instead of feeling alone, scared, or confused, you can associate that memory with a respectful caring guide, with a comfortable protected setting, and a process of trying to understand.
The second way seems so simple but is really profound.  We have found that the easy-seeming act of naming your feelings, putting words to them helps to settle the brain; it lessens any activity that may be going on in your brain's alarm system.  Sometimes a therapist will label the feeling you are expressing, for you, or-at least suggest a label.  If it resonates with you, then you also receive that wonderful moment of feeling understood.

Sunday, September 25, 2011

Lucien and Suzy

Welcome to my blog!!

 Lush Morphologies by Gary Brewer, 2009

Thursday, September 22, 2011

New Beginnings to Come

Ping H. Chen does some spectacular photographs.  He has permitted me to use them to illustrate my blog.  Here is the first of one of his.

"In life, cycles recur endlessly;
think of the seasons, the phases
of the moon, and the tides which
continually change.  Today,
be open to new beginnings to come."

Sunday, September 18, 2011

Balancing Act

Keeping your life and your Self in balance takes attention

Keeping  your life in balance means not working too much, not playing too hard, not letting your 'me-time' turn into isolation, not using your physical self so much (in sports or a labor job) that you induce damage to your body, or distracting yourself with entertainment (partying, gaming) in such large doses that your mind turns to mush.  Most of us need or at least could use all of these things but, and this is key, in moderation.

One of the ways to plant the seeds of compulsion and, even, addiction is doing too much for too long, of one thing.  In a previous post, I wrote about how behaviors and substances are sometimes used to escape/avoid, to numb the emotions, or to achieve a false high---leading to dependence.
Most people can not only do all of the above things but, will find them much more delicious and gratifying in small doses  The first bite of a choice cupcake or candybar is divine but as you continue eating, it's almost as if your taste buds become dulled and 3/4 of the way through, that delicious cupcake just isn't as exciting anymore.  Drug addicts sometimes describe the compulsive search for the massive high of the very 1st dose, never again to be experienced.
A beautiful, unusual bouquet of flowers can have a luscious fragrance and be beautiful visually unless you work in a florist shop.  Too much of a good thing overloads our senses and removes the charge.

A lot of people don't like to hear this, the oft offered advice:  All things in moderation.  Some people hear this as a restriction-they want to be able to generate extremes-but actually as referred to in the post So You Want to be Free, you actually preserve your freedom of choice if you don't overindulge.

Today is my birthday.  I decided to begin a new tradition:  A Birthday Resolution.  My resolution is to try to move towards an even amount of work and play in my own life.  I've worked very hard all my life and I have accumulated an array of responsibilities, so, for me, this will be a challenge.  But it will be an effort toward balance.  It reminds me of people who invest in the stock market; periodically, and on a regular basis, they have to "re-balance their portfolio".  They have an investment strategy that they've committed to and they have to re-balance from time to time to keep the portfolio in line with their goal.

Excess isn't healthy.  Overindulgence is what the word says it is---too much.

We notice this imbalance when we see a person who is prone to emotional extremes.  "Experiencing emotions is, of course, a normal part of life, but extremes can induce imbalance and illness..."  Dr, Maoshing Ni.    Impulsive actions can also lead to repercussions.  "When you are visited by emotional extremes, use deep breathing and rest to restore your metabolic equilibrium."  Dr. M. Ni

The old adage:  Think before you speak can come in handy.  (Save yourself from saying something you might regret but can't take back.)  Giving yourself a little time before you respond to another, and before you take action can yield a superior plan.  That's what I find.

Wednesday, September 14, 2011

To Revisit and Transform

"Self-regarding intensity"

"It's that singular drive to revisit and transform, to keep seeing freshly and more deeply, that runs like a river...of forward-flowing energy, constantly pressing on, ceaselessly learning and innovating, discarding and reappropriating, looking forward and backward...and feeling as fully..." as one can.Steven Winn
Such wonderful writing, not about therapy but struck me as beautifully describing the self-actualizing person, the one who is not satisfied with an unconscious life, the one who seeks, the one who wishes to discover-the world, yes, but, above all-themselves.  (For more on the self-actualizing person, read Abraham Maslow)

Friday, September 9, 2011

Know Thyself

That which you have loved with youthful enthusiasm and admired with youthful ardor, that which you have secretly and mysteriously preserved in the innermost recesses of your soul, that which you have hidden in the heart, that you always approach with certain shyness with mingled emotions, when you know that the purpose is to try to understand it.  Soren kierkegaard

Sunday, September 4, 2011

The 10-Minute Relationship Miracle

Learning to listen well is one of the most loving and most useful skills we can develop

 Listening, the art of listening, empathy, the importance of listening is something I have written about in a number of posts.  Here, a colleague, Vivian Baruch, has described a technique that any two people can use and develop.  It's one of the things that a therapist might typically suggest for certain couples who come for counseling.  It is, of course, helpful to have a therapist to coach you in using this and to help with the snafus that might come up, particularly at first.  But, it is laid out clearly enough here that if you follow the instructions, it could work as excellent self-help.  Try it!

Monday, August 29, 2011

School Refusal

Some families have a child who has a problem attending school.

Here is a brief recognition and overview of this problem that is a tremendous challenge to the families who find themselves faced with it: A child who cannot or will not actively participate in school.  It is stressful for parents  because they worry about the child's future.  The problem can be significant and effects, not only the child's educational/academic future but also their emotional and social development.  These are long-term effects.
Of course, like everything I address on this blog, there are always exceptions.  Some kids will do fine with an alternative source of education.  But, by and large, not attending school is a sign of a disturbance in the family or an undiagnosed problem of the child's.

According to G.B. Haarman, Psy.D., LMFT, there are ..."four significant factors in school refusal
  • emotional sensitivity
  • lack of parental awareness
  • concurrent antisocial behaviors
  • incomplete academic work"
Sometimes the reason behind the behavior is anxiety or depression, difficulty socializing, ADHD or other learning disorders.
Solutions sometimes involve a support plan and encouragement by the parents and teachers or other school personnel, together.  Sometimes working with a family therapist will help.  Sometimes a personal tutor will be useful and supportive.
Children need to be able to relax.  Children need to have friends.  Children need loving help with getting their homework done (not the discipline and punishment route many families take).

Occasionally a parent will not have, themselves, the knowledge to help their child with their schoolwork.  In this case, sometimes, just demonstrating a value on education and being a comforting, encouraging presence for the child while they do their work is effective.  Often, high school students who are in the academically talented program at their own school, will be available to hire for tutoring.  Younger children usually respond very well to this and will work hard for a teenager whom they will probably look up to.
Facilitate a good relationship between your child and his/her teacher---that can make a huge difference.

I wish you parents all the best as you move to help your child succeed.

Has this come up in your life or the life of your family?  What happened?