I meet the most incredible people in my work. Struggle as they might with various vices like substance abuse, serial monogamy, stormy relationships or keeping a job, the people I’ve worked with consistently have a surplus of one thing I highly value: empathy. Image via Wikipedia It seems as if people who have suffered greatly often have the ability to understand other’s pain at a deeper level than most people. Often they have a depth of insight that far exceeds their “normal” peers.
_ This is the second in a series of articles on emotional intelligence for personal growth. The first part is here._ Mindfulness is a non-judgmental, present-centered awareness in which each thought, feeling, or sensation that arises is acknowledged and accepted as it is. It is a skill that is learned by committed practice. The object is to focus one’s attention on thoughts, feelings and events in the present moment while remaining curious, open, and accepting whatever occurs.
Image via Wikipedia I caught this article at Psychcentral.com, [ Image via Wikipedia I caught this article at Psychcentral.com, ] . It struck me as a counter-intuitive finding for a research study. I’ve been helping clients build self-esteem for over 30 years and while positive thoughts is not a short road to better self-esteem, it certainly does work over the long run. I’d estimate that at least six months is required to make significant progress with self-esteem from solely refocusing on the positive, and some people require much more time.
Image via Wikipedia Recently, I exchanged messages with [Michele Rosenthal], author of the blog, [Parasites of the Mind]. She asked me a very good question, one that is so much a part of my everyday work, a good long contemplation was needed just to tease out a good answer. “Speaking of inspiring, how do you inspire a client to believe in what he/she is doing? It’s so difficult to believe in anything when PTSD has settled its big black cloud on your head.
Since I heard of all the excitement in the therapy literature about forgiveness therapy, I’ve been a skeptic. I’ve worked with a lot of people who have experienced unforgivable abuse. Often they are tortured by their feelings of anger, resentment, helplessness, violation, and shame for allowing themselves to be a victim. They also feel guilt about their anger with the perpetrator so much so they feel morally obligated to forgive the perpetrator.
Image via Wikipedia I have been really enjoying my access to a large number of professional journals over the past couple years. Working at a teaching hospital definitely has it’s academic perks. I’ve been particularly gratified to see a growing sophistication in research methods, creative approaches and a maturing view of results. Until recently, practice based research articles have often taken the form of providing some support for a therapist preferred approach to therapy.
Aaron Beck, considered the Father of Cognitive Therapy, is an American psychiatrist and a professor emeritus at the Department of Psychiatry at the University of Pennsylvania. He is President of the Beck Institute for Cognitive Therapy and Research that is directed by his daughter, Judith S. Beck, Ph.D.. He is noted for his research in psychotherapy, psychopathology, suicide, and psychometrics, and the Beck Depression Inventory (BDI), one of the most widely used instruments for measuring depression severity. At age 87, the man is still publishing, building on his pioneering work on the cognitive model of depression. In his latest article published in the American Journal of Psychiatry, he recalls his early work:
“Caught up with the contagion of the times, I was prompted to start something on my own. I was particularly intrigued by the paradox of depression. This disorder appeared to violate the time-honored canons of human nature: the self-preservation instinct, the maternal instinct, the sexual instinct, and the pleasure principle. All of these normal human yearnings were dulled or reversed. Even vital biological functions like eating or sleeping were attenuated. The leading causal theory of depression at the time was the notion of inverted hostility. This seemed a reasonable, logical explanation if translated into a need to suffer. The need to punish one’s self could account for the loss of pleasure, loss of libido, self-criticism, and suicidal wishes and would be triggered by guilt. I was drawn to conducting clinical research in depression because the field was wide open–and besides, I had a testable hypothesis. I decided at first to make a foray into the “deepest” level: the dreams of depressed patients. I expected to find signs of more hostility in the dream content of depressed patients than nondepressed patients, but they actually showed less hostility. I did observe, however, that the dreams of depressed patients contained the themes of loss, defeat, rejection, and abandonment, and the dreamer was represented as defective or diseased. At first I assumed the idea that the negative themes in the dream content expressed the need to punish one’s self (or “masochism”), but I was soon disabused of this notion. When encouraged to express hostility, my patients became more, not less, depressed. Further, in experiments, they reacted positively to success experiences and positive reinforcement when the “masochism” hypothesis predicted the opposite (summarized in Beck). Some revealing observations helped to provide the basis for the subsequent cognitive model of depression. I noted that the dream content contained the same themes as the patients’ conscious cognitions–their negative self-evaluations, expectancies, and memories–but in an exaggerated, more dramatic form. The depressive cognitions contained errors or distortions in the interpretations (or misinterpretations) of experience. What finally clinched the new model (for me) was our research finding that when the patients reappraised and corrected their misinterpretations, their depression started to lift and–in 10 or 12 sessions–would remit.” We owe a lot to Dr. Beck. His cognitive model of depression still dominates how I and most of my colleagues write treatment plans for persons suffering with depression. Our goal is to inspire and teach our clients to change their negative self-evaluations, correct distorted memories, and create an expectation of success. The only problem is depression is not that simple. Try as they might, many clients are able to recognize what they need to do, understand how their thoughts about themselves and their world need to change, are able to state those changes, and diligently practice them. But when they really need to be able to master their fate, when ruminative thoughts spiral downward into the depths of depression, their efforts quickly collapse and they succumb. So is the Cognitive Model of Depression wrong? No, I think it’s incomplete. There is the biomedical model of depression involving errant neurotransmitter levels treated by various anti-depressants. That discussion is beyond this article’s purpose. I’m more interested in what we as therapists can do differently in the counseling office. Of course we need to be sure a severely depressed client is referred for a medication review. But I want to know how we might better facilitate our clients attempts to master their mood. To this end, I will review my recent reading on the subject of emotion and argue to include emotion in a new Cognitive Theory.
Mindfulness is a very simple concept, but a skill that escapes a lot of people. Simply put, when we are mindful we act as an observer of our minds, our thoughts and feelings, without judging, or holding onto anything. The object is to be completely present in the moment, mostly focused on our senses, our eyes, ears, nose, and skin. Having complete faith in ourselves, we simply accept whatever comes, assuming we have all we need to cope with anything as best we can.
Shame has been a particular interest for me. It has appeared repeatedly as a major barrier in therapy, especially in those for whom therapy has failed in the past. It takes a lot of courage to re-enter therapy after feeling it was previously insufficient. Fortunately, a person returning to therapy after a less than satisfactory experience is significant motivated to try new ideas. Agreeing to therapy is a humbling experience in and of itself.
BPS RESEARCH DIGEST reviews recent research articles in professional journals. It’s a good place to try to keep up with the literature. It has been a pleasant surprise indeed that many psychodynamic principles have recently demonstrated in research. Unconscious motivations, emotion based early learning have repeatedly been demonstrated. Now I was pleased to find the begins of a research demonstration of one of the most important insights into the obstacles for change that emerge in therapy: the labeling effects of diagnosis and the self-destructive nature of shame.