On Finding Out How We Don't Know Ourselves in Therapy and Counselling. (On Defences, Part Five.)16/5/2015 For an introduction to defence mechanisms in counselling and psychotherapy, please read earlier posts in this series. If you're familiar with these ideas, or have already read earlier posts, please read this post about the defence mechanism of acting out. Compared to some of the more subtle or slippery defence mechanisms that we've discussed, such as projection, acting out is generally fairly easy to recognise. In fact, usually when people act out, it is with fairly extreme behaviours that are difficult not to notice! Acting out involves behaving in an extreme way as an alternative to feeling and tolerating an uncomfortable emotion. Common examples include people who act out by cutting themselves, to avoid overwhelming feelings, or to avoid a feeling of numbness. (People also cut for other reasons, but acting out is commonly part of the dynamics of cutting.) Another example is that of a person who hits their partner, rather than feel and tolerate anger, powerlessness, or shame. Acting out is a defence mechanism that a counsellor or psychotherapist will often, in one way or another, help their clients to change, simply because acting out can cause a lot of suffering both to the client and to those around them. As with other defence mechanisms that are easily noticed and potentially destructive, acting out can bring with it a lot of shame. The normally polite person who acted out by drunk dialing their boss and abusing them will feel mortified the next day, and will probably find it very difficult to get help from a therapist. It is important that the therapist does not avoid talking about the destructive behaviour (because it really is a problem that needs to be dealt with), but it is also important that the therapist conveys a lack of judgement or condemnation. Given that most of us at times resort to the defence of acting out, and given that often the acting out will be something we later regret, what helps? One of the most common things that helps with acting out is learning to use words rather than actions to express our feelings. This may sound simple, but often it's not. To use words to express our feelings we need to first be able to identify what we're feeling. Learning to identify what we are feeling can be difficult. It may help to have a therapist who can express what we might be feeling, so that we can decide if that fits or not, and we can learn the language to fit the emotion from how the therapist has been talking to us. Perhaps we know what we're feeling, but don't feel confident about expressing it. A psychotherapist or a counsellor may help with this by helping us to find clear and assertive language, or to deal with the fear of how others might respond to our expression of feeling. So, to summarise the above, therapists can help us with acting out by helping us to use words rather than actions to express ourselves. However, this may not be the most important approach for everyone. Some people know what they're feeling, and how to find words to express this, but when under stress find it difficult to avoid acting out anyway. Such people may find a DBT program helpful, particularly skills such as mindfulness that help regulate impulsivity and the intensity of the emotion that is at risk of being acted out. Through mindfulness practice we let go of the impulse to judge or analyse or act on thoughts and feelings. We do this in mindfulness each moment, when we notice our distracting thoughts or feelings, and bring our attention back to whatever we're focusing on, whether it be our breath, body sensations, a view out the window, or a piece of music. Mindfulness has been shown to be effective in reducing the impulsivity even of violent and impulsive offenders, so it clearly really does work. Not only can mindfulness help us to not impulsively act out an overwhelming feeling, but we also find that through accepting rather than judging our emotions, we begin to feel soothed and the painful emotion reduces in intensity. There are many styles of psychotherapy and counselling that integrate mindfulness into the therapeutic process, including DBT, ACT, and MBCBT. Some people seem to fear that through learning to regulate their emotions rather than act them out, they will lose the dramatic or creative aspects of their personality that they value. My experience is the opposite. I have found that through doing this personal work people boost their creative or dramatic potential by being able to add a degree of measured skillfulness and control to the spontaneity that they so value. So, if you're thinking about changing your habit of acting out, you have everything to gain, and nothing to lose. That said, you may need to learn to assert yourself more, because it is possible that your habit of acting out developed because that's what worked to get people to understand that you needed help.
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On Finding Out How We Don't Know Ourselves in Therapy and Counselling. (On Defences, Part Four.)15/5/2015 To understand more generally about the concept of defence mechanisms, and how they relate to psychotherapy and counselling, please read prior posts in this series. To learn more about the defence of this post: sexualisation, please read on.
When we use the defence of sexualisation we imbue something (or someone) with sexual significance in order to avoid our anxieties around feelings such as aggression, dependence, or loss. Like other defence mechanisms, there is something remarkable about our capacity to do this. We not only avoid experiencing something painful, but through the pleasure we receive through the sexual association, we may actually be able to make that experience pleasurable. In general, a psychotherapist or counsellor will only confront a client with their defence if it is hurting them. This seems worth pointing out given our propensity to make judgements around sexuality. Sexualisation isn't bad, and is not something to be ashamed about, but sometimes it gets in the way of living a fulfilling life. To clear up another possible misconception, the defence of sexualisation is quite a different concept from the concern about people (usually children or women) becoming sexualised. According to Duchinsky this different and later use of the term sexualisation developed in the USA in the 80s, to describe a maladaptive form of socialisation which causes a premature entry by the child into adult forms of sexual subjectivity and desire. It seems likely that many of those who have been prematurely sexualised in this later sense of the word will then resort to the use of sexualisation as a defence mechanism, but they are different ideas. To bring this out of the heady realm of theory, it might be useful to give a couple of common examples of the defence mechanism of sexualisation. Because men are often taught that we must be independent, many of us feel uncomfortable with dependence. But, inescapably, being social animals, we are dependent on others for social connection. When men who are uncomfortable with their need for dependence feel lonely or disconnected they may sexualise this threatening sign of dependence. Instead of seeking out intimate emotional connection, they may go out on the town looking to "get laid" and having the sort of sex that leaves them feeling more empty and alone than ever. (This pattern is not restricted to men, but seems more common in men due to masculine socialisation to be independent.) In extreme form this can result in men (or women) seeking psychotherapy or counselling for sexual addiction or other sexual problems that are really problems with emotional intimacy. A more common example of the defence of sexualisation amongst women can arise in women who have been taught in one way or another that women are weak and men are powerful. Such women, being afraid of powerful or aggressive men, may sexualise this fear to the point where they instead feel attracted to powerful or aggressive men. Another side effect of this is feeling understandably envious of the power that men are perceived to (and may actually) have. This form of sexualisation is actually the basis of Freud's much maligned and misunderstood concept of penis envy, which (depending on how you interpret Freud) can be seen as a sympathetic and understanding view of the terrible impact on women of patriarchy. Women (or less frequently men) who sexualise in this way often come to psychotherapy or counselling having had a string of very painful relationships with men. Most of us find talking about sex uncomfortable, perhaps especially if we're talking about a difficulty that relates to our experience of sex and desire. This means that often in therapy I've noticed that clients talk about everything other than sex. Therapists may be hesitant to ask about sex, out of fear of this being interpreted as dirty or seductive or leading by their clients. On the other hand, because of many of our shyness about discussing sex, if a therapist doesn't ask, often a client won't talk about sex. It's difficult. In couple's therapy, talking about sex can be particularly complicated, as sometimes the sexual topic that one couple feels they need to bring up, is the source of great shame for the other. There is no easy fix for this, but having a therapist who feels comfortable talking about sex, does help. On Finding Out How We Don't Know Ourselves in Therapy and Counselling. (On Defences, Part Three.)12/5/2015 So far in this series of posts on defence mechanisms we've covered the defence mechanisms of withdrawal and sublimation, and we've talked a little bit about how this relates to the counselling or psychotherapy process. For background, read prior posts. Otherwise, please read on for today's post on the defence mechanism of projection.
In popular culture in the West today, most of us have a basic understanding of the concept of projection. When faced with an impulse within ourselves that we see as unacceptable, we may project it out on to the other. This allows us to perceive the other as having that impulse, and thereby relieves ourselves of the conflict we feel over having an unacceptable impulse. Whereas the defence of withdrawal, depending on severity, may range from unhealthy to fairly healthy, and sublimation is generally a healthy defence mechanism, projection is generally understood as a somewhat or very unhealthy defence mechanism. Projection has the capacity to significantly distort our view of reality, and our capacity to relate to others. Many counsellors or psychotherapists will try to help their clients to project less, and sometimes to instead adopt more healthy defence mechanisms. An example of this is someone who has become familiar with their tendency to project, and is able to reflectively question the truth or falsehood of their projection based on the facts of the present situation. This would be an example of replacing the defence of projection with the generally more healthy defence of intellectualisation. Some defences are used heavily by particular personality types. Projection is a good example of this. People with paranoid personality styles frequently project, in particular they project their anger and sense of judgement or hostility on to others. The paranoid person's tendency to vigilantly scan for any sign of untrustworthiness in others, and tendency to interpret facts in line with their projections, can make them very hard to establish intimate and trusting relationships with. On the other hand, a paranoid person is so sensitive and vigilant to signs of untrustworthiness in the other, that they can be excellent when this is an asset, such as in detective work or other jobs involving detecting fraud. Another example of projection at work is in the case of bullying, in which the bully projects their own feared sense of vulnerability onto another, and then persecutes that other person. It can be useful for the bully and the bullied alike to understand what is being projected, and to not get tricked into missing the strength of the person being bullied, and the vulnerability of the bully. As a psychotherapist, I often notice my clients projecting things on to me. (Though it is important to remind myself that often there is a grain of truth in a projection, so that I don't disown my own imperfections!) Usually, a client who projects something on to me will also project that same thing on to others, and that is usually part of the cause of the problem for which they sought therapy. Depending on the situation as a therapist I might help my client to see the inaccuracy of their projection, or, I might instead help my client to explore the full extent of this projection that might be harder for them to learn about in another context outside of the therapy room. It is not uncommon for clients in therapy to project boredom, judgement, criticism, or anger on to their therapists. By naming these perceptions to a therapist who is confident in working with projections, you may be able to significantly benefit your own therapeutic work. Sometimes people also project positive aspects of themselves such as generosity and competence on to others, because it may be disturbing to recognise these qualities in ourselves if we have a strong self image to the contrary. Though projecting our positive qualities on to others may not seem as problematic as projecting our negative qualities, it may have a negative impact on our self-esteem. On Finding Out How We Don't Know Ourselves in Therapy and Counselling. (On Defences, Part Two.)8/5/2015 Welcome to my series of posts on the concept of defence mechanisms, and on how this concept can help us to understand ourselves in psychotherapy and counselling. If you haven't read my prior post on defence mechanisms, you may find it helpful to read it now as an introduction, then return to read this post.
In this post today we turn our attention to the defence mechanism of sublimation. We sublimate when we transform a socially unacceptable urge into an urge that is beneficial and acceptable to the community. An example is the religious tradition of celibacy, in which erotic urges or energy are transformed into spiritual and/or creative pursuits. When this works well, the conflict between the erotic urge and communal needs is circumvented, and the individual who is sublimating their sexual desire is not left frustrated, but instead experiences satisfaction via the creative or spiritual work that they accomplish. When this process of sublimation is working poorly, we see incidents such as the terrible phenomenon of sexual abuse being committed by catholic (and other) clergy. (Having said this, I'm sure these incidents of sexual abuse by clergy involves many other psychological processes, so please forgive the simplification.) Another example of sublimation may be the artist's relationship with the muse, in which the erotic energy towards the muse (a real or imaginary figure) fuels works of great creativity. It's worth noting that although psychoanalytic thought gets a lot of flack these days, at times seeming bizarre for it's reducing our ideas of life into strange contorted expressions of craving for sex, this is a misrepresentation of psychoanalytic and psychotherapeutic thinking. The word erotic derives from eros, which is intimate or romantic love (as opposed to selfless love.) Psychotherapy understands the erotic as much wider and more important than mere sex, the erotic is an energy that creates intimacy, sex, romance, and a great deal of our passion and energy for life. The goal of psychoanalytic psychotherapy is not to dismantle all of a person's defences, but to help a person to graduate to using defences that serve them better. Healthy sublimation is regarded as one of the most mature and worthwhile defences. When other conflicts and less helpful defences are clearer out of the way, through psychotherapy or counselling a creative person may be able to clear their creative block, and free up more energy than ever before for satisfying creative work. A spiritual person whose sublimation is not serving them well, may be able to renegotiate their relationship with sexuality through therapy, hopefully with the outcome of feeling less frustrated and more connected to their spiritual side. On Finding Out How We Don't Know Ourselves in Therapy and Counselling. (On Defences, Part One.)4/5/2015 The concept of defence mechanisms is one of the oldest psychoanalytic concepts. LIke other psychological concepts, defence mechanisms have to an extent reached into popular consciousness and understanding. For instance, we have an understanding that denial is a way of warding off knowledge that seems unbearable.
Like many psychoanalytic concepts, defence mechanisms are provocative. Defence mechanisms are not the tamer idea of coping strategies. Defences are a matter of life and death. The client sits securely (or insecurely) behind their defences, their only safeguard against a therapist who is waging an offensive war aimed to bring reality crashing in on them (all for their own good, of course!). It may be evocative, and may capture the imagination, but that that's not the way therapy is. Or perhaps ever was. My recent study of intensive short term dynamic psychotherapy (ISTDP) has made me look again at the currently neglected (even amongst psychoanalytic psychotherapists) idea of defence mechanisms. Beginning to incorporate ISTDP into my practice has made me much more ready to point out my client's defence mechanisms to them, and to help them understand the cost of using those defences. This series of posts will try to capture the lived experience of using some of the more common defence mechanisms, as well as the costs that this can have. We'll start with the defence of withdrawal. Touch a sea anemone, and you'll notice the tentacles instantly shoot backwards... And then over time watch as the anemone cautiously begins to unfurl it's tentacles back out into the world. Some people act like this. Dreading overstimulating emotional contact, they withdraw either emotionally or physically to preserve their sensitive inner world from the perceived threat of devastation. This may be a conscious choice, or it may still be a choice but one that is made at quite an unconscious level. Withdrawal may be slight, such as taking a moment to look away during a difficult conversation, in order to marshal one's thoughts, or it may be extreme and prolonged such as the case of someone who lives mainly in their own fantasy world rather than through real interactions with other human beings. One of the advantages of using withdrawal as a defence mechanism is that unlike many other defences, it may leave our view of reality relatively undistorted (compared to, for instance, a defence such as projection.) On the down side, by overusing the defence of withdrawal we may lose opportunities to learn better how to overcome difficult interpersonal challenges, and we may help create dynamics in which others such as our partner, may have to chase us in our withdrawal in order to maintain a relationship. Counselling and therapy isn't about dismantling our capacity to withdraw (or use any other defence mechanisms), but to help us to know what we are doing by using them, and to at times make choice to not defend ourselves, or to use different defences when that would help us to live happier lives. Though it's not developing at the break-neck speed of the physical or biological sciences, research is developing our understanding of what helps relationships to work, and why. As a couple's counsellor or therapist I was reading the research summarised below to help me to help the couples I work with, though you may find that you can directly apply these findings to your own relationship and get some benefits. Research summarised in psychology today affirms that couple's therapy does work, and looks at first factors that give the most benefit.
Though this is a list for couples therapists, none of it is anything that you can't improve on your own. On the other hand, if you would like a helping hand with this, please get in touch with us! Leaving or needing to leave a relationship is a frequent reason for people to seek psychotherapy or counselling. For some people the process of ending a relationship, though painful, is relatively straightforward, and certainly does not require therapy. However for others, the process is agonising, protracted, and can even be disabling in terms of a person's ability to work, care for themselves, or maintain other important relationships.
Recent research suggests that addictive processes may be involved, for those who struggle severely with ending relationships. Particularly early on, relationships can trigger the dopamine system in our brain - that's the pleasure center that makes us feel really good. Drugs like cocaine similarly stimulate the dopamine center of our brains. The researchers of this study have wondered if the task of leaving a relationship or "falling out of love", for some, might be the equivalent of an addict giving up cocaine. While I don't know enough about neuroscience to critique the research, certainly subjective addiction related feelings of craving, difficulty with self soothing, and obsessive focus on the substance (or person) of addiction rings true. If leaving an addictive relationship is like giving up a drug habit, then perhaps the following common features of counselling or therapy for addictions might be helpful for some: Motivational interviewing: The therapist does not take sides about the need to leave or stay in the relationship (in contrast to friends and family who probably have strongly expressed opinions), but helps the client to come to their own decision based on weighing up the alternatives in a personal way. Relapse prevention: Going back to an addictive relationship is common. Having a relapse prevention plan may help by identifying triggers, such as loneliness or comparisons with others who are in relationships, and making practical plans for coping with these feelings. A supportive therapeutic relationship: Just as addiction is often isolating, and accompanied by immense shame, sometimes people feel ashamed of their difficulty leaving a relationship, and may have become isolated from supportive friends. A warm and non-judgmental therapeutic relationship can form a regular stable base in a person's life, from which they can make the courageous changes they wish to make. A recent research study summarised here in Science Daily has found mindfulness based cognitive behavioural therapy to be more effective than ongoing use of antidepressants to reduce the risk of people relapsing into depression. This is a significant finding, because four fifths of people who suffer from an episode of depression will relapse into another episode at some point in their life.
To be fair, the differences between mindfulness based therapy and medications was not statistically significant. However, even if the two treatments are equally effective, as might well be the case, this will still be significant for many people. Many people do not like to take psychiatric medication, either due to side-effects of the medication, or due to a wish to be pro-active rather than relaying on a pill. The alternative, that of doing eight 2.25 hour long group sessions, with the option of four sessions of follow up over the two years, is not onerous. Furthermore, some participants reported feeling empowered by learning mindfulness skills - something I've never heard in relation to taking medication. Whilst both options can be effective, it's nice to hear alternatives to medication validated, as well as the transformative power of mindfulness.
Finding motivation and staying motivated for change can be hard. Whether you're trying to lose weight, improve your work performance, or become more focused in your sports training, these tips can help. How do we know this? These principles are drawn from a form of psychotherapy or counselling called motivational interviewing. The evidence shows that it can help with the hardest of changes, like getting an alcoholic to stop drinking, a heroin addict to stop shooting up, or even with stopping smoking cigarettes (which is more addictive than alcohol or heroin!) If this approach can work with these issues, then do you think that maybe it can help get you to the gym? You might want to try these tips in the order presented.
Tip 1: Explore the Ambivalence Be honest, you want this change that you're thinking of, but you also don't want it. Change would be nice. If you get fit you might feel healthier, more sexy, your mood might improve from the endorphins, you might attract a partner, and lots of other benefits. Make a list of all of the benefits of making the change you want. BUT! Making this change also won't be nice. Exercise is hard. At times you won't feel like it. You might feel awkward at first, or might be afraid of failure. Make a list of all of the reasons not to make this change. Be honest, there's a reason you haven't done it yet. Now sit back and weigh up the pros and cons of change. It's not a guarantee that you'll pick change, but it will probably help you to move out of stuck ambivalence, which is tiring and frustrating. Tip 2: Feel the Discrepancy Between How Things are and How You'd Like Them to Be Our motivation comes from this discrepancy - things aren't how we'd like them to be... otherwise, we'd have no motivation to change. Spend some time reflecting on, or telling a friend about how things are and how you'd like them to be. You might start with the facts of the situation, but what really motivates us is feelings. When you can feel your dissatisfaction, rather than ignoring it, you're much closer to being ready to change. This might be a bit painful or scary or frustrating, but if you're focusing on something that's good for you, it may be worth it. Tip 3: Focus on What's Possible You might have done the above two steps and feel really fired up about making your change, but not do the necessary actions to make that change real. Why? If you don't think it's possible for you to succeed, you probably won't try. Make a small, realistic goal, or problem solve the challenges until you feel confident enough to actually try. Good luck for making your changes! |
AuthorsMichael Apathy and Selina Clare are practitioners of psychotherapy at Lucid who are excited about fresh, innovative, and effective therapy for individual and environmental change. Categories
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