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Is there a cure for Intellectualizing??? How do you stop???

Okay so I’m in the car right now dictating my post in a random stream-of-thought fashion….

I downloaded a dragon dictation app to my phone.  I’m trying to switch things up a bit & work my way out of “academia mode”.  I’m bored as FUCK of these research paper styled blogs.  Honestly, I don’t think I’ll ever be able to completely shake my nerd-girl ways.  I’ve always interested the study of human nature and my blog will always reflect this.  However, I feel like I’m falling into a rut.

I have a desire to show and not tell.

  1. The problem with academic writing, (other than the passive third person style), is the fact that you’re being objective and analytical.   It allows you to adopt a  mindset that is conducive to seeing things as they are from a scientific lens.
  2. I’m interested in learning the basics of creative writing.  To hell with rules.  I want to tell a story, express my thoughts, beliefs, or feelings, and describe my own life experiences.

If I’m being honest, my writing style doesn’t just reflect the fact that I’m in Graduate School.  I have a tendency to intellectualize.  This defense mechanism is effective in distancing me from problematic emotions that I’m trying to avoid.  In this post, I’m going to mix things up a bit.  What follows are a few random segments of things I’ve recorded on my Dragon Dictation App….

I had a really crappy shift last night!!!!

“Here’s the thing:  Between work, school and family life, I find I’m in over my head.  The littlest things have been driving me batshit crazy.  I have absolutely no patience whatsoever & am turning into a horrid cunt rag….

I was on a floor that was very understaffed. There were 7-8 patients to a nurse on a med-surg floor. Everyone’s in a bad mood & I hit the ground running.

Unable to get a report, I hit the ground running.  I find myself entering “Git-Er-Done Mode” & run around like a chicken with my head cut off.  I focus on the task before me, complete vitals, clean up the rooms, pick up the linen bags and answer all call lights.   Inevitably, I run into that one person who manages to drive me absolutely insane.  As my patience is tested, I bite my tongue and plaster a fake smile on my face.

As much as this troubles me, I have to be honest I’m at my wits end.  I can do no better….
There are only so many hours a person can spend taking care of others…

For example, there’s this guy on the floor who had a hip replacement that got infected.  He has a weak bladder as a result of his “prostate issues”.

As the only tech on the floor with over 20 patiences, I find myself spending the majority of my time in his room.  While I don’t want to ignore my other patients, I’m told he is a fall risk.  I end up going into his room about every hour or so, so he can stand up to pee.  Additionally, he can’t pee in bed so we must endure the process of getting him in and out of bed takes about 20 minutes.  He is in a lot of pain, and is not steady on his feet.  I hold him up as he uses the urinal to pee.  He only produces about a few tablespoons at a time.  By the end of the night his patience has grown thin and becomes angry that I am not moving fast enough.  I want to cry because he doesn’t realize how many other patients I have to care for.  However, I say nothing and do my job as expected…

I become disgusted with his impatience…
I want to tell him what I think about his inability to show me respect & gratitude.
However, I somehow can’t find the words to say how I feel to someone who isn’t willing to listen.
I ask him if there is anything else he needs on my way out the door in the most polite voice I can muster….

The idea of having to deny my feelings to myself is triggery in ways I can’t quite explain.

The frustration can overwhelm me so I numb myself into a zombie-like emotional stupor to get through the night.

And then there’s the issue of lazy staff & being shit on as a float-pool night shift tech…

As the float-pool tech I’m usually assigned the toughest clients on the toughest floors.  Additionally, since I work the night-shift, I’m often on the floor to myself.   This is maddening, primarily because I’m not able to ask for fair treatment.  You know the whole “nurses eat their young” bullshit.

A convenient example of this bully-behavior occurs when lazy nurse play on their phone while gossiping and their eating dinner at the nurses station.  They can’t be bothered to get off their sorry asses to answer a frickin call light . I’m in no position to voice my opinion as a float pool tech I have nobody in my corner.  If I do, I only do so in the most polite and professional voice possible.  Either way, I have to muscle my way through the evening, and try my best to forget about this infuriating behavior on my way home.

After full work-weekend like this (Friday – Sunday from 7p – 7a) I drive home in a overtired stupor.

I crank the music on loud and slap my cheeks on the way home in an effort to stay awake  By the time I get home, everybody is gone.  Kelly is driving to work and the kids are starting their day at school.   Monday’s like this are my only day off.  I spend most of this time napping and cleaning.  The house is usually a mess:  the trash needs to be taken out and there are piles of dish and laundry to clean.  I grit my teeth and get down to business.  My goal is to finish cleaning the house before 10 so I can fit in 4-5 hours of nap-time.

Once I arrive home with the kids shift two starts   I feed them an early meal, help with homework, and play the role of taxi cab driver.  Once my husband is home, I focus on completing some last minute paperwork for an a.m. meeting with my internship supervisor.  I then work from Tuesday – Thursday 8-3 at a homeless shelter providing individual and group therapy….

and then before I know it Friday has arrived & the cycle continues….

I just visited my psychiatrist & am beginning to realize how traumatizing this invalidation has been….

I can’t help but notice how much of what we become is a byproduct of others’ demands.  I’m  an adaptive reaction to the demands placed upon his by significant others and society in general.   I still grieve over the idea that validation is something I may never receive with regards to some critical traumas in my childhood.

The lingering question which remains is: “Was it real or just in my head?”

I know: that sounds like a stupid question.  However, as I reflect on my childhood experiences, what pains me is that I can’t point at a single person who ever looked at me and saw me hurting. I was struggling and in a lot of pain, yet never heard anyone say:

“I see your sad, let me give you a hug, it’ll be okay.”
“What happened was bad, I’m sorry to hear about it”.
To this day, nobody in my family is willing to acknowledge the hurt I endured.  At school, classmates blamed me and teachers pretended not to notice.  “It” fucked me up further by using this baggage against me.   Consequently, the process of healing has been very lonely since nobody can fully understand and support me in my own trauma recovery.  I am left with a loss of something profound that has left me grieving.  And since there’s no remedy for the loss, I must accept it fully as a reality of my life.  Despite my mind’s inner protestations.

I’ve struggle to play catch-up for lost time but find that doing so isn’t fully realistic.

There are critical years in which I failed to progress developmentally as others did.  There are these letters that I dug up in the hallway closet to my sister.  I’m a freshman in college and complaining about the other residents on the dorm floor I resided on.   They were filled with an insecurity, hatred and frustration that pertained to something I didn’t want to see you didn’t want to acknowledge about the state of affairs in my life.

I was an ostracized kid who had no friends from the age of 11 on.

I was a bullied child who experienced chronic rejection.  

This left me with many critical years of lost socialization opportunities.  

Fitting would prove to be difficult if not impossible.

The painful reality: I was different.

College proved to be a continuation of events in high school.  The state of affairs I tried so desperately to run away from in high school were repeated in college.  I really was different & hated to admit it.  Fitting in wasn’t really in the cards for me.  My life experiences were so divergent from theirs since we were just on very different pages.  There’s nothing I could have done to catch up and I was stupid to think this was possible.  I didn’t want to see this since it was tied up with so much unresolved hurt.

 I guess this is why I continue to struggle in making friendships….

I have created two opportunities to forge a friendship.  On Wednesday I’m getting together with a fellow intern at Panera.  On Thursday, several ladies from work are getting together.  I’m uncertain how things will progress & frankly nervous about going, but will give it a swing.

If for no other reason than to address my insecurities head-on…

Tuesday, March 28, 2017….

Its 7:45 at night about two weeks after I originally posted this.  The hamster wheel of responsibilities has continued unabated.  I still work Friday – Sunday 7p – 7a.  I still spend Tuesday – Thursday 8a – 3p at my internship site.  I often bring home stacks of paper work from my internship and if I’m lucky I get a few hours of family time.  Monday is my only day off and I use it to nap since I’m exhausted…

…Anyway, during my therapy session last week, a crazy, serendipitous, ironic, and strange coincidence occurred!!!

This therapy session happened last Friday morning & its just now that I find myself processing the things we had discussed that day.  After I provided a few updates & reflected the impact of recent events, he brought up the issue of intellectualization.  He “called me out” in his calm, still, nonjudgmental manner. informing me that I tend to do it often.

I recall discussing how various trauma triggers throughout my week brought up painful memories.  I shared how I felt like a well within me that inner well of frustration, I was running on empty.  As he sat there in his calm and empathetic manner, I felt compelled to do the same.  A feel hurt lingered underneath causing tears to well within my eyes and a lump form in my throat.  I sat there dumbfounded for what seemed like an eternity.  Where the heck had this come from? Honestly, I didn’t know this well of emotions was there.  How was it, that I was able to not feel my feelings and conceal them so effectively from my own awareness?  How numbed was I to the reality within me?   However, rather than sit with this question in stillness, I fell back to that standby coping mechanism: “intellectualization”.  In an effort to move forward towards understanding, I said to myself:

“For heaven’s sake get a hold of yourself!!!”

I admitted to him honestly, my shock & befuddlement.  I asked him, “what is it you’re tapping into and how did you know it was there?”  He replied that it is a common reaction to prolonged trauma.  My mind floated naturally to the overly researched and clinical examination of my own past (read this blog).   I described the ready-made explanation for the how and why of my life.  He smiled back at me as I talked without interruption and I knew I was doing it again…

“Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves.” (van der Kolk, 2015, p.97)” 

So this experience was an answer to my prayers from the man upstairs…

You see, I’m just months away from completing my education.  I will be done shortly & it couldn’t come soon enough.  School will be a thing of my past & I won’t have to spend all my spare time studying, reading, or writing papers.  So what can I do with my spare time?  I will be using my degree to start a new career & plan to look for a new job.  However, the question of “what now” still arises.

I want to continue moving forward.  This education has been a useful vehicle to propel me forward in this respect.  I need to focus on the next phase of my journey.  I realize now it should include the psychological and spiritual healing I’ve put off for so long.

For the longest time, I’ve planned to continue my education and pursue a Phd. There’s part of me that likes the idea of “Going All The Way” in order to prove myself.   However, this ego-based drive is probably not healthy (if I’m being honest).  Like Dorothy and the ruby slippers, I don’t need to go any further than within myself to realize my value.  Seeing validation from others in this way, can only perpetuate the same flavor of bullshit that has infected just about every area of my life.   This academic pursuit will only enable me to keep perpetuating the erroneous myth that intellectual understanding can equate to healing.

The intellectualizing really has to stop.  I need to do move forward into uncharted territory.  The path before me is filled with a strange mixture of fear, excitement, & happiness.

So this inner creative person, is lurking within who is repressed, annoyed and frustrated.  She wants to express herself freely, through whatever means that tickles her fancy.  I simply hope to express myself freely and see where things lead.  I wish to use these ideas floating inside my brain and transform them into something tangible that can exist in the world “out there”….

However, there is one critical caveat.

The motivating factor underlying this path should be to continue my spiritual journey of personal healing and growth.  I need to develop a relationship with the man upstairs.  I need to find avenues that can allow me to reconnect my “numbed out” mind with my body… I suppose we’ll just have to wait and see what happens…

References

Van der Kolk, B. A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.

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Pulling my Head out…..

I’m so F*CKING busy it really isn’t funny….

I’m currently in the 11th week of my second internship course.  As a full-time working mother with two young boys at home, I rarely get a day off.  I’m managing to maintain 60+ hours a week.  I work Friday-Sunday 7p-7a as a C.N.A.   I work at a homeless shelter providing individual and group therapy as a student therapist 8-3, Tuesday – Thursday.   I divide my spare time between: (1) family time, (2) conscientious self-care, and (3) mounds of paperwork….

I feel overwhelmed by how much I have to learn…

 I have just one more week left.  As I progress, I feel a burgeoning sense of ignorance:  the more I learn, the less I feel I know.  This perplexing experience leaves me feeling ambivalent.  I’ve worked so hard over the last five years to complete my graduate degree.   After spending half a decade cramming my mind with information, I feel at times it matters little when you get to the pragmatics of day-to-day direct client interaction.   There’s only so much you can learn about “how to be a therapist” from a textbook. When I expressed concern about the limitations of my current skill level, my supervisor joked: “Give it five years”….

So anyway, I started seeing a psychiatrist….

Until recently, I’ve had the same therapist.  I’m forever grateful for the personal growth I was able to achieve as a result of my experiences as her client.  However, in this last year I’ve desired to really understand the profound and lasting impact of past traumas in my life.  I searched for a psychiatrist who could provide a unique perspective on things.  Last Friday, I had my fourth session with this new psychiatrist & are just now moving beyond the initial “get to know you” process.   In our third session, I decided to take a risk with this new mental health professional & share honestly various aspects of earlier traumas: (things I’ve really resisted speaking with anyone).  To be honest, he’s the first person I’ve really opened up to honestly about these early experiences and their lasting impact on me.   Anyway, in our first session after sharing this information, I’m appreciative of the opportunity to reflect upon the impact of these experiences.  I walked away last Friday, with much to think about & reflect upon.

What follows are just a few random things I learned about myself after our last session… 

1st: Past experiences with emotional invalidation are still VERY, VERY, VERY, VERY big triggers…

The third session with my new psychiatrist was quite a pivotal moment.

I decided to be completely honest for the first time and share aspects of traumas that I had – until that moment – been unwilling to talk about with anybody.  During the week between my third and fourth session, many “interesting things came up”.

This session was on Friday at noon (its the only real time I have off where I’m not completely exhausted).  I was at my internship site Tuesday – Thursday.  I napped Friday morning since I had to work that night.  At 12:30 I had a session with my therapist & drove home afterwords to do some housework.  After picking up the kids from school I made dinner.

While getting ready for work, I started to feel depressed.  I didn’t quite understand why, and tried to push this feeling out of my mind.   It wasn’t until I started driving to work that the waterworks started.  I began to cry uncontrollably and had difficulty seeing the road.  While I wanted to call in, I realized a doing so “last minute” wasn’t feasible.  So I collected myself & went through the motions.  The weekend was a blur.  I did my job, came home and slept.  Before I knew it, Monday had come & I was just exhausted.  I slept all day and didn’t get off the sofa.

…Tuesday-Thursday rolled around again, and I was in the swing of another “work week.”  With a busy schedule filled with supervisory meetings, individual sessions, and group therapy meetings, I had a lot on my mind.  I struggled that week, feeling overwhelmed and anxious.  I wondered how I would be able to complete my internship….

Then Thursday evening came, & my husband surprised me by taking the afternoon off.

We spent the evening together: (a belated valentine’s).   I had a chance to breathe.   During this rare evening of “private time” with my hubby of 17+ years, I was finally able to stop and reflect on the past week.  He knows me like the back of his hand and could tell something has been wrong all week.  He expressed his concern to me: “you’ve been off all week, what’s up???”

When he asked this, I began crying. He held me a while and I told him: “I simply wonder if any of it was real? Or if it all was my fault & I’m the crazy one?”  He looked at me perplexed.  I provided the “cliff-notes version” of past traumas I’ve still struggled with.  I recalled, the most painful thing about the whole experience was the “gaslighting” nature of it all

  1. “All involved” acted on willful blindness, unable to acknowledge obvious fact that these shitty things happened to me and it was traumatic.
  2. Rather than acknowledging my feelings, I was blamed for what had happened. Somehow it was my fault and for that matter, my feelings were unjustified since “I did this to myself”.

And then the four session came up & I was able to finally process the feelings that came up during the last week.

I talked about everything that happened with a nervousness.  The idea of continuing with this level of honesty was terrifying.  However, my psychiatrist provided a sympathetic and calming presence, letting me somehow know it was okay.  During the course of our conversation, he questioned me at one point the meaning of the statement: “know what I mean?”   I was saying it frequently, stopping at points to make sure he was following me.  He reassured me he was, and understood completely.  “Was it rhetorical in nature?”  I stopped to ponder the question, unable to provide an honest answer.  A smile floated across my face as I was reminded of that famous Ernest quote: “know what I mean Vern?”

So what’s up with the “Know what I mean?” Question???

I do feel it is in part a rhetorical question, in the sense that it reflects the fact that I question the validity of my own past experiences.  Since nobody exists from my childhood, who is able to validate and fully understand the nature of my traumas, I wonder if it was really “all me”?  The logical part of my mind yells out “Pure idiocy” as these very words are being typed.  You see, I know logically, that the experiences are valid to me, as real, regardless of whether others are able to understand it.  The trauma was there, it was difficult, and painful, right?   YES, duh!!

However, the emotional part of my mind remains stuck as a little girl who simply was hurting, and didn’t understand the “gas-lighting” nature of things.  I felt I was what was wrong, it was my fault, & I’m the crazy one.  This is where the “know what I mean?” question reflects a desire to seek “safety”.  Will this person, I’m talking to invalidate my feelings??

2nd:  I appear to engage in a form of self-invalidation that reflects what I experienced in my childhood.

This brings me to the second major insight from my fourth session:  I engage in a form of self-invalidation that reflects early unresolved childhood experiences.  What’s pathetic is that while I’m already very aware I do this – I still do it.  WTF!?!?!  It appears that my desire for self-understanding, has yielded me an ability to write a book about myself, and little else.  It appears intellectual self-understanding, cannot really replace true healing.

3rd:  my favorite defense mechanisms are: (1) intellectualization, (2) denial & (3) dissociative emotional numbing.

Yup, I do these things.  As you can see by the content in this blog, I’m a “nerd-girl” art heart.  I get this tendency to intellectualize from my parents:  As doctors, their education and intellect was a superb defense.  It allowed them to create the perfect defensive armor.  They were flawed human beings lurking underneath a veneer of intelligence & merit-based respect.  As for the denial & dissociation, I have this disturbing ability to hold outside my mind the very feelings that have overwhelmed me.

NOW WHAT!?!?!

I have to keep reminding myself its not the journey, its the destination.  It seems like I’m an onion: you peel away one layer, and another arises.   Jere are a few things I am going to work on:

FIRST, I need to work on a relationship with “the man upstairs”

SECOND, I need to follow Bessel Van Der Kolk’s advice:  “You need to find some way where your body once again feels like ‘I am in control of myself.'”

THIRD, I need to apply what I learn to my future therapy practice.


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PART ONE: I am a “Seer of Unseeable Things”

I’ve been mulling over the purpose of this blog lately. Realistically, I suspect it will reflect the state of my mind’s inner workings & what I’m focused on at the time.  Since I’m completing a graduate degree, my posts have had an academic focus.  However, over time I hope to do much more with it….

I am a “seer of unseeable things”

One experiential thread woven throughout the fabric of my  life is a feeling of living in opposite-land.  In this frustratingly unique life position I am a seer of unseeable things which others are blind to.

Truth becomes bullshit and bullshit becomes truth…

Throughout my life, I have struggled with the existence daily experiences that I know as matters of fact and others perceive as blasphemous bullshit.  Instead a slew of social rules (i.e. bullshit) are presented to me as a preferred and/or desired way of being.  I am to tow the line or suffer the consequences.

I attribute this two three factors:

Firstly, I am an INFP

The above video provides an excellent visual depiction of the introverted feeling function from an “insider’s perspective”. The view from inside the fizzy pop can is different than others might be lead to believe based on outside appearances.

Sometimes I wonder if my experience made me how I am or if I make my experiences through how I perceive them.  The Myers Briggs Personality Type Indicator provides excellent insight into this “chicken-or-egg-question”.   I process information based on extraverted intuition.  This perceptual function has boundless curiosity, preferring to synthesize seemingly disparate perspectives into a multifaceted perspective based that carries greater truths not otherwise really see.  I make decisions and judgments based on deeply felt values that reflect the sum total of my life experiences.  I know this respect I’m a “lone wolf” who marched to the beat of my own thumb.

I seem to naturally gravitate toward a contrarian view of things: profoundly am aware of the idiot bullshit that underlies convention.

Secondly, I grew up a bullied & ostracized oddball.


I was always on the outside looking in.   The social universe of peers, friendships, and cliques was always foreign to me as a scary and mysterious universe!   For whatever reason, (an innate predisposition toward dorkiness), I was always the girl with cooties that nobody wanted to play with.   I did my own thing & retreated into my own world.  These early socialization experiences left their mark upon me as an adult incapable of faking normal.

You see, we all utilize our childhood as a developmental reference point experientially.  The coping methods we use & level of success we encounter in handling developmental tasks leave their mark.  I was fearful of social situations as a bullied child, had zero sense of self-efficacy. And adapted by retreating into my own world.

It’s, therefore, not really surprising that I am an introvert who is reluctant to open up to others. I have difficulty establishing friendships & trusting others…

Finally, I’m a biracial

Click here for a bill of rights for people of mixed race heritage


There are four abstract constructs which together are effective in developing a basic understanding of a biracial individual’s experience of race.  Together they explain what it is like to live within an unclear “in-between” space. These constructs are: (1) genotype; (2) phenotype; (3) identity; & (4) culture.  Understanding how they converge within an individual’s life can help quite a bit in explaining their racial identity.  They are useful in understanding the diversity of experiences amongst biracial experiences, as well as the issue of colorism…

Genotype vs. Phenotype…

Genotype refers to the DNA you carry within you.  You get half from your mother and half from your father.  For example, at geneaology.com they studies of populations around the world.  When individuals are isolated historically these populations tend to share genes for traits that are conducive to survival in that area.  When you submit a test at genealogy.com, they tell you what subsets of the human population are present in your genes.

Phenotype has to do with your physical features, how do you look?  What is the color of your skin, your face shape, and hair color?  The point is, you can have the same set of parents, but inherit different subsets.  Therefore, two genetically biracial individuals can have very different appearances.

I have a genotype / phenotype mismatch problem…

What is Identity?

The DSM-5 Manual defines Identity as follows:  “[the] experience of oneself as unique with clear boundaries between self and others; stability of self-esteem and accuracy of self appraisal; capacity for, and ability to regulate, a range of emotional experience.” (American Psychiatric Association, 2013, p823).  As a biracial individual the experience of how others see us diverges from the inner knowing of who they are.  Regarding how others’ experience, I feel as if I’m a man inside a monkey suit wearing upon my being the preconceived notions of others.  I wait for somebody to see within to the real me, but it happens rarely.  R.D. Laing (1990), summarizes this experience succinctly in his book “The Divided Self”.  In contrast, the description of our inner sense of self is best described in my old course textbook (Corsini & Wedding, 2013).

I cannot experience your experience. You cannot experience my experience. We are both invisible men. All men are invisible to one another. Experience is man’s invisibility to man. Experience used to be called the soul.” (Laing, 1990, p18).
“The usual sense of the self as being who we ‘really are’ and as being continuous and consistent over time seems to be an illusory construction of imprecise awareness….similar to the ‘flicker fusion phenomenon’ by which photographs projected successively on a movie screen…we suffer from a case of mistaken identity. We are not who, or even what, we thought we were. What we take to be our real self is merely an illusory construct” (Wedding & Corsini, 2013, p467).

What is culture?

Culture provides another set of mental programs relevant to a society (Chung & Bemak, 2002). It consists of a shared system of meanings within society that define modes of expression and communication, (Chung & Bemak, 2002; Nazir, et al, 2009). It influences how we view the world around us and sets the normative standards for behavior (Chung & Bemak, 2002; Nazir, et al, 2009). As a form of “mental programming” (Chung & Bemak, 2002, p282), it defines our value systems and preferred ways of thinking and feeling.

So what does it mean to see unseen things?

**As a biracial individual I am unable to take sides and am provided a unique view of the social world that mono-racial individuals cannot conceive.  I am not what I am perceived to be. 
**As an INFP, it means I live in a rich inner world filled with uncommon yet-valid truths unrecognized to the majority as contradictory to conventional thinking.
**As a bullied child I was never provided an insider’s view of the social world.  I stood outside the social world.  I wanted in but never gained access.  I did my own thing and can’t handle the idea of having to “fake normal”…

believe it or not there’s actually a point to all this pissing & moaning 🙂

On the one hand, I find myself doubting the validity of my own experiences.  Was it real?  If it was real then the world is filled with idiots who prefer to engage in pluralistic ignorance in the name of Santa-Clause-Like bullshit notions.  Or, am l the crazy person filled with irrational & delusional thoughts?  If so, should I be locked away somewhere?   How do I filter through the reality of my experiences and manage the disparities between my inner and outer worlds?

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Chung, R.C.Y. & Bemak, F. (2002) The relationship of culture and empathy in cross- cultural counseling. Journal of Counseling and Development. (80) pp154-158.
Coplan, A. (2004). Empathetic engagement with narrative fictions. The journal of aesthetics and criticism.62(2)
Dictionary.com (n.d.). Suspension of Disbelief.  Retrieved from: http://www.dictionary.com/browse/suspension-of-disbelief
Goffman, E. (1959). The presentation of self in everyday life. Garden City. Doubleday.
Laing, R. D. (1960). The divided self. New York: Random House
Nazir, A, Enz, S, Lim, M.Y., Aylett, R., & Cawsey A. (2009). Culture-personality based affective model. AI & Society. 24(3) pp 281-293.
Wedding, D., & Corsini, R. (2013). Current Psychotherapies. (9thed.). Belmont, CA: Cengage Learning.

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A PTSD Survival Plan….

As I may have mentioned earlier in this blog, I have PTSD.  Coming to terms with this diagnosis has required me to develop a greater understand of the symptoms I’m experiencing.  I’ve also had to accept that I’ve had this disorder for much of my life.   My perception of “normal” is therefore skewed and I’m left wondering what it might feel like….

…The other concern which occupies my mind is the fact that this diagnosis has no cure.  Coming to terms with this fact has required me to fully develop a realistic understanding of healing means.  PTSD is managed and not cured.  This has been a bitter pill to swallow.  I mourn what could have been, and feel like a cumulative byproduct of others’ opinions about me.  I have to accept, regretfully, that I allowed the worst of my bully’s words throughout life, to become my truth.  Overcoming the cumulative byproduct of these early traumas has consumed much of my life.  On the alter of healing, a potential of “what could have been” has been sacrificed.  My own personal sense of self, has been consumed by external factors including a socially-relevant idea of my utilitarian value.  I feel like a man in a monkey suit with a scarlet letter sewn on front.  The fact that this perceived value has no basis in reality of my ultimate worth seems pointless.  I protest against the idea that anybody external to myself defines my ultimate worth.  However, by iterating this fact, I feel like that kid in story “The Emperor’s New Clothes”.  At times I speak the truth and yet get crucified for it.  It seems as if the rules of the game in life are set up to drive me mad.  Socially relevant “truths” carry the weight of a collective systems of belief in which the majority of us play by the rules unquestioningly.  Acting otherwise seems like a radical idea to some….

…..And as I read this stream-of-thought, I realize it reflects intrusive memories of recent events that have trigged painful memories, I had naively believed were buried in the past….

A Trigger & Reminder…

“The traumatic event can be re-experienced in various ways.  Commonly, the individual has recurrent, involuntary, and intrusive recollections of the event…depressive rumination…intrusive distressing memories….(American Psychiatric Association, 2013, p. 275).”

The above video, provides a good sampling of the rhetoric I’ve heard during this election.  I brought it up on the November 8th, as the election results began pouring in.  Its worth noting, that my husband and I have divergent political beliefs.  He is an ardent conservative and Trump supporter.  I am a progressive who voted for Hillary in the hopes of preventing a Trump presidency. As I expressed my concerns regarding this hateful rhetoric, memories of a time long ago rendered my brain.   Feelings of shame fell over me as memories of past abuse flashed through my mind.   I began crying uncontrollably, as my husband immediately dismissed my concern, iterating the what he heard that night on the Fox network.

Before I begin, I must admit I’m not a very politically-minded person and this post has nothing to do with who is president.  It is a personal recollection of an experience that points out vividly the lasting impact of PTSD on my daily life.  

Needless to day, shock & panic took over as this year’s election results began pouring in.   Panic & anxiety set in as I struggled to understand his appeal. The very idea that Donald Trump would be president horrified me.   My mind vacillated between shock and horror, panic, and numbness.   As this painful reality set in, I describe how hurtful Trumps words were for me to hear as a trauma survivor.   Rather than providing comfort and an empathic ear, he became defensive and angry.   Misperceiving my concerns as an attack of his own political beliefs began criticizing and attacking everything I said.   This sent me into an emotional tailspin.   I ran headlong into an interaction that was reminiscent of a child that involved a complete dismissal of my thoughts and feelings.

As I struggle to manage the effects of this election on our marriage, I came to realize my symptoms were evidence of a diagnosis and not an ardent political belief system.  I’m coming to the realization that I need to take this PTSD diagnosis seriously.  What is it that causes these emotional flashbacks and the painful distressing memories?  

A Survival Tool-Kit…

What follows is a quick list of steps I can take to manage trauma triggers and the emotional flashbacks that might ensue.  I need a plan of action, to endure the resulting PTSD symptoms should they flood my mind.  Mind you this is something I create for my own benefit.  I’m not an expert here, I’m a sufferer who is learning to cope.  Here’s what I’m doing now & what appears to be working.  In this respect, it is a quick reminder on how to survive emotional flashbacks, should they recur.

STEP ONE:  Find a Psychiatrist.

Currently I’m only seeing a therapist.  I am not taking any medications and don’t have a psychiatrist following my case, since the one who diagnosed me retired.  This first step is much more frustrating that I might have imagined.  However, I’m happy to admit I’ve finally find somebody.

STEP TWO:  Identifying Trauma Triggers.

“Trauma triggers are reminders of a traumatic experience that provoke continued trauma symptoms. Trauma triggers can be internal or external stimuli, (Trauma triggers, 2012).”  At myptsd.com, site owner Anthony, makes a point of arguing the semantics of what is and/or isn’t a trigger, according to his self-imposed expertise (myptsd.com, 2015).  As a sufferer I don’t feel these semantics are of any value.  Instead, for survival purposes, self-awareness is the ultimate goal.  What is it that has produces these painful reactions to reminders of past traumas?  The DSM-5 manual notes the foll0wing about trauma triggers:

“[they can be] events that resemble or symbolize an aspect of the traumatic event, (e.g. windy days after a hurricane, seeing someone who resembles one’s perpetrator”.  The triggering cue could be a physical sensation (dizziness….rapid heartbeat). (American Psychiatric Association, 2013, p. 275).”

“Even though it may sometimes feel like PTSD symptoms come out-of-the-blue, [they] rarely spontaneously occur….cued by something in our internal (thoughts or feelings) or external environment (…a stressful situation). (Tull, 2016a).”  It is for this reason, that the above description from the DSM-5 manual is useful as a jumping off point.   The following questions are posed in an article I found online titled: “How to Identify & Cope with your PTSD triggers?” (Tull, 2016a).

FIRSTLY, “what types of situations are you in (Tull, 2016a)?”

Utilizing the above example, I was in the middle of a conversation with my husband.   Throughout the election, the rhetoric (see video) has been hard for me to take in.  When I expressed my horror that a man with corrupt value system was in office, he became angry.  He began dismissing my perspective and refused to hear my concerns.  A critical aspect of this exchange reminded me of that bad relationship from long ago where my feelings were continually dismissed and belittled.   While not intended, my mind was thrown into a wellspring of negative emotions.  

SECONDLY, “What is happening around you (Tull, 2016a)?”

We were in the basement watching television together.  The kids were upstairs playing.  I remember feeling exhausted, still recovering after a three-day weekend night shift.   I drifted in and out of consciousness, taking cat naps throughout that evening.  Realizing our divergent political belief systems were problematic this election season, we’ve avoided the subject.  That evening we had agreed to not watch the results together.

With an f-d up sleep schedule, I found myself battling insomnia at 1 a.m.  I took out my iPad and decided to read a few blogs I like to follow.  The post I found announcing Trump’s win was unexpected, since this specific blog doesn’t cover the subject of politics.  As I started crying, my husband rolled over and asked me what I was reading.  This is when the conversation happened and things went downhill.

THIRDLY, “What kind of emotions are you feeling (Tull, 2016a)?”

A mixture of anxiety, fear, and depression overcame me.  They were to remain for the rest of the week as I began feeling I was left to “white knuckle it”.  Desperate for a magic “happy pill” to make the feelings go away, I was angry at myself for not finding a new psychiatrist since my last one retired.  Finally, I can’t help but compare my reaction to others’ I know who voted against Trump.  While my parents and sister were shock and worried about the nation’s future, somehow they remained more in control.  Like the above video, they found some ability to remain positive and keep things in perspective.  My mind, on the other hand, began spinning out of control…..

FOURTH, What thoughts are you experiencing (Tull, 2016a)?”

Intrusive and painful memories entered my mind.  I tried willing them to go away, but somehow found this impossible.  The most exquisitely painful memories that still haunt me, aren’t physical abuses, but simply harsh and abusive words.  Nothing can scar your soul more that emotional abuse and an endless barrage of hate and contempt.  The painful aspect of these experiences that still haunts me is that nobody acknowledged my feelings.  They did these mean things to me and let it known to me that it was my fault and I deserved what I got.  Somehow this fucked-up sentiment hurt the worst.

FIFTH, What does your body feel like (Tull, 2016a)?”

My body drifts back and fourth between a state of hyper-arousal and dissociative numbing. At a moments when the emotional pain is literally excruciating, I curse my family and their undying love for me.  If it wasn’t for this, I could just “off” myself and be done with it.  Enduring somehow has felt like a curse.  However, much I want to live and keep going, the struggle has been difficult.

STEP THREE:  Distract First…

When experiencing flashbacks or dissociative symptoms, first distract then challenge.  Distraction techniques involve “coping tools designed to ‘ground’ you in the present moment…so you can retain your connection with the present moment, (Tull, 2016b).”  The DBT distress tolerance and mindfulness skills described in this blog are useful as a jumping off point.  Distracting ourselves from a situation or trigger that can cause us pain, can ground us as we focus on the five senses (Tull, 2016b).  For example, one client I met recently has an aromatherapy glass roll-on bottle which she carries everywhere.  I, on the other hand, have utilized calming music, exercise or mandalas as a tool for distraction.

STEP FOUR:  Challenge Second….

Anthony at myptsd.com (2015), makes a useful point regarding ptsd triggers:

“Categorize your triggers as realistic or unrealistic. You may want outside opinions on this….Review your cognitive biases based on your immediate thoughts and reactions to the trigger, and have counter-statements prepared to confirm the unrealistic aspect of the trigger, (myptsd.com, 2015).”

This suggestion is useful in developing an awareness of how PTSD symptoms often reflect past events or unresolved cognitive biases, and not present situations.  Marsha Linehan’s emotional regulation skills a re useful in challenging our emotions and thoughts.  The ultimate goal here is thinking through them and not with them.

STEP FIVE:  Seek Support.

Tull (2016b), suggests finally, to utilize any support system we have in place.  “If you know that you may be at risk for a flashback or dissociation by going into a certain situation, bring along some trusted support.  Make sure that the person you bring with you is also aware of your triggers and knows how to tell and what to do when you are entering a flashback or dissociative state, (Tull, 2016b).”  My husband, sister, and parents have been a critical first line of defense here.

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing
myptsd.com (2015, September, 2). PTSD Triggers.  What triggers PTSD symptoms?  Retrieved from:  https://www.myptsd.com/how-to-use-triggers-as-a-means-to-recovery/291/
TRAUMA TRIGGERS. Encyclopedia of Trauma. Jan. 1, 2012.
Tull, M., Phd. (2016a, May, 4)  How to identify and cope with your PTSD triggers.  Retrieved from:  https://www.verywell.com/ptsd-triggers-and-coping-strategies-2797557
Tull, M., Phd. (2016b, September, 6).  Coping With Flashback and Dissociation in PTSD.  Retrieved from:  https://www.verywell.com/coping-with-flashbacks-2797574

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Reality Therapy

Who is William Glasser?

William Glasser was born on May 11th, 1925 in Cleveland Ohio.  He earned an undergraduate degree in chemical engineering, a Masters in Clinical Psychology, and finally his MD.  He completed his Psychiatric training in 1957.  He was married 47 years until his wife’s death and had two children.

What Glasser Believed

“Very early Glasser rejected the Freudian model, partly due to his observation of psychoanalytically trained therapists who did not seem to be implementing Freudian principles. Rather, they tended to hold people responsible for their behavior, (Corey, 2015, p. 315).”  William Glasser developed Reality Therapy to address a key problem with psychoanalysis: that it taught people to blame others for their behaviors (Sharf, 2015, p. 417).  In Glasser’s Reality Therapy, he sought to develop an approach to therapy that  that reflected his  clinical experience.    As a result of this experience, “Glasser became convinced that it was of paramount importance that clients accept personal responsibility for their behavior. (Corey, 2015, p. 315).”  In many respects, Reality Therapy appears to be similar to REBT as a practical cognitive and behavioral approach (Rosenthal, 2005).  However there are a few key differences.  While Glasser focuses on relationships and an awareness of one’s choices, Ellis is focused on irrational beliefs and behavioral change.  Additionally, while it contains techniques that reflect behaviorism, he ultimately disagreed with Skinner.

Criticism & Praise

Rosenthal, (2005) notes that since this theory is practical, straightforward “and not cloaked in theory, it is attractive to social workers, case-workers, teachers, juvenile workers, rehabilitation specialists, (Rosenthal, 2005).”   However, some have also criticized this method is overly simplistic and ignores the unconscious as irrelevant to his approach (Rosenthal, 2005).

Characteristics of Reality Therapy

The Problem & It’s Solution

“Reality therapists believe the underlying problem of most clients is the same: They are either involved in a present unsatisfying relationship or lack what could even be called a relationship…Few clients understand that their problem is the way they are choosing to behave. What they do know is that they feel a great deal of pain or that they are unhappy…(Corey, 2015, p. 316).”

As the above quote states, reality therapists define the goal as unsatisfying relationships and poor behavioral choices that cause unhappiness.  In contrast, REBT focuses on irrational beliefs while psychoanalytic theorists state answers lie in the unconscious.  Consequently, Reality Theorists are not interested in helping client’s gain insight into their irrational behaviors or resolving unconscious conflict. (Wubolding, 2013, p. 293).  Instead Glasser aims to help clients make better behavioral choices since he defines problems as involving poor behavioral choices (Corey, 2015; Wubolding, 2013).   By helping clients make better behavioral choices, they can become more successfully fulfill basic human needs such as love, belonging, freedom, achievement, etc. (Corey, 2015).

Thoughts on Diagnosis…

Glasser’s theory rejects the traditional DSM-based perspective of diagnosis except when absolutely necessary (i.e. insurance coverage purposes), (Corey, 2015).  He rejected the notion of a label that defined someone as mentally ill and that the primary solution involved medication.  Instead, in Glasser’s view, the problems ultimately came down to the behaviors people choose to engage in when attempting “to deal with the pain and frustration that is endemic to unsatisfying present relationships, (Corey, 2015, p. 317).”

Choices Not Symptoms

“Reality therapy helps people examine their wants and needs, evaluate behaviors, and make plans for fulfilling needs (Wubolding, 2013, p. 293).”  Glasser rejected other approaches on the basis that they allowed clients to blame others for their behavior (Sharf, 2015).  Instead, reality therapy is based on the notion that “the only person you can control is yourself, (Corey, 2015, p. 315)”.  Rather than complaining about external circumstances or criticizing others, reality therapy is focused on oneself.  Symptoms of a mental illness are instead conceived as consequences of our behavioral choices.  The symptoms represent the problem while our choices reflect our solution.

Emphasis on Self-Responsibility

“If we choose all we do, we must be responsible for what we choose. This does not mean we should be blamed or punished, unless we break the law, but it does mean the therapist should never lose sight of the fact that clients are responsible for what they do (Corey, 2015, p. 315).”

Click Here To Read My Post Titled: “Accepting Responsibility: “Shame, Blame, Resentment”  

Focused On The Present

While Glasser does believe that we are products of our past history, the solution lies in the present.  If we focus on the past, (Corey, 2015).  In this respect, while Reality Therapy appears to acknowledge our problems are often associated with a multifactorial cause, the workable solutions lie in our behavioral choices.  When we focus on things beyond our control like the past we become a victim.  When we focus on the choices we’ve made, we become empowered with a realistic and remediable solution.

Rejection of Transference

“Glasser contends that transference is a way that both therapist and client avoid being who they are and owning what they are doing right now (Corey, 2015, p. 320).”  In other words, since transference issues pertain to unconscious memories of past events, they aren’t relevant to the solution.  From a reality therapy perspective, focusing on transference issues in order to uncover unresolved issues within our unconscious is a waste of time.  Instead, Glasser believes we can only be what we are in the present (Corey, 2015).

Basic Concepts

Control Theory

Glasser developed Reality Therapy in the 60’s as a result of his years of experience at a “state institution for delinquent adolescent girls, [in which a] focus on friendliness and responsibility was found to be helpful (Sharf, 2015 p. 417).  Later in 1981, Glasser wrote a book titled “Choice Theory” which emphasized the phenomenological pictures we create in our mind.   This phenomenological experience of our world determines our behavioral choices.  Consequently, we”behave to control the world…[it] does not control us (Rosenthal, 2005).”  The solution we desire ultimately lie within.

The Thermostat Analogy

file5331257892459Glasser describes the brain as an internal thermostat, that functions to assess how effective our behaviors are in responding to our environment (Corey, 2015; Wubolding, 2013).  This process begins when we utilize our senses to observe the world outside ourselves.  We choose how to respond based on these perceptions and how they correlate to our basic human needs (Wubolding, 2013).  In other words, the brain assesses the effectiveness of our behavioral responses to our environment. Psychiatric symptoms are best understood from this perspective according to reality therapy.

A picture of reality

img_2878“Glasser (1981, p. 126) makes the point that we do not live ‘to any extent in the real world’ (Sharf, 2015, p. 419).”  In other words, it is ultimately our perception of reality that determines our behavior.  Do we see reality as it is?  Wubolding, (2013) notes “The input desired from the world enters the brain first through the sensory system and then through two filters: the total knowledge filter, by which the perception is first recognized, and the valuing filter, by which the person makes a positive or negative judgment about the perception, (p. 295).  Our innate human drive to fulfill certain elemental needs like love, and belonging, create the motivational force underlying our valuations of the external world.  In this respect, our perceptions often act as self-fulfilling prophecies, until we understand where our choices lie.

A View of Human Nature

“Choice theory posits that we are not born blank slates waiting to be externally motivated by forces in the world around us….Rather, we are born with innate human needs such as survival, love and belonging…that drive us all our lives, (Corey, 2015 p. 317).”  In this respect, reality therapy conceives all behavior as purposeful in nature (Wubolding, 2013).  We are driven by our innate human needs….

…On the surface, this perspective of human behavior sounds much like Skinner’s mechanistic view of human nature.  However, Reality Therapy notes that we respond to this drive by making behavioral choices that correlate with our perceptual understanding of reality (Wubolding, 2013).

Explanation of Human Behavior

According to choice theory, all behaviors are a reflection of the personal choices we make to fill personal needs (Wubolding, 2013).  Additionally, Glasser states that: “behavior is made up of four inseparable but distinct components— acting, thinking, feeling, and physiology—that necessarily accompany all of our actions, thoughts, and feelings, (Corey, 2015, p. 318).”  Wubolding, (2013) adds that behaviors can be thought of a form of communication, wherein we inform others of our underlying motivations.

“Physiology refers to both voluntary and involuntarily bodily mechanisms, (Sharf, 2015, p. 421).”  EXAMPLE: I experience physiological anxiety.
“Thinking includes both voluntary and involuntary thoughts, (Sharf, 2015, p. 421).”  EXAMPLE:  I think about our mounting debt.
Feelings include an endless array of both positive and negative emotions, (Sharf, 2015). EXAMPLE:  I feel frustrated about paying it off.
“Doing refers to active behavior…voluntary or involuntary, (Sharf, 2015, p. 421).”  EXAMPLE:  I bitch and whine endlessly.
“behavior is a language, and that we send messages by what we are doing, (Covey, 2015 p. 319). EXAMPLE:  I communicate a lack in faith that we can get through this.  

Additionally, Glasser utilizes a diagram as an analogy to describe how he conceives human behavior (Sharf, 2015).  Our needs exist as the engine or motivate fuel that drives our behavior while our individual wants are much like a steering wheel by providing us some direction (Sharf, 2015).  Now if we have a front wheel drive car, actions and thoughts are the front wheels, while feelings and physiology are the back wheels (Sharf, 2015).  This analogy is keeping with Glasser’s assertion that innate needs are essential as a point of understanding human behavior, while describing how we can gain control of the vehicle.

Basic Human Needs

Glasser believes that our conceptions of our external world are defined by an innate desire to satisfy our innate human needs (Sharf, 2015).  Consequently, reality as we experience is a subjective creation and not an objective fact.  “For example, a woman with anorexia may have a picture of herself as fat, (Sharf, 2015, p. 420).”   These needs provide motivation for our behavioral choices and are universal in nature since they are innate rather than learned (Wuboldt, 2013).  Glaser describes five basic needs:

SURVIVAL: “Taking care of oneself by eating, drinking, seeking shelter, & resisting illness, (Sharf, 2015, p. 420).
BELONGING:  A basic  desire for love &acceptance from others as well as a feeling of cooperation in significant relationships, (Sharf, 2015).  
POWER:  A need to “be better than others often conflicts with our need for belonging, (Sharf, 2015, p. 420).”  This esteem or feeling worthwhile by achieving our personal goals. 
FREEDOM:  A desire to live life on our own terms and have control over how we choose to express ourselves (Sharf, 2015).  
FUN:  a need to engage in experiences and activities one finds enjoyable (Sharf, 2015). 

The Nature of Choice

“When a person perceives that he or she is getting what is desired from the external world, the five needs are satisfied. But when there is a difference between what is desired and the input one receives by way of the perceptual system, the person is motivated to generate a choice, a behavior in the external world, (Wubolding, 2013, p. 295).”

How does reality therapy address the issue of illogical human behavior? In other words, why would we choose for ourselves a state of being that is displeasurable?  Glasser describes in his theory for reason why a person would choose an unwanted state of being (like anxiety or depression)

FIRSTLY:  Individuals sometimes choose to be anxious or depressed because it is a preferable to displays of anger (Sharf, 2015).  (EX – I vacillate between anger & depression in response to the money issues rather than lashing out in anger.)
SECONDLY:   Individual’s sometimes choose to be angry or depressed because it yields a more helpful response from others.  (EX – when my husband sees me becoming anxious about our debt, he watches the budget closely, and the kids whine less about shopping).
THIRDLY:  “Individuals choose pain and misery to excuse their unwillingness to do something more effective (Sharf, 105, p. 422).”  (EX – For example, I choose to remain in an abusive relationship for promises of acceptance, rather than heal older traumas from my childhood).
FOURTHLY:  Sometimes people opt for anxiety and depression because it can help them gain control of other’s responses (Sharf,  2015).  
In other words, “when people choose misery…it is because these are the best behaviors they are able to devise at the time, and these behaviors often get them what they want. (Corey, 2015 p. 319).”

In this sense, Glasser does not view illogical behavior as a matter of mental illness, but instead as a “creative solution” to a complex problem (Sharf, 2015).  The key question for therapists then would be: What purpose does this behavior serve?  Answering this question will require utilizing Glasser’s Car Metaphor for perspective since individual’s may not directly choose these behaviors.  “People do not choose pain and suffering directly; rather, it is an unchosen part of their total behavior, (Corey, 2015, p. 319).”

EXAMPLE ONE: A person can play victim because it gives them a sense of control over others and they can feel a sense of validation and self-righteousness that their hurt was in fact caused by other people.  An unchosen part of this total behavior is that they become helpless.  Solutions can only be defined in terms of others
EXAMPLE TWO:  When I become depressed I start focusing on regrets from my past (i.e. unforeseen illness and mounting medical bills).  I use these past experiences to predict future events, and see nothing about the same in my future.  This causes heightened anxiety as I begn thinking in terms of worst case scenarios.  This helps me feel prepared for the worse, however renders me helpless.  All I can do is worry and complain.  

A Theory of Personality

“Reality therapy teaches that human beings choose behaviors. When choices are made, people discover that the result attained is desirable or undesirable. They thus discover whether their behaviors are effective or ineffective in satisfying their needs. They also discover whether particular aspects of the external world are pleasurable (need-satisfying), painful (not need-satisfying), or neutral, (Wubolding, 2013, p. 299).”

According to Glasser, personality development begins with a basic understanding of our needs, and how to best fulfill them.  Life experiences accumulate to create a perspective that we utilize to understand our world.  Since all behaviors are designed to fill our needs, our identity is based on how successful we are at meeting them (Wubolding, 2013)….

Success Identity

A success identity can be thought of as “a responsible individual who develops a high degree of self-esteem, personal strength, and [successful in meeting their] needs, (Rosenthal, 2015).”  In order to develop a success identity we need to be willing to develop a “repertoire of skills for meeting the fiveneeds of belonging, power, fun, freedom, and survival in positive ways, (Wubolding, 2013, p 301).”  A resource I found for this post describes three key elements necessary for the development of a successful identity (Wubolding, 2013):

“(1) a desire to fulfill human needs effectively without infringing on the rights of others; (2) elements of a positive life direction include the following positive symptoms such as “altrusim…effective thinking…self-confidence…effective behaviors; (3) and a positive addiction for meditation and noncompetitive exercise (Wubolding, 2013, p. 301).”

Failure Identity

A failure identity “is characterized by faulty perceptions and irresponsible behaviors, (Rosenthal, 2015).” Their behavioral responses are ineffective in meeting their life needs.  In contrast, the development of a failure identity is byproduct of three factors:

“(1) giving up…(2) [engaging in]…ineffective behaviors such as antisocial actions…negative thoughts [and] feelings; (3) and unhealthy addictions, (Wubolding, 2013, p. 301).”

The Reality Therapy Process

Rosenthal (2005), completes his discussion of reality therapy by providing an overview of the process in eight key steps:
“(1) establishing a relationship; (2) Focusing on current behavior; (3) Requesting client participation in evaluation process; (4) developing a plan for change: (5) committing to therapy; (6) accepting responsibility; (7) avoid punishment & while utilizing judgment to ascertain willingness to change; (8) finally, remain persistent, (Rosenthal, 2005).

Facilitators of Change

How does Reality Therapy make change happen?  Wubolding, (2013) states that Reality Therapy provides hope to clients in the form of a realistic solution.  Corey, (2015) states that change happens “when [clients] are convinced that their present behavior is not getting them what they want and (2) when they believe they can choose other behaviors that will get them closer to what they want, (p. 325).”

  1. Reality therapy facilitates change because it helps us understand how we are behaving from moment-to-moment throughout our lives, (Wubolding, 2013).
  2. Reality therapy facilitates change by helping us find effective solutions to gain control over our lives and increase our overall effectiveness in meeting our needs, (Wubolding, 2013). 
  3. The therapeutic relationship facilitates change by [roviding the client a friendly and safe environment in which to examine their total behaviors.
  4. Reality therapy facilitates change by helping improving their ability to engage in honest self-evalaution (Wubolding, 2013).  

Assessment

Reality Therapy does not utilize assessment for diagnostic purposes, but instead as a facilitator of change (Sharf, 2015).  Wubolding (2013) notes that “all change, great and small, is preceded by the client’s judgment that life is not as it could be and that a better, more rewarding future is possible, (p 310).  In other words, helping a client understand how change is possible, itself is a huge step.  Sharf, (2015) notes two key elements focused upon in a Reality Therapy approach include: an assessment of wants and total behaviors:

ASSESSMENT OF WANTS & NEEDS:  What does one want and how do these wants represent the five human needs Glaser has discussed?  How can they describe the need between what they want and what they have?
ASSESSMENT OF TOTAL BEHAVIOR:  Utilizing the metaphor of the car, what are your actions, thoughts, behaviors, and physical symptoms.  How can you describe your responses to difficult life situations, in this matter?  

WDEP System

“the WDEP system…represent[s] a cluster of skills and techniques for assisting clients to take better control of their own lives and thereby fulfill their needs in ways satisfying to them and to society, (Wubolding, 2013, p. 304).”  Each letter represents a different step in the overall therapy process which naturally begins with the establishment of a therapeutic relationship (Sharf, 2015).

“WDEP…refers to W = Wants, D = Direction & Doing, E = evaluation, & P = Planning, (Sharf, 2015, p. 424).”
STEP ONE “As client’s what they want, (Wubolding, 2013, p. 304)” This means examing one’s personal wants and how they influence their perceptions of reality.
STEP TWO“Ask clients what they are doing and their overall direction, (Wubolding, 2013 p. 305).”  This is can help clients examine the motivations underlying their behavior and what changes they can make.
STEP THREE“Ask clients to conduct a searching self-evaluation, (Wubolding, 2013, p. 305).”  For example, how realistic are their needs and are their behaviors taking them in the direction of their goals?
STEP FOUR “Ask clients to make Plans to more effectively fulfill their needs…. The plan should have SAMIC characteristics—i.e., it should be Simple, Attainable, Measurable, Immediate, and Committed to, (Wubolding, 2013, p. 306).”

Therapist Attitudes

“The following are attitudes that counselors adopt when handling difficulties in exploring total behavior, evaluating the behavior, making plans, and committing to plans: (1) No excuses for failure to follow through on plans are accepted…(2) The counselor does not criticize, argue with, or punish the client… (3) The counselor does not give up on the client, but persists, (Sharf 2015 p. 428).”

Therapeutic Strategies

Finally, before I end this post, I think its useful to list a few therapeutic strategies listed in Sharf’s (2015) textbook.  He begins by noting that this method is not “technique focused” (Sharf, 2015, p. 430).”

  1. QUESTIONING:  Developing a variety of ways to ask clients about their inner world is useful in exploring the elements of one’s total behavior.
  2. BEING POSITIVE:  “The reality therapist focuses on what the client can do. Opportunities are taken to reinforce positive actions and constructive planning, (Sharf, 2015, p. 431).”
  3. METAPHORS:  Glasser seems to describe the use of metaphor as a way of utilizing the client’s language to describe their needs and total behaviors.  This can be useful in talking about things in a manner which is congruent with their own experience (Sharf, 2015, p. 432).
  4. CONFRONTATION:  As stated earlier, one essential therapeutic attitude involves the refusal to accept excuses from your clients, (Sharf, 2015).  Confronting the client doesn’t necessarily mean that you’re rejecting the client or being negative.  Instead it means a firm line is drawn that forces the client to accept responsibility.
  5. PARADOXICAL TECHNIQUES:  “Paradoxical techniques are those that give contradictory instructions to the client, (Sharf, 2015, p. 432).”  This method appears similar to Viktor Frankl’s paradoxical intention technique that involves having the client engage in a highly exaggerated and inappropriate level of a specific behavior they hope to extinguish.  For example, this can involve reframing how we think about a topic, or prescribing a schedule for certain maladaptive behaviors in order to control them better (Sharf, 2015).

References

Corey, G. (2015). Theory and practice of counseling and psychotherapy. Retrieved from: http://bk.unesa.ac.id/wp-content/uploads/2015/09/Theory_and_Practice_of_Counseling.pdf
Glasser, W. (1981). Station of the mind: New direction for reality therapy. New York: Harper & Publisher.
Reality Therapy / Choice Theory: Chapter 8. (n.d.) Retrieved from:  http://www.willamette.edu/~regray/cm/CH%208%20Reality%20Therapy.pdf
Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.
Sharf, R. S. (2015). Theories of psychotherapy & counseling: Concepts and cases. Cengage Learning.
Wubbolding, R. E. (2013). Reality therapy for the 21st century. Routledge.

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Transactional Analysis

***This post is a study exercise as a I prepare to take the NCE exam.  It contains excerpts from other posts that can be found hereherehere…&… here***

Eric Berne, (1910 – 1970) was born in Canada as Leonard Bernstein.  His father was a physician who died when Eric was young.  His mother was a writer.  In an effort to follow in his father’s footsteps, Eric Berne also became a physician, graduating in 1935.  After completing his internships, and becoming an American citizen, he changed his name to Eric Berne.  He started his practice in Connecticut and married his wife, Ruth in the early 40’s.  They had two children together.

Rosenthal, (2005) states that Transactional Analysis is often referred to as a “Populist Therapy Method”, since it is fun and easy for the laymen to understand.  While developing his approach, he made a point of simplifying the language and wrote several books on the subject including.

An overview of Transactional Analysis….

matryoshka-970943_1920Utilizing insights from this theory, my therapist keeps nesting dolls on the coffee table in her office.  Utilizing them in conversations from time to time, they have been productive tools for reflecting on the opposing ego states underlying my stuckness.  It seems my own “inner critic” and “hurt child” are fighting for “control” and as a result I’m getting nowhere.  Now that I’m a student, and reading Eric Brene’s works, it may be useful to quickly review some essential concepts.

Selfdefinition.org (n.d.) describes transactional analysis as a theory of social intercourse.  According to Eric Berne, “The human brain acts in many ways like a camcorder, vividly recording events.” (ericbrene.com, n.d.).  While not necessarily remaining available for conscious retrieval, the emotive consequences of these events and our experiences of them remain.  It is only when interactions and events, trigger these memories that the effects of these events arise.  This cognitive process is much more complex in an individual with PTSD as you might imagine.  In an effort to provide convenient constructs to discuss the transactional process between these ego states, Eric Brene created several key concepts in this theory.  For example, structural analysis involves an examination of the various mental states I described earlier (“inner critic” vs. “hurt child”).  In contrast, transactional analysis examines the dynamics of social interaction and how these elements of our psyche play their role.  The nesting dolls in my therapy sessions provide a convenient method of illustrating Eric Brene’s concepts of ego states.  Rather than conceiving of these ego states as Freudian structures in the brain, Berne states they are “phenomenological realities” (ericbrene.com, n.d.), that represent consistent patterns of reacting to life events.  Additionally, these phenomenological realities are based on past choices in response to life events.  Therefore, his conception of personality development is less determinstic than Freud.  For example, my own “hurt child”, reflects Eric Brene’s child ego state in which past experiences are experienced from the standpoint of their emotive impact.    In my specific instance, this is where most of my unresolved traumas exist.  In contrast, the Parent ego state, represents my own “critical parent”.  The critical parent’s camcorder provides an overview of early life experiences and the implicit messages they contained.  Finally, as I understand it, Berne’s adult ego state, reflects closely Marsha Linehan’s wise-mind concept.

T.A. Ego States…


529807Ego states refer to experiential realities that also represent a consistent pattern of relating with the world around us (Ingram, 2012)  Analysis of ego states is called Structural Analysis (Rosenthal, 2005).  Since, only one ego state is dominant at any point in time, our communication style and body language often communoicates which ego state we are operating out of (Rosenthal, 2005).

Three primary ego states exist in transactional analysis: parent, adult and child. The parent ego state is a representation of the way parents and other authority figures conduct themselves. The parental ego influences us by echoing the learned rules and morals communicated to us from authority figures throughout our life. Two main forms of parental ego states include the nurturing and critical parent. The child ego state, in contrast, is archaic and emotionally 490629driven. Comprised of our own first-hand early childhood experiences, it reacts impulsively with others on the basis of these deep emotional memories. Two versions of the childlike ego state exist: the rebel and hurt child.  Finally, The adult ego state is much like the wise-minded DBT perspective. In this respect, it is fully present in the moment and is capable of making realistic appraisals based on all perspectives, including thoughts and emotions. As somebody who is trying to lose weight, a funny description of each state is provided in my textbook:

“[rebellious child] I’m going to eat what I want and you can’t stop me…[hurt child] I know I am bad; what’s wrong with me. I’m trying, but just can’t…[nurturing parent]…don’t worry, I know you’re stressed. Go ahead and have some ice cream…[critical parent] you should take those pounds of. What’s wrong with you?! You’re an indulgent loser…[Adult] Lets come up with a plan where I can maintain a steady weight loss of one pound a week yet still eat foods I enjoy and have certain meals where I can disregard the rules.” (Ingram, 2013, p 295)

Basic Concepts….

Defining Transactional Analysis

Transactional analysis can be thought of as an attempt to understand social interactions between individual ego states (Rosenthal, 2005; selfdefinition.org, n.d.).

TRANSACTION – a unit of social intercourse, where two or more individuals interact

TRANSACTION STIMULUS – the actions and/or words from another acknowledging our presence & reacting to our behaviors.

TRANSACTIONAL RESPONSE –  is naturally our chosen manner of responding to transactional stimuli.

Types of Transactions

Berne also classifies types of social transactions in his theory, these include: (1) complimentary transactions; (2) cross-transactions; and (3) gimmicks, (Rosenthal, 2005).

Complementary Transactions

complimentaryAre predictable interactions based on the natural order of a relationship between individuals.  Responses are predictable, parallel and can proceed in this manner as long as all individual respect the parameters of the relationship, (selfdefinition.org, n.d.).   Rosenthal, (2005) describes these as healthy relationships. For example, when interacting with my kids I’m adopting a parent ego state, they can expect when they talk to me.

Cross-Transactions

pac10Rosenthal, (2005) describes these as unhealthy relationships, (i.e. hurt child / critical parent).  Communication that is not complementary creates conflict and causes a breakdown in understanding.  It can be best described as a form of transference.  For example, let’s say I’m talking to my husband about the bills.  I assume I’m talking to an adult.  However, I get a response from his “Hurt Child”, and pouts when I begin discussing our spending this last month.

Gimmicks

Gimmicks are used in games for a payoff – or ulterior motive (Rosenthal, 2005).  Selfdefinition.org, (n.d.) notes that they can involve the activity of more than two ego states are at play during an interaction. Gimmicks are based on our social needs.  In order to meet these social needs, our true feelings psychologically can contradict how we behavior in the social transaction.

In my last internship I received no support or training and was overwhelmed.

I initially engaged in a complementary transaction with my supervisor, and notified them the 70+ hour work week was too much.

However this didn’t work, they were desperately understaffed.

Therefore, I bided my time, appearing appreciative and friendly.

However, I was seething in frustration underneath.

I desired to make a good impression.

This is a gimmick.

Strokes

selfdefinition.org (n.d.) defines as a unit of social interaction that are interpreted as a form of physical or verbal recognition.  They can involve a form of intimate physical contact or include verbal recognition.  Rosenthal, (2005), notes that they can be either positive or negative.

Rituals & Procedures

Typically socially interactions exist as a series of events that are learned as a result of previous interactions.  Procedures are series of complex transactions such as the standard greeting of a casual acquaintance when you ask them about how they’re doing and they say fine in the grocery store.  They serve the purpose of allowing us to folllow social rules while acknowledging others without expending a great deal of mental energy.  In contrast, rituals are byproducts of external social requirements (i.e. scripts, schemas and/or frames).  An excellent example of a formal ritual includes the typical Catholic mass (selfdefinition.org, n.d.).  We all know what’s expected and behave accordingly.

Games

Like rituals and procedures, games exist as a series of typical events in the course of our interaction with others.  However, what makes them unique are that they include a series of gimmicks and can be characterized by an ulterior motives, and concealed motivations.  Rosenthal, (2005) describes them as containing underlying messages that contradict our behaviors, preventing intimacy and honesty.  They are repetitive in nature and color the nature of our unhealthy relationships.

Berne’s Scripts

In his book “Transactional Analysis in Psychotherapy”, Eric Berne, (1961), provides a theory which is useful in analyzing social interactions.  His theory uses the concept of life scripts to describe a set of “unconscious relational patterns” (Erskine, 2010, p. 24).  Developed in childhood, they are relational patterns that reflect our attachment history and are repeated throughout life.  Scripts exist within limbic memory and influence our thoughts, perceptions and behaviors.  Finally, they provide “a generalization of specific experiences and an unconscious anticipation…that will be repeated throughout life” (Erskine, 2010, p. 22).  Berne uses the term “transference phenomena” (Ereskine, 2010, p. 15) to describe this repetitive nature reflected through our relationship history.

Our life script unfolds “like a novel based on messages accepted in childhood.  Therapy is based on creating new decisions and re-writing your own life script.”  A physician by the name of Stephen Karpman, (who studied under Eric Berne)(, has developed a “drama triangle” that builds on this concept.  It consists of the concepts of the concepts persecutor, victim & rescuer.  These roles are described below:

Life Positions…

transa6In the second of his videos (theramin trees, 2010), delves into how our own ego states interact with significant others.  Why is it this endless cycle occurs?  In answer to this question, (theramin trees, 2010), mentions the concept of “life positions”.  In transactional analysis, this concept refers to a consistent belief about ourselves in relation to others.  As a broad stance we take in relation to others, it might convenient to think of “life positions” as self-imposed roles.  We distort our realties through these life positions, and utilize patterns of interaction with others as preferred coping tools.   Naturally, the benefit of a “life position” is its pay-off.  Theramin trees (2010), suggests to viewers, that in addition to desconstructing transactions to gain clarity, we should let go of the payoff that allows these cycles to continue.  Without the payoff (i.e. need fulfillment) the “life position” is no longer a logical choice.

“I’M OKAY YOU’RE OKAY”

Since this position conceives everyone as equals, it promotes well-being in your social interactions  You do not act from a position of superiority or inferiority so are effective in meeting your own social needs in a positive and mutually healthy relationships

“I’M OKAY YOU’RE NOT OKAY”

This life position “causes clients to blame others for their difficulties and cause paranoia and criminal tendencies, (Rosenthal, 2005).”  You place yourself in a dominant or superior position over others and tend to project inadequacies onto others.  Donald Trump Exists Here.  

“I’M NOT OKAY YOU’RE OKAY”

This is my own life position as a result of childhood ostracism. It caused me  to feel inept and inferior to others, and led to feelings of severe depression and suicide ideation during my teens.

NOBODY OKAY

Rosenthal (2005) states people here are often “homicidal, suicidal, both or schizoid”.  Are frequently overwhelmed with feelings of anger or betrayal.  It is characterized by extreme apathy and existential hopelessness.

A Personal Application…

“Transactional analysis often regards the experience of ‘ feeling stuck’ as the manifestation of an impasse or an intrapsychic conflict or interpersonal roadblock…my own aim here is to broaden the theory of impasses, exploring whether and how ‘stuckness’ may constitute a developmental opportunity” (Petriglieri, 2007, p185).

Resistance from this theoretical perspective can be “explained as a battle between inner parts: one part wants to change, while the other does not…” (Ingram, 2013, p 234).   According to transactional analysis, within us exist ego states that represent experiential realities from various stages in life.  Within each ego state is a typical coping style or pattern of relating to those around us. As I recall, two in particular have been engaged in a perpetual lifelong battle….

My Hurt Child

The child ego state can be thought of as an inner mental recording of painful childhood experiences.  When encountering triggers that remind us of these events, we’re sent back in time.  Emotionally, we can re-enact these early experiences with those around us. For example, within me lives a “hurt child” who was bullied kid and had no friends.  This hurt child asks, “I know I am bad; what’s wrong with me” (Ingram, 2013, p. 295).  She is submissive, insecure, with no sense of self.  Filled with a sense of shame, she seeks validation and acceptance from others – wherever she can get it…

My Critical Parent

The parent ego state reflects messages we receive from authority figures in our lives and standards of conduct we were taught.  My own critical parent, consists of messages from my parents that emotions were bad and creativity was a waste of time.   My critical parent consists of message from parents and teachers who ignored and overlooked the bullying.

My critical parent might say “you should take those pounds off. What’s wrong with you?! Your an indulgent loser (Ingram, 2013, p. 295).”  
My hurt child will be filled with feelings of insecurity as a former “ugly duckling”.  Shame takes over in reaction to the random characteristics that happen to define my meatsuit

References

Berne, E. (1961). Transactional analysis in psychotherapy: A systematic individual and social psychiatry.
ericberne.com (n.d.) A description of transactional analysis.  Retrieved from:  http://www.ericberne.com/transactional-analysis/
Erskine, R. G. (2010). Life scripts: A transactional analysis of unconscious relational patterns. London: Karnac.
Ingram, B.L. (2012). Clinical Case Formulations: Matching the Integrative Treatment Plan to the client. (2nd ed.). Hoboken, NJ: Wiley. ISBN: 978-1-118-03822-2
selfdefinition.org (n.d.) Games people play by Eric Berne. Retrieved from:  http://selfdefinition.org/psychology/Eric%20Berne%20-%20Games%20People%20Play.pdf
Theramin trees [screen name] (2010, June, 10) Transactional Analysis 1: ego states & basic transactions  Retrieved from: https://www.youtube.com/watch?v=nKNyFSLJy6o
theramin trees [screen name] (2010, June, 17) Transactional analysis 2: games. Retrieved from:  http://youtu.be/YOqJ4sc9TAc
Petriglieri, G. (2007). Stuck in a moment: A developmental perspective on impasses. Transactional Analysis Journal. 37(3), 185-194.

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About me

Hello, my name is Kathleen

108803I am a happily married mother to two young boys living in the Midwest.  Between work and home life, it seems all I do is spend my hours in the service of others.  At the end of the day, I feeling like a bowl of cold lumpy oatmeal.   I try to gather what’s left of my patience, but I often feel I’m scraping the bottom of the barrel.  After almost 10 years of this autopilot existence, I’m left wondering why life’s mundane details always seem to get in the way.   I often feel I’m expected to relax and enjoy the scenery on a train that is barreling forward at 100 miles an hour.  I’m afraid if I stop and blink I might miss it. It’s for this reason that I start this blog. It serves as a critical outlet where I can regain my sanity at the end of a long day.

Wanna learn more about me??? Click the links below…


imageI have a NERD-GIRL like obsession for subjects pertaining to mental health & blog about it often.


imageI do not hide my “true self” out of fear or shame.  As my husband says “Opinions are like assholes, everyone has one…”


imageI consider myself to be a “reformed fuck-up”.  I have this infuriating habit of needing to learn life’s lessons for myself…(like french kissing a light socket to see what happens) fortunately I’m a fast learner.


watercolorfamilyclearI am a MOM.  I hold a debt of gratitude to them, for the lessons they’ve taught me.  Living up to the requirements of this role is my biggest priority…


I am an INFP Personality Type: an Introverted Feeler who sees the world through the eyes of extroverted intuition. 


imageMisery is caused by a refusal to accept facts. Therefore, I willingly admit to being a freaky oddball.  


imageI’ve spent too long as a walking-shit magnet.  Like Dorothy’s slippers, I had the solution to my problems all along.  I just needed to believe in myself….


imageI’m the luckiest gal in all the world.  I’ve really come a long way.  I’m on the right side of the equation where clarity lies.  Who I am is a matter of my own determining…

I’ve grown well beyond my own self-imposed limitations, & for that I’m endlessly grateful…
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Subscribe here…


1456452This blog represents a place where I shed the pretenses of daily life.  I hope to claim ownership of my life story since this is essential for healing & growth.  For the  “internet voyeurs” out there, you’re in for a real treat as I engage in “radical honesty”.  I’m putting myself out there, without shame or apology.  I’d love it you’d join me.
921754I spend 99.9% of my personal & professional life in the service & care of others.  Interactions develop a one-sided feel due to the nature of the relationships I find myself in. Personal feelings & thoughts are a secondary matter.  In this blog I state things that remain “unsaid” elsewhere in life.  I ask questions that have remained “unasked”.  I set aside political correctness & really GO THERE…
img_2921Keep in mind, this candor doesn’t have devious intentions.  I’m not playing the victim & feeling sorry for myself.  I have no desire to engage in a political or social debate if it involves a “taking sides” mindset.  I just have a boundless intellectual curiosity.  I desire to understand this world in which we live…
I’d love it if you’d follow me as I take this journey through life… Click Here to Drop Me a Line if you wish!!
231062I’m honestly quite proud of what I’ve created here.  I see no reason why a person can’t engage in intellectual curiosity & mindless fun while looking good 🙂 … On a serious note, I really have put quite a bit of work into it.  Not only is it well-designed, the content is well-thought out and researched.  Enter your email below & be the first to receive personal freebies & updates…
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img_0513I Look forward to hearing from you!!

 

 

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Post Archive of My Favorite Subjects….

imageIts funny, I was never a good student growing up.   The bullying was tough, & focusing on my education was impossible.  As an adult, I find myself back in school pursuing a graduate degree.  I have to admit I’m a bit of a “geek”, I really enjoy education as an end goal in itself.  This page contains an alphabetical list of favorite subjects (As well as a miscellaneous array of fun stuff).

Assessments

What is the WHODAS???
The Hamilton Depression Rating Scale
An ACE’s Study Assignment
Treatment Plan
Biopsychosocial Assessment
Mental Status Exam
Suicide Assessment
Understanding & Handling Resistance


A Review of Basic Counseling SKills

Confrontation, reflecting, focusing & influencing
Questioning & Listening Responses 
Active Listening Skills
Basic Attending Skills
Empathy, what is it? 
Feeling the Incompetence
Validation: what is it exactly?


Blast from the Past

The Story of an Almost Suicide
The Happy Family Game
Raggedy Ann & The China Dolls
A Recovering Schlumpadinka
“Why couldn’t I be what they want?”
“I’m sort of like a social plague. Why do I have to be me?”
In my Own Defense
I Suffer From Pathological Naviete
The Girl Who Refused to Speak
In my an “other”
An Interview with my Mother
I am a parental child and scapegoat
OMG he’s leaving us!


Case Formulation

MCC 670 – Data Gathering Assignment
MCC 670 – Metamodal Questions
MCC 670 – BASIC SID
MCC 670 – Defining the Problem 
MCC 670 – Setting Outcome Goals
MCC 670 – Subjective vs Objective
MCC 670 – Treatment Plan
MCC 670 – Crisis & Trauma
MCC 670 – Clinical Hypothesis
MCC 670 – Attachment Interventions
MCC 670 – Body & Emotions
MCC 670 – Existential & Spiritual Models
MCC 670 – Social & Environmental Models
MCC 670 – Behavior & Learning Models
MCC 670 – Cognitive Models
MCC 670 – Psychodynamic Models


Counseling Ethics

Boundary Setting
Informed Consent…
Nature & Limits of Confidentiality


Dialectical Behavioral Therapy (DBT)

DBT Skills – Emotional Regulation
DBT Skills – Interpersonal Effectiveness
DBT Skills – Distress Tolerance
DBT Skills – Mindfulness
DBT Skills – Radical Acceptance
What is DBT?


Group Therapy Classes…

((During my very first internship, I was expected to run several therapy groups independently. No curriculum was provided, so I had to scramble to learn the subject.  What follows is a log of research-related information which chronicles this experience.)))

Codependency Class Research
Parents in Recovery Research 

Identity & Self-Perception

Identity Defined
Personal Identity – on being full of hot air
Ego vs Shadow
On Being Contrarian
The Nature of Belief Systems
The Go-It-Alone-Mentality
PART ONE: I am a “Seer of Unseeable Things”
PART TWO: Understanding “Unseen Things”


Life Lessons

The Art of Failure
psychology of the Trump supporter
Second Chances
Loving what is right or hating what is wrong?
Seeking answers: on my computer
Living in Oppositeland
Feeling the Gratitude….(& A Few Oprah Favorites)
A Genogram Assignment
An Emotional Hot Potato
A Quick Show-N-Tell
One Life. Live it!
Promises
Is there a cure for Intellectualizing???
A Final Creative Project
What Would They Say?


Misunderstanding & Forgiveness

Anatomy of a Misunderstanding
& Cancer Trumps PSTD
Transactional Analysis (A Move Beyond Understanding)
The Power of Forgiveness
What Forgiveness is & isn’t
Collateral Damage
“I message” vs. “you messages”
“And” Statements vs. “But” Statements 


Myers Briggs Typology (MBTI)

INFP: “A food log for the mind…”
Understanding Introverted Feeling
Understanding Extroverted Intuition


Motivational Inteviewing & The Stages of Change

Stages of Change
What is Motivational Interviewing?
Motivational Interviewing & Resistance
Motivational Interviewing & Ambivalence
“Git Er Done!!!” – Motivation & Change
Stages of Change: Treatment Needs & Strategies….
Stages of Change & Domestic Abuse Survivors
Dealing with Uncooperative Clients
Changes Talk


Nature of Love

Twisted Self-Deception
Codependency, what is it???
The Irony of Love
It’s Unspoken Rules


Sometimes I Feel Overwhelmed: here is me “pissing & moaning” about it

shit job
I hate my fucking job
Pulling my Head Out
OMG!!! I Really Need to Take a Frickin’ Chill-Pill…
Sofa-Surfing With My Husband…
When Will This Fuckin’ Hell End???


Parenting Experiences

and it only took one month!
My Shameful Parenting Story
Good-Enough Parenting
Happy Birthday Piglet!!!
My Mother’s Day
He Turns 16 Today!!!
Sofa-Time Snuggle
OMG He’s Leaving us!!!


Self-Help Junkie

Insights from Brene Brown
Understanding Shame


Stuckness & Resistance

“Getting Unstuck” & Why I Started this Blog
Defining Goals for This Blog
My Merry-Go-Round
An Underdog’s Credo: “Choking vs. Panic”
Arrested Development (Erikson Not the Show)
Dealing with Uncooperative Clients
Understanding & Handling Resistance
Coercion & Confrontation
Accepting Responsibility: shame, blame, guilt & Resentment


Studying The DSM-5

mdd-vs-dysthymia
Antisocial Personality Disorder
Dexter Morgan
Psychopathology & DSM Diagnosis
Dexter Morgan
schizophrenia
childhood onset schizophrenia
the accurate diagnosis of psychosis
Generalzied Anxiety Disorder
G.A.D. – “The Stress is Killing Me!!!”
An Overview of Childhood Anxiety Disorders…
An Overview of Autism
An Overview of ADHD
An Overview of Bipolar Disorder
An Overview of Depression
Conduct Disorder & ODD (An Overview)
Borderline Personality Disorder


Studying for the NCE – “Assessment Section”

Rosenthal on Assessment Section of NCE
Transforming Raw Scores
Validity
Reliability
Cognitive Assesssments
Norm/Criterion/Self Referenced Scoring
Basic Assessment Skills 
NCE Assessment Section – “The SASSI”
NCE Assessment Section – “The MMPI”
NCE Assessment Section – (Midterm Review Notes???)
NCE Assessment Section – (Cognitive Assessments)
NCE Assessment Section – (Reliability)
NCE Assessment Section – (Validity)
NCE Assessment Section – (Transforming Raw Scores)


Studying for the NCE – “Family Therapy Section”

Rosenthal on Family Section of NCE
Essential Family Skills
What is Family Therapy?
Solution-Focused Family Therapy
Murray Bowen Family Systems Theory
A Family Genogram
Contextual Family Therapy
Symbolic-Experimental Therapy
Satir Human Validation Process Model
Imber-Black Family Secrets
Strategic Family Therapy
Narrative Family Therapy
Emotionally Focused Therapy


Studying for the NCE – Research & Program Evaluation

NCE – Research & Program Evaluation


Studying for the NCE – Group Therapy

NCE – Group Therapy


Studying for The NCE – Social & Cultural Foundations

Multicultural Competency
A Cultural Self-Assessment
Culture & Rapport
Counseling Latino Clients 
Psychological Testing Bias
Counseling Older Adults
Asian-American Families
Understanding LGBT Clients 
Understanding Native Americans


Studying for the NCE – Counseling Theories

Choosing a Theoretical Orientation
Introduction To Behavioral Approaches
Classical Conditioning
Operant Condition-Inspired Models of Therapy
Karen Horney (Psychoanalysis)
Alfred Adler (Alderian Psychology)
Carl Jung (Analytic Psychology)
What is Psychodynamic Therapy???
Freud’s Ego Defense Mechanisms (Psychoanalysis)
Sigmund Freud (Psychoanalysis)
Rational Emotive Behavioral Therapy
Aaron Beck’s CBT
Bandura’s Social Learning Theory
Carl Rogers Nondirective Approach
Transactional Analysis
Reality Therapy 
Existential Psychotherapy
Gestalt Therapy
Narrative Therapy
Solution-Focused Therapy


Studying for the NCE – Human Growth & Development

Attachment Therory
Robert Kegan “The Evolving Self”
R. J. Havinghurst
Lev Vygotsky
Harry Stack Sullivan
Margaret Mahler
Freud’s Psychosexual Stages
Lawrence Kohlberg
William Perry
Jean Piaget


Studying for the NCE – Career Counseling

Rosenthal Overview of Career Counseling
Prescriptive vs. Proscriptive Decision Making
Self-Efficacy
Super’s Model
SSI Method
Parson’s Steps


The Nature of Emotions

The Nature of Emotions: Part #1
The Nature of Emotions: Part #2
The Intelligence of Emotions…
The Intelligence of Emotions, (Contd.)
Feelings about Feelings
Stolen Watermelons Taste Better


Miscellaneous

Dreams, Plans & Goals!!!
Fuck Facebook!!!


 Trauma & Healing Old Wounds

(HERE’S MY HUBBY’S STORY)“It was the most miserable day of my life” 

The earliest origins of my trauma started at home and continued at school.  There was no abatement for me, it was ongoing and continual.  I was completely alone
  1. (IT STARTED AT HOME) Happy Family Game
  2. (IT CONTINUED AT SCHOOL) The Girl With The Cooties
  3. (& THE BULLYING GOT REALLY BAD) Bullying as a Group Process
  4. (& THEN I EXPERIENCED OSTRACISM BY MY CUNTY COUSINS) Raggedy Ann & The China Dolls
And these experiences left me with a lousy self-esteem & years of built-up misunderstanding that took a while for my family to work through  They struggled to accept the traumas I was working through, & strangely enough I had to apologize for the reality of this fact.
  1. (HERE’S WHERE I HAVE TO APOLOGIZE FOR MY OWN HURT)Anatomy of a Misunderstanding 
  2. (THIS DESCRIBES MY FEELINGS OF SHAME & INVALIDATION) Shame, Invalidation & A Little Baggage
  3. (& HERE IS THE COLLATERAL DAMAGE) Collateral Damage
But leaving home didn’t solve matters.  I carried the aftereffects of these early experiences with me & They infected my life, like the bubonic plague.
  1. (THIS IS A CONSEQUENCE OF PROLONGED SOCIAL ISOLATION)“Why Couldn’t I Be What I Want?”
  2. (THIS IS WHERE I ATTRIBUTE MY LIFE – A BYPRODUCT OF A SERIES OF UNFORTUNATE CIRCUMSTANCES – TO MYSELF….SINCE EVERYTING IS COMPLETEY MY FAULT) “Why do I have to be me?”
  3. (THEN HERE IS WHERE THINGS GET REALLY BAD, I MEET “IT”) Stages of Change
  4. (THEN THIS IS WHERE I MEET AN ASSWIPE WITH ZERO EMPATHY WHO TAKES ADVANTAGE OF ME) A Recovering Schlumpadinka
  5. (AND THIS IS WHERE I FEEL COMPLETELY BROKEN & ALONE) The Story of an Almost Suicide
However, it does get better, but not without a few hiccups along the way.  Here are the latest posts describing my journey toward healing.
  1. (THEN MY PARENTS SUPPORT MY SISTER THRU CANCER & I REMEMBER THE TRAUMA OF BEING ALONE IN THE HOSPITAL AFTER A SUICDE ATTEMPT.  THEY WERE NEVER THERE FOR ME)  & Cancer Trumps PTSD
  2. (THIS IS WHERE I TAKE A CLASS ON THE DSM-5 AND REALIZE I HAVE DISSOCIATIVE PTSD) Dissociative PTSD
  3. (THIS IS WHERE I WRITE DOWN MY SURVIVAL PLAN FOR A WORLD THAT FEELS LIKE A HOT POTATO)A PTSD Survival Plan
  4. (THIS IS WHERE I RECOGNIZE TRAUMA AS A COLLECTIVE & SOCIOLOGICAL PHENOMENON) Collective Trauma
However, I hate to leave on such a down note.  Here are my reflections on this lifelong journey of healing.  
  1. (HERE I DESCRIBE THE OPTIONS FOR THOSE WHO WISH TO BEGIN HEALING) Holding onto Hurt or Letting it Go
  2. (HERE IS A BIT OF ADVICE I HEARD FROM A CLIENT) HOPE = “Hold on Pain Ends”
  3. (HERE I REFLECT ON HOW HEALING HAS ALLOWED ME TO GET “UNSTUCK”) “Getting Unstuck & Why I Started this Blog”

Finally, here are a few references pages, containing critical information I need to access often.

This link provides information on how to properly complete essential paperwork I will encounter as a therapist.
This post provides an overview of the Mental Status Exam.
This post provides an excellent summary of Substance Use Disorders as discussed in the DSM-5

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An Emotional “Hot Potato” (more thoughts on self-deception)

This is “part two” of a post on “twisted self-deception”. The Stanford Encyclopedia of Philosophy defines self-deception as: “the acquisition and maintenance of a belief (or, at least, the avowal of that belief) in the face of strong evidence to the contrary motivated by desires or emotions favoring the acquisition and retention of that belief, (Self-Deception, 2006).”  Twisted self-deception on the other hand can be defined as, “instances [in which]…people deceive themselves into believing things they do not want to be true” (Mele, 1999, p. 117).  Two questions have perplexed me greatly about this issue of twisted self-deception:

FIRSTLY, how can someone act as both the deceiver and the deceived? 

SECONDLY, Why does someone believe something they don’t want to be true?  

I feel I managed to address these questions to my own personal satisfaction in the first post.  However, my ultimate goal was in attempting to apply this insight to the issue of addiction.  How does twisted self-deception pertain to instances of recovery from addiction?  While completing a reading assignment for my future internship, I uncovered some useful information worth commenting on here.

Mistaken Beliefs About Recovery…

Gorski & Miller (2013) discuss “Mistaken Belief’s About Recovery” in Chapter 5 of their book “Staying Sober” and make the following comments:

“There are a great many mistaken beliefs that trap relapse-prone people into a state of hopelessness. Many people have these mistaken beliefs and act as if they are true…Mistaken beliefs about relapse create self-fulfilling prophecies. When mistaken beliefs become ‘true’ to you, you act as if those beliefs are true (Gorski & Miller, 2013, p. 103).”

This insight provides an explanation for how we can deceive ourselves.  By failing to get that beliefs act as self-fulfilling prophecies means, our handling of them is one-sided.  Rather than examining them critically, we utilize life experiences as evidence & support for our belief system, (when in fact they are byproducts of it).   What follows is an overview of common mistaken beliefs about recovery according to Gorski & Miller, (2013).

Role of Substance Use…

Gorski & Miller (2013), state that it is common for many in recovery to believe that recovery means abstinence and relapse simply means using.  Consequently, the primary goal is to not use as a matter of conscious and deliberate choice.  Gorski & Miller, (2013) note that addiction is a biopsychosocial process with many sobriety based-symptoms that linger after a person has quit using.  Managing and understanding these symptoms is essential if one is to succeed in recovery

Relapse Warning Signs….

Gorski & Miller (2013) caution that “a common mistaken belief is that relapse just suddenly and spontaneously occurs without warning signs” (p. 107)…Or, they might believe that warning signs only pertain to usage of alcohol or drugs.  Interestingly, Gorski & Miller (2013) caution the role of denial in blocking one’s awareness of critical relapse symptoms.  As I reflect on my own experiences with twisted self-deception discussed in the previous post, I can appreciate the power of denial in this instance.  I was so caught up in my own emotional survival during “the it years” that I couldn’t see how my life was spiraling out of control.

Relapse & Motivation…

Many people in recovery believe that “if I relapse, I am not motivated to recover…I have not hurt enough to stay sober (Gorski & Miller, 2013, p. 109-110).”  The fact is, those in recovery may understand that they need to quit and know this is the solution.  Much as I understood during “the it years” that the solution to my situation was leaving, the pain of unresolved traumas was overwhelming.  In a mirror-like sense, Gorski & Miller, (2013), note that “most relapse-prone [addicts] are in terrible pain…the pain is so severe it prevnets them from functioning when sober” (p. 110).  In other words, it isn’t about motivation, (or a lack thereof).  A failure to get this fact can produce feelings of great shame.

Beliefs about Treatment…

“Many people who are recovering from addictive disease work very hard to recover…yet they fail” (Gorski & Miller, 2013, p. 111).  Consequently, they believe that treatment is either ineffective or 100% effective. and that failure is a byproduct of being “constitutionally incapable of recovery” (Gorski & Milller, 2013, p. 111).  This final insight is also helpful for me in better understanding the nature of addiction.  Individuals struggling with recovery can struggling with feelings of helplessness & hopeless as I did when trying to leave “it”.

What is Your Emotional Hot Potato????

The above video comes from a book by Shel Silverstein titled “The Missing Piece”.  I think it effectively communicates a core issue underlying the notion of self-deception.  The purpose of self-deception is so we can live in our own preferred version of reality.  This version of reality supports our preferred system of beliefs.   It also edits out those things we do not wish to understand & hate to accept.  It is like an emotional “hot potato”.  We would prefer to willfully deny this fact through an array of cognitive mental gymnastics, than accept reality as it exists.

Sometimes the truth can truly hurt & facing it can appear an overwhelming & impossible task…

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References

Gorski, T. T., & Miller, M. (2013). Staying sober : a guide for relapse prevention. Spring Hill, Florida: Herald Publishing.
Mele, A. R. (1999). Twisted self-deception. Philosophical Psychology, 12(2), 117-137.
Self-Deception (2006, October, 17).  Retrieved from:  http://plato.stanford.edu/entries/self-deception/
Shapiro, D. (1996). On the Psychology of Self-Deception.  Social Research, 63(3). Retrieved from:  http://www.communicationcache.com/uploads/1/0/8/8/10887248/on_the_psychology_of_self-deception.pdf

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