Mood, disposition and disorder

In a previous post I referred to suicide as a “mood-specific” behavior, and I feel the need to clarify this statement. I wrote that nobody suicides when they’re in a happy mood, suggesting that if people in a depressed mood can “ride out” the mood without doing something lethal, the urge to end their lives will pass when their mood changes. Moods are transient emotional states that can be prolonged by irrational thinking and by ruminating.

Thoughts such as “My life is my problem; the only way to solve my problem is to end my life” can seem logical to a person in a depressed mood. When the mood passes, the person will likely recognize the thought as irrational – or at least as one that doesn’t have to be acted on immediately. Suicide hotlines have prevented many impulsive (mood specific) suicides by helping people to not act on suicidal impulses and to ride out the depressed mood – or to sober up. This principle doesn’t apply to suicidal people who experience chronic depression.

While moods aren’t enduring emotional states, dispositions are. We each have a unique disposition or set of dispositions. For instance, we’re each disposed to be somewhere on the continuum between optimism and pessimism – glass half full vs. glass half empty. I don’t know whether one’s disposition is a result of nature or nurture, or some combination of the two. Other adjectives I’ve heard used to describe disposition include gloomy, chipper, pushy, cranky, generous, stingy, passive and aggressive. They are a component of our personality. As a psychological construct, disposition has so many variables that it’s hard to precisely define or to measure, so these are just my opinions. Dispositions tend to be enduring traits, but that’s not to say that they can’t change over the course of one’s life. For instance, I think that people who’ve tended to be distrustful of others can learn to be more trusting, given enough positive experiences with trustworthy people.

When anxiety and depression are chronic emotional states that seriously affect our functioning, they’re diagnosable as psychiatric disorders. There’s considerable scientific evidence that there’s a biological basis for such disorders, although irrational thinking patterns can exacerbate them. The key to distinguishing  pathological states of anxiety and depression is impairment. Even during the saddest times in my life, my sleep and appetite weren’t seriously affected, and I was able to function adequately. I cried but didn’t have crying spells, and have never come close to attempting suicide. (I’m  not taking credit for this; I consider myself very fortunate.) During my year-long employment in an extremely stressful job, I suffered sleep loss; but my sleep improved immediately after I quit the job.

People who suffer from chronic anxiety and depression often get blamed for their symptoms, because they’re not understood as the symptoms of a chronic mental disorder. Because of the widespread stigma attached to mental illness, many people don’t feel the empathy they might feel for someone with a debilitating physical disorder. And people who suffer from these mental illnesses often blame themselves, telling themselves they “should be” able to control their symptoms. Others self-medicate with alcohol and other drugs that might give them short-term symptom relief, but only add drug dependency to their list of problems.

It’s hard enough to have a mental illness and to have to deal with societal stigma; but in addition, mentally ill persons are increasingly neglected in this country. The mental health system is shamefully under-funded, which explains why so many people with mental illnesses are homeless, why hospital Emergency Departments all over the country are swamped with people who are experiencing a psychiatric crisis, and why jails and prisons have become major providers of mental health services.

Everybody experiences anxiety and depression, and most of us learn how to cope with these transient conditions, because they’re not overwhelming or disabling. But some people with chronic anxiety and/or depression can’t cope without help from social support systems, whether in the form of professional services or community resources – family and otherwise – that recognize mental illnesses as treatable conditions, and provide needed help.

I’m taking a break for a couple of weeks, but will be back with a new post in early June. In the meantime, you can access other things I’ve written at my website: jeffkoob.com. It features links to my books, samples of my artwork, and a short story, “Demon Radio.”

It’s only Monday if you think it is

This post is one of my occasional philosophical departures from my usual subject matter. Although it isn’t specifically about rational thinking (which I’ve written about in previous posts), it is about mental habits and how they can shape our experience. I even intend to examine what “is” is.

Things that we know and experience through our senses are phenomena: rain, wind, temperature, the day/night cycle, seasons, etc. Mental concepts – noumena – such as justice, authority, honor, nationality and race don’t exist in the same way rain exists. For one thing, they’re not Absolutes; they mean different things to different people. And yet we often act as if certain noumena were as real as rain. Race used to be thought of as a biologically-based reality. Now we know that it’s a social construct based on culture and tradition. All homo sapiens belong to the human race, despite variations in outward appearances.

Days, months and years are all phenomenal, based on planetary rotation, the lunar cycle, and the earth’s orbit around the sun, respectively. The convention of the week, however is noumenal – it isn’t based on any natural phenomenon. The seven-day week has long been the standard way of sub-dividing months throughout the industrialized world, and most of us organize how we spend our time using this noumenal convention.  “Monday” (for instance) is a social construct.  But it’s only Monday if you think it is.

Try this thought experiment: Imagine waking up on the beach, alone, on a desert island. You’ve been delirious with a fever and don’t know how long you were “out of it,” so you’ve lost track of what day it “is.” You have no sensory way of determining it, and it doesn’t even matter in any practical way whether it “is” Monday or Tuesday, because you’re not on anybody’s schedule. Will you arbitrarily choose a day of the week as your baseline and keep track of what day it “is”? Or will you adopt a different mode of thinking and just live each day on the island, without having to give it a name?

Even though it’s just a mental construct that most of us buy into, the day of the week may control our actions and thoughts, and even our moods. You might hear someone who works Monday through Friday complain about having the blues “because it’s Monday.” He’ll predictably perk up five days later because it “is” Friday, the start of the weekend (another noumenal concept). Which brings us to the question of what “is” is.

“Is” can be used to cite a phenomenal reality (it is raining), a noumenal belief (it is Monday), or to state a quality or property of a thing (the apple is red) – the Aristotelean “is of equivalency.” In the first instance, regardless of what I may believe, I’ll get wet if I step outside when it’s raining. As regards the second instance, wars have been fought over where, exactly, the border between two countries “is.” In the third instance, if one person in a room says “It is hot in here” and another person in the room says “No, it’s not,” one of them has to be wrong. What “is” is the basis of many a dispute, whether interpersonal or international. Such disputes can be avoided by dropping the pretense of objective truth implied by an “is of equivalency,” and “subjectivising” the statements: “I’m hot.”/ “I’m not.” No conflict about what “is.” Whether or not Sally “is” pretty can be viewed as a matter of subjective opinion, not of objective fact. Beauty is, after all, in the eye of the beholder.

E-prime – English that omits all forms of “is” – is a tool for learning about the linguistic traps that can be set by its use. Nobody has ever suggested that E-prime should replace English. (It’s often more precise than English, but doesn’t lend itself to poetic word formulations.) But try writing without using is/am/are/were etc. and it will help you to appreciate how much you tend to unconsciously objectivise things you believe to be true or important.

Here are some translations of English sentences into E-prime: English – She is pretty. E-prime – I find her attractive/pretty. English – This is really difficult.  E-prime – I really have a hard time doing this. English – Look, it’s a UFO! E-prime – I can’t identify that flying object. English – Time is money. E-prime – Earning money correlates to a high degree with the way you spend your time. English – This is Monday. E-prime – Because of the social convention of the seven-day week, most people think of today as Monday. English – He is a liar. E-prime – He lies a lot. English – God is love. E-prime – I believe in God as the embodiment of love.

There’s some overlap in the ideas I’ve written about here and my previous posts on rational thinking and cognitive behavior therapy. Linguistic conventions can make us prisoners of language. Wittgenstein wrote, “The limits of my language are the limits of my universe.”

Some irrational self-talk involves the “is of equivalency.” The thought “I am a Loser” presupposes that people are either Winners or Losers and might mean any of several things to different people. It might mean “I think that I lose more often than I should” or it might mean “I’m destined to fail, no matter what I do.” In either case it’s an irrational simplification that can’t help anyone to achieve their goals. “Being a Loser” is a self-limiting noumenal notion.

It’s only Monday (or Tuesday, etc.) if you think it is. Monday isn’t real in the same way that rain is real.

 

Anger Management II

My father was an Army officer and a strict disciplinarian, but he was a gentle man by nature and never spanked me when he was angry – except once.  When I committed a spanking offense such as lying, he might get angry, but would order me to go to my room and wait. By the time he came to administer the punishment,  he’d have calmed down, and would hug me soon afterward, to let me know all was forgiven and that he loved me. He did the same with my brother and sister. Spankings were few and far between in the Koob household, and none of us children were ever called “bad” or “stupid.” None of us were ever slapped or beaten.

I’m extremely grateful to have grown up in a loving family, with minimal use of corporal punishment. But I’m also grateful that my father slipped that one time and spanked me, not because of something I’d done, but because he was angry. I still remember the feelings of helplessness and rage that accompanied the physical pain. I’m grateful because my father’s slip gave me a taste of what it’s like to be physically abused, and it heightened my empathy for victims of abuse. In my career as a therapist I would work with many men, women and children who grew up in families where physical and emotional abuse was commonplace. One of the most common “invisible scars” of abuse is  residual anger.  Sometimes a reservoir of accumulated rage erupts as angry or destructive acting-out; sometimes the rage is repressed, and manifests as depression.

People who have temper problems usually came by them honestly. If some – or many – of the adult role models in a child’s social environment are physically and/or verbally violent, violence can become normalized. Violence is a sad legacy in some families, passed on from generation to generation. But it only takes one generation to break the chain of family violence, and I’ve been privileged to work with parents who were determined not to do to their children what was done to them by their own parents.

I’ve taught anger management to many parents who were ordered into counseling by family courts, as well as people who entered counseling voluntarily because they had anger issues to deal with. I’ve also taught anger management to groups of cops, parents, teachers, and Marine Corps drill sergeants. I started my group presentations by talking about the origins of anger control problems, the importance of parents role-modeling the non-violent resolution of conflicts, and my guidelines for spanking.

It is sometimes possible to raise a child well, without using physical pain as a teaching tool. But if a parent finds it necessary to use corporal punishment, it should be the punishment-of-the-last-resort. If you have to spank a child frequently, it’s not working; find out what does. Finally, never inflict pain on your child when you’re angry. All you will teach him or her is to role-model that it’s okay to hit when you’re angry. After a calmly-administered spanking, make sure the child understands why you felt the need to spank in this instance, and express your love, verbally or with a hug. If you slip, like my father did, you owe the child an apology.

Learning anger management doesn’t mean you won’t get angry anymore. Everybody gets angry sometimes- except maybe the Dalai Lama. My definition of practicing anger management is that you can still make good decisions, no matter how angry you are. You don’t do or say things you’ll regret later. As with stress management, the first step in learning to manage your anger is a self-assessment. Knowing the “why” of your anger problem isn’t as important as knowing the “whats.”

How does your anger typically manifest? Aggression, passive-aggression? Physical harm to self or others? Verbal aggression? How does your anger management problem affect your life? What are the predictable triggers  for your anger reactions? What are your cues? (Physical signs that you’re angry, such as a rapid heartbeat or a flushed face.) Once you’ve completed your assessment, you’re ready to try out whatever physical and mental anger management techniques you think might help you to change your behavior.

Physical anger management. If one of your cues for anger is rapid breathing, you can learn breath control. If muscle tension is a cue, you can learn to relax the muscles you typically tense when you’re angry. The key is becoming mindful of your triggers and cues. You can learn to physicalize your anger in a non-threatening and non-destructive manner, jogging, or doing pushups, or working out on a punching bag. If you can walk away from the situation that triggered you, you might be able to regain your cool quickly. Other factors in physical anger management are  adequate sleep and good nutrition.

Mental anger management. I’ve already written several posts about rational thinking, and think it’s the key to mental anger management. If I give situations and other people the power to “make me mad,” I’ve placed the locus of control outside of myself; I blame externals for my anger and for my behavior when I’m angry. If my locus of control is internal, I understand that I generate and sustain my own anger in response to things that happen (or don’t happen) in my life, and can control my behavior no matter how angry I am. If I know that someone is trying to trigger me, I can deny him the satisfaction. People who don’t rise to the bait can’t be hooked.

I’ve had the advantage of going through a “plebe system” at The Citadel – a military academy – which is like nine months of boot camp in the armed forces. I’ve had the experience, multiple times, of having an upperclassman scream in my face, or make me do pushups until I collapsed in a pool of sweat. Although I wanted to punch some of my antagonists, or curse them and walk away, I had to remind myself that this wasn’t personal. If I wanted to graduate from The Citadel, it was something I had to endure for my freshman year. I now see that, like boot camp, it was a stress inoculation,  and a preparation for combat.

Anger is a universal experience, and isn’t necessarily a bad thing. It’s fully justified in some situations, and may even help us to survive, as with a soldier in combat. Practicing anger management means knowing that you’re in control, even when angry.

Stress Management

We’ve all heard that prolonged stress negatively impacts our health, but stress isn’t necessarily a bad thing. Dr. Hans Selye, one of the pioneers of stress management, said that stress can be “the spice of life or the kiss of death.” He labeled negative stress distress and positive stress eustress. If we choose to ride a rollercoaster, or to scale a cliff, or watch a horror movie, we’re choosing to experience stress. Stress is an unavoidable fact of life, and a stress-free life would be an uneventful life – boring. Sexual excitement is a form of stress, and we all enjoy an adrenaline rush from time to time, especially if we chose the stimulus that triggered it.

Our autonomic nervous system, which regulates automatic behaviors, has two branches: sympathetic and parasympathetic. Both are involved what Dr. Selye called the “fight or flight” response. Activation of the sympathetic response gears us up, preparing us to fight or flee, whether or not we’re in danger. Heartbeat and breathing instantly become more rapid,  delivering more oxygenated blood to the brain and the extremities. Blood pressure and blood sugar rise, muscles tense in anticipation of action, and you may experience a jolt of adrenaline. After the event or situation that triggered the sympathetic response is past, the parasympathetic branch kicks in, reversing the fight or flight response and allowing us to “rest and digest.” We’re told not to go swimming right after eating a meal, because our blood flow has been re-directed from our extremities to our gut, increasing the possibility of a muscle cramp.

The fight or flight response evolved to help our ancestors to avoid being eaten and to hunt dangerous prey. If you’re a soldier in a combat zone, or a cop, or a firefighter, you may experience it on a regular basis. But although only a few of us in modern society frequently face physical peril – other than heavy traffic – we respond to perceived existential threats, even if we’re not actually in immediate danger. Combinations of financial, social and environmental stressors (How am I going to pay the rent? Is my wife being unfaithful?) can result in a high level of distress, sometimes manifesting as anxiety.

Anxiety is similar to fear, although the causes might be multiple and may not be immediate physical threats. A person having an anxiety  attack may experience their fight or flight response as paralyzing. Once you’ve had one, your fear of having another one becomes yet another stressor in your life. If you only occasionally have fight or flight reactions, stress may not be a significant factor in your health. But if you have them frequently, your health may be affected. But frequent fight or flight reactions aren’t the only stress-related threat. Chronic overstress – having more on your plate than you can handle – can kill.

Stress management doesn’t mean eliminating stress. It means controlling the amount of stress in your everyday life and, where possible, eliminating stressors. There are both physical and mental aspects to stress management. But first you need to identify the sources of stress in your life, your triggers for stress reactions, and how stress affects you.

If you need to practice stress management, start with an inventory of your stress factors: job security and satisfaction, finances, safety, residential issues, and personal relationships. Think of how you might be able to reduce unwanted stress in each area. It may mean some tough choices. Then list the kinds of situations and events that tend to trigger stress reactions. Being aware of your stress triggers may help you to prepare for them or learn ways to avoid them. Become more aware of how you typically respond to stress triggers and overstress. Do you somaticize (physicalize) it into headaches or bellyaches or backaches? Do you stay angry or depressed? Do you worry excessively? Anxiety has many faces , including free-floating (generalized) anxiety, panic attacks, and phobias – including social phobias. After doing this analysis of the role of stress in your life, you’re ready to look at physical and mental stress management techniques.

Physical stress management techniques include breath control, learning to relax your muscles, meditation, self-hypnosis, yoga, exercise, good nutrition, and adequate sleep. Avoid self-medicating with alcohol or other drugs. If you’ve listed rapid breathing as a stress symptom, you can learn to slow your breathing when you’re under stress. This helps to bring the fight or flight response under your control. There are many techniques for relaxing tense muscles, and relaxing the body tends to simultaneously relax the mind. I used to teach clients a method of focusing on the sensations in each of the muscle groups of the body in turn, tensing and relaxing each muscle group until they became aware that they could relax them at will by focusing on the changing sensations. It’s a form of mindfulness.

Learning time management or anger management might be part of your stress management plan. The best single mental stress management I’m aware of – besides meditation, which calms both body and mind – is rational thinking. (I’ve previously published several posts on rational thinking as a learnable skill.) Any stressful situation can be made more stressful by the way we think about it, and the effects of stressors in our lives can be minimized by thinking about them rationally. Failing to achieve something you wanted to achieve doesn’t make you “a Failure.”  Telling yourself that you’ll never get over a loss can be a stress-inducing self-fulfilling prophesy. Thinking that they “can’t stand” something has never helped anyone to cope with distress.

Some stressors can be minimized or overcome, others can be tolerated until circumstances change, by developing coping skills. We can all learn to manage our stress to some degree, if we understand it for what it is and make a conscious effort to control its effect on our lives. Coming up with your own personalized stress management plan and implementing it can help you to become more resilient in times of adversity, and might add years to your life.

 

Attributions and the blame game

Part of the human condition is that we tell ourselves stories that help us to make sense of our lives. Making sense of things is a subjective process, but in our stories, we objectify. We often make ourselves the Good Guy, and others the Bad Guy(s) in our personal mythologies. I ran into Good Guy versus Bad Guy interpersonal conflicts innumerable times in my career as a psychotherapist. Of course there are bad situations that are entirely attributable to other people or to some external factor, but it’s often easier to blame some person or some external thing than  to examine your own co-responsibility for finding yourself in an undesirable situation. Instead of working on ourselves, we can attribute our problems to external factors.

I’ve written  previously about avoiding the “monofactorial hypothesis” that A caused B. (“He became an alcoholic because he stopped going to church.”) The monofactorial hypotheses is simplistic, whereas human behaviors and relationship dynamics can be very complex and multifactorial. I’ve also written about the way people give away their own power when they blame other people for their emotional state or their behavior. (“I wouldn’t have hit him if he hadn’t dissed me!” or “She ruined my life when she ________.”) In another post I wrote about Dr. Erik Berne’s book The Games People Play, in which he identifies interpersonal “games” such as Wooden Leg. This game involves statements like “But for my ‘wooden leg’ (i.e. family history, shyness, unpopularity, bad luck, etc.) I would/would have _________.” There may be an element of truth in a stated belief such as this, but there are likely other factors at play.

Many people come to therapy because they feel out of control in some area of their lives. Frequently they have pat explanations of how people and circumstances are making their lives difficult or intolerable, without factoring their own contributions to the problem into the equation. But before I go on I want to be very clear that I’m not blaming anxious or depressed people for their symptoms, especially people suffering from clinical anxiety and depression. However, even people with these chronic conditions can worsen their symptoms by the way they think. Some people attribute their anxiety and depression entirely to external factors, but to some degree they’re unconsciously “doing” anxiety and/or depression.

Many people with anxiety disorders and phobias come up with unique behaviors or rituals that subjectively help them to cope with their symptoms. These behaviors can affect relationships in minor or major ways. The only explanation for the symptom-relief is the person’s belief in their efficacy. I worked with one highly anxious woman who’d “discovered” that crunching on shaved ice cubes temporarily relieved her anxiety. That meant that her lifestyle was restricted to situations where she had constant access to ice, every waking hour. Most people in her life found her persistent ice crunching very annoying. In therapy I got her to see how she was, to some degree, “doing anxiety,” by convincing herself that she had to constantly crunch ice, and worked with her to find better ways to cope with her anxiety. Eventually we got past her exclusive focus on symptoms, and examined the root causes of her anxiety.

Some depressed people “do depression,” or exacerbate their clinical depression, by the way they think. The deep sadness we feel when we experience a significant loss is a natural response. But we can block the natural healing/recovery response to a tragic loss by our thinking, i.e. “I’ll never get over this.” or “I deserve this suffering because I ______.” It’s only human to attribute blame or responsibility onto externals, and sometimes there are  external factors – things we can’t control – that are understandably heartbreaking or discouraging or infuriating. But attributing blame and responsibility can be an excuse, or a distraction from choosing to change yourself in positive ways.

We are, by our very nature, subjective in the way we convert our perceptions – our experience – into cognitions. Some people are more objective than others, because they strive to be fair and objective, and to pay attention to the role of their own thought processes in their experiences. Having witnessed and dealt with countless interpersonal conflicts as a psychotherapist, I’m quite aware of the tendency of people to think of things in in Good Guy/Bad Guy terms. I try to practice what I preach when I’m having a relationship conflict. I ask myself, “How much of this is him/her/them, and how much is me?” This has helped me to resolve conflicts, so it’s become a reflex.

Often there’s a third important factor in the equation – the situation or context. Sometimes that situation or context is a major determinant in what’s going on, and has to be taken into account and given due weight as a relevant factor. In such situations the analysis can be two-sided (“How much is me and how much is IT?), or when others are involved, three-sided (“How much is me, how much is him/her/them, and how much is IT?”) Both as a therapist and in personal relationships, I’ve found this way of thinking to be helpful in coming to terms with problems in my life, without creating new ones by the way I think.

If I blame external factors as the only things holding me back, I have to wait for them to change before I take action. If I take my share of the responsibility for being in an undesirable situation, I can start working to change it immediately. In situations that are entirely attributable to externals, all we can do is work on our attitudes and coping skills.

 

 

 

The Gloria sessions

I’ve written posts about my education as a psychotherapist in the humanistic psychology program at the University of West Georgia, and my exposure to a variety of therapeutic modalities. These included Rogerian (client-centered), gestalt, and cognitive behavioral therapy. I remember watching a videotaped film titled “Three Approaches to Psychotherapy” that I’ve always thought of as “the Gloria sessions.” For many years this film was only available for viewing by professional therapists, faculty, and students of psychotherapy; but now all three sessions can be viewed on YouTube.

In 1965 a courageous young woman named Gloria – a divorced single mother – agreed to be videotaped in brief therapy sessions with three of the most influential American psychotherapists of the twentieth century: Dr. Carl Rogers (client-centered therapy), Dr. Fritz Perls (gestalt therapy), and Dr. Albert Ellis (cognitive behavioral therapy). Watching the sessions again, I was reminded of Gloria’s courage and candor. The production quality isn’t always good and following the Perls  session takes concentration, due both to poor sound quality and Perls’ thick German accent. But if you want to see three masters of psychotherapy at work, this film is a treasure trove. Their approaches to working with Gloria are very different.

In each segment, the therapist briefly describes his approach to therapy, then works with Gloria, then comments on the session. In the first segment Carl Rogers says that if the therapist can establish certain conditions in relating to the client, “therapeutic movement” will predictably occur. The first condition is genuineness, and the second is congruence – meaning that your non-verbal communication is congruent with your verbalizations. The third condition is transparency , meaning that the therapist hides nothing and can be easily “seen through.” Rogers states that if these three conditions exist, and the therapist can be in tune with the client’s “inner world” (how she experiences herself in the world) insights and growth will follow.

During the session Gloria keeps trying to get Dr. Rogers to give her advice about making a decision, and dealing with guilt feelings related to the decision. He never accedes to her request, but keeps accurately reflecting on what she’s saying, allowing her to eventually take ownership of the issue, and to trust her own judgment. (Contrary to popular belief, good therapists seldom or never give advice.) Rogers is comfortable with silences, and at one point asks, “What do you wish I’d say to you?” She gets it. In his commentary, he remarks on how her “then-and-there” orientation at the start of the session quickly becomes a “here-and-now” focus. He highlights the “I-Thou” quality of their experience, rejecting Freud’s intellectual concept of transference/counter-transference in favor of Martin Buber’s term for authentic relating. He concludes, “Gloria and I really encountered each other” and says he thinks that both of them benefitted from their brief encounter. Watching again, I can’t help but agree.

Perls puffs on a cigarette while he describes gestalt therapy, and Gloria lights up at the beginning of the session, admitting that it’s a response to anxiety. In his introduction Perls, like Rogers, endorses the I-Thou relating essential to the therapeutic relationship, and the idea that therapy should not dwell on the then-and-there, but should always focus on the here-and-now of direct experience. He states that a gestalt therapist never offers interpretations, but provides clients with experiential opportunities to discover things about themselves, often by interrupting the client’s verbalizations and calling attention to automatic behaviors that the client is usually unaware of. Early in the session Perls labels some of Gloria’s behaviors as “phony” – which has a specific meaning in gestalt therapy. She’s initially bewildered and angry, feeling judged. She’s very defensive, but Perls doesn’t back off, and Gloria appears to catch on to what he’s saying by the end of the session. He was never judging her; he was giving her an experiential lesson in her automatic, typical defenses. It’s known in gestalt therapy as “being on the hot seat.” It was Perls who wrote what became known as the Gestalt Prayer, which starts with: “I am not in this world to live up to your expectations and you are not in this world to live up to mine.”

In his introduction, Albert Ellis expounds upon the notion that – contrary to Freudian psychodynamic theory – the past isn’t the primary determinant of present-day distress or dysfunction. The past may have a role in its formation, but it’s present behaviors that maintain the problem – specifically, the irrational things we tell ourselves about our experiences and their consequences. As I’d remembered, Ellis came across like the  stereotypical pushy, fast-talking New Yorker, but his words were precise and logical. In his short session with Gloria he manages to convey the principles of rational thinking, by applying them to Gloria’s anxieties about dating and seeking a life partner. She appears to grasp the notion that she makes undesirable situations worse by catastrophizing. “Don’t beat yourself over the head or convince yourself you’re a no-goodnik, just because you didn’t get the outcome you wanted.” He explained how he gives his clients behavioral homework assignments to complete between sessions, and suggests that Gloria should set up opportunities to take some small risks, instead of holding back in social situations. Its a behavioral technique called exposure, and Ellis was one of its early proponents.

When I first saw “Three Approaches to Psychotherapy,” I remember that there was a brief interview with Gloria after the sessions; but I wasn’t able to find it online. As I recall, Gloria said that she liked Carl Rogers the best, and learned some valuable things from Albert Ellis; but her session with Fritz Perls was the one she most benefitted from. If you don’t understand the basics of gestalt therapy, what Perls says and does in the session won’t make much sense. It shook Gloria up; but that’s what good gestalt therapists do, and Perls was one of the best. I highly recommend the Gloria sessions to social science students, psychotherapists in training or practice, and people who want to know more about psychotherapy.

Little did I know when I first watched the film that I’d actually meet Rogers and Ellis. I’ve already written about my brief meeting with Carl Rogers. In a later post I’ll describe my encounter with Albert Ellis.

On not giving away your power

Quite a number of times during my years in community mental health I had public school students (mostly boys) referred to me for counseling by their schools, due to fighting. These students definitely did not want to attend mandatory counseling sessions, so I used that as a lever, saying “Let’s see if you can learn to control your temper in two or three sessions. It’s up to you how long you have to come in for counseling.” I fully understood that when a teenager is being taunted in front of his peers, it feels more powerful in the moment to start swinging than to stand there feeling humiliated. So I framed their problem as one of giving away their personal power when they let themselves be goaded into losing their temper and fighting. Before I got into teaching anger management skills, I had to convince these students that I could help them. I often used set-up “punchlines” and strategic metaphors in therapy.

My first therapeutic hook was to show them a hand-lettered cardboard sign on a loop of string, which I’d hang around my neck. The sign read “If you want to make me mad, call me a _______.” I had a number of smaller signs that  I’d hold over the blank: “retard” “punk” “homo” “Mama’s boy”. With a straight face I’d offer to give the signs to the student, to wear at school. Of course he’d decline my offer, confused as to why I’d think he’d want to wear it in the first place. Then I’d give him my punchline: “You may as well wear it. Your behavior already tells people the same thing the sign says. The guys who give you a hard time just have to find out which of these things to call you, to make you lose control. It only makes you feel strong when you fight, but you’re actually giving away your power. When a bully goads you into throwing the first punch, he’s gotten what he wants. He knows that you’re the one who’s going to be suspended.”

My second hook was a metaphor that actually involves fishing. I’d ask the student if he’d ever gone fishing, and most had. I’d ask if they’d ever tried fishing without bait. Of course they’d say they always used bait. Then I’d say, “Because you know that a fish wouldn’t bite a bare hook, and the bait hides the hook. And that’s what happens when your enemies at school make you lose your cool. Their words are the bait that hides the hook. Once you bite, they’ve got you.” I’d pantomime reeling-in a fish, then suggest that keeping control of your behavior when you’re angry is a strength. (I realize that there are times when a cool-headed decision to fight is an appropriate response to bullying, but I won’t get into that circumstance here.)

There are other ways that people frequently give away their power to other people or to circumstances beyond their control. An event such as a traffic jam doesn’t have the power to make you mad, unless you invest it with that power. It’s one thing to say that you became angry when you got stuck in traffic, and quite another to say – as many people do – that being stuck in the traffic jam “made you” angry. The traffic might have triggered your anger, but it didn’t cause it.

Sometimes people blame their feelings or actions on others: “I wouldn’t have hit him if he hadn’t dissed me!” People who attribute their anger to other peoples’ behavior (i.e. “You make me angry when you contradict me!”) are making an indirect demand: “Don’t contradict me, or you’ll have to deal with my anger.” As with blaming circumstances for one’s anger, there’s a big difference between “I get angry when you _________” and “You make me angry when you _________.” The difference is in locus of control. Does control exist within me, or outside of me? Owning your anger is a strength.

If I blame external triggers for my anger, I’m giving them power over me. If I own my anger, I’m more likely to control its duration and its influence on my behavior. I’m not stating this as an absolute. If someone were to sucker-punch me, I’d certainly attribute my anger to his behavior. I’m just making the point that if I own my anger, I’m less likely to reflexively hit him back. (Which may or may not be the best response.) Thinking that I generate my own anger in response to external triggers is more rational than thinking that others can pull my strings, and that external triggers cause my anger.  Staying in control of your behavior and making good decisions while experiencing a strong emotion is a strength.

Another common habit of people who can’t differentiate between their rational and irrational thoughts is catastrophizing or awfulizing. When something inconvenient, unpleasant, disappointing or hurtful happens, there’s nothing to be gained by mentally labeling it as “terrible” or “awful,” or saying that you “can’t stand it.” Of course real tragedies and major losses can truly be terrible and overwhelming , but exaggerating the negative impact of an unwanted, unpleasant experience just makes it all the more unpleasant. Each of us has the ability to assign meaning and give weight to events, and catastrophizing is another way that people diminish their own power. Sometimes we spend ten dollars of adrenaline on a ten-cent problem, because of the way we think about it.