8/18/20 Addictions (in a pandemic)

“To thine own self be true.” — William Shakespeare

We are all pleasure seekers. There are pleasure centers located in the human brain which, when activated, are associated with feelings of euphoria. This happens to us every day. During the day we go through naturally occurring periods when we feel comfortable, secure, happy, and fulfilled-and this is followed by periods when more negative feelings are aroused (anxiety, insecurity, discomfort). We humans are highly reinforced by positive feelings of pleasure. We want to experience euphoria again and again. Fortunately, that’s not all there is to life.

Addictive behavior can be seen as an attempt to control our daily cycles by maximizing pleasurable feelings and decreasing the frequency of negative feelings. At first we may even succeed for a while in doing this, but our basic nature has a way of catching up with us. We probably need our down phases of the daily cycle as much as we need the more positive ones-if for no other reason than that the negative parts of the cycle help us appreciate the positive ones even more. Our negative experiences strengthen us and help us to become survivors. They assist us in learning wisdom and integrity. There are few things in nature which are not cyclical. Attempts to find constant pleasure through addictive behavior are usually futile. The negative phase always revisits us and brings balance back into our lives. There is no escaping our basic nature. And there is no escaping the escalation and debilitating results of the quest for constant pleasure. In future articles I will continue on this vein, adding a deeper dimension to the parts of us we feel we need to medicate, verses work with.

Making Life Changes, Pt. 2

Research has identified six major stages in the change process, as described in Changing for Good by Prochaska, Norcross, and DiClemente. A key to successful psychotherapy is knowing the stage you are in for the problem you are working on. While these are identified as “stages,” it is important to remember that it is common for a person to move back and forth between stages in terms of their needs at various times. It is not a failure when you need to go back to a previous stage, in fact, you may have to go backward before you can go forward again. Lets examine the 6 stages:


1.)  Precontemplation Stage- while others around you may be able to see there is a problem, precontemplators fail to see the problem and see no need to make changes.

2.)  Contemplation Stage- the contemplator is tired of feeling trapped by self-defeating behavior. People at this stage feel that they can start making changes within perhaps the next six months or so. They admit that there is a problem in their way of living and starting thinking about ways to come to terms with it.

3.)  Preparation Stage- those in the preparation stage are planning to take action within the next month. They have made the commitment to change their problematic behavior in the near future. However, they may still have some ambivalence about starting the change process.

4.)  Action Stage- the action stage is the one that is the most visible to other people. This is the stage where most of he change activity takes place, and it is the stage where the greatest degree of commitment is needed. This stage takes real work- but if the previous stages have been addressed adequately, then this stage has a higher probability of success.

5.)  Maintenance Stage- maintaining the changed behavior requires a long-term effort and a revised lifestyle. Making the change in the action stage is not enough- it means staying with the changes from now on. There may be a temptation to go back to the old behavior.

6.)  Termination Stage- the termination stage is the stage of victory over the old self-defeating patterns. The lifestyle change has taken hold and the old behavior will never return. The temptations have disappeared. The person can now go on living without fear that a relapse will occur.

Making Life Changes, Part 1


Why do people seek help from a psychotherapist? Psychotherapy helps people in many ways. For some, it is a way to understand themselves better. For others, it helps to find meaning in their lives. Some have a definite problem they want to address (like, “Is my job right for me?”), while others have a specific conflict that appears repeatedly in their lives- for example, “Why do I always end up in fights with the people I’m closest to?” Some may want an objective listener who will always look out for their best interest. A large number of people, however, seek therapy in order to come to terms with self-defeating behavior that they know they must change because it is jeopardizing their health, their future plans, or their relationships with friends and families. They want to make life changes.


The list of self-defeating behaviors is endless. People want to quit smoking or abusing alcohol and other drugs. They want to control their weight, exercise more, be more optimistic, quit procrastinating, stop trying to control other people or letting others control them. They want to stop spending so much money or so much time online- so they seek help from a psychotherapist.


Fortunately, therapy can help people address these problems, but only if the person is ready to make the lifestyle changes required to bring the self-defeating behavior under control. Making life changes is easy for some people. For others, the changes seem enormous and the person goes into relapse repeatedly. Think of the number of smokers you know and the number of times they have tried to quit. Think of the number of friends you know who have tried repeatedly to diet, only to gain all the weight (and more) back within a year.


Change can happen when the person is ready to change. A psychotherapist can help people identify their readiness to change and move toward the stage of taking action to make the changes occur. A major emphasis in therapy is examining why change may be difficult and understanding how to get past the roadblocks that stand in the way of change.

To Be Continued…


Relationship Conflicts “Where Did the Love Go?”


Relationships are seldom as simple as we would like. They bring out our needs, anxieties, and conflicts with people from out past- parents, friends, and former partners.


When we enter into a relationship we expect to be loved just for being who we are. A relationship should provide a safe zone where our partner values us for expressing our own uniqueness. This is a simple expectation. Indeed, this is the way most relationships start out. Why does it seem so hard to maintain this ideal, blissful state of unconditional love over time?


Our relationships with our partners are colored by our own personal legacies. We often react to our partners as if they were someone else, and this will likely cause conflict in the relationship.


How we perceive our partners is influenced by how we learned to deal with other people in the past. This process can go back into early childhood, even to infancy. Indeed, our earliest primary attachment to a caretaker- a mother, a father, perhaps another adult- can have an effect on how we deal with other people for the rest of our lives. For example, if our earliest experiences taught us to trust in the world, then we are likely to take a trusting attitude toward people throughout our lives. Conversely, if a child is never shown love during the earliest stages of life, it may be a challenge during adulthood to learn how to experience and express love. Early experiences from childhood can have a powerful effect later on. (This is a strong argument for treating children well.)


Children experience both good and bad in the world. Plenty of good experiences, like love and trust, feel comfortable and produce a positive self-image in children- a positive way of defining themselves. Bad experiences create feelings of conflict and frustration. These negative experiences also go into the self-definition that the child eventually develops. But they don’t feel compatible with the more positive feelings, so, according to one theory, the child projects them onto somebody else. Projection means finding in someone else the qualities that you don’t want to accept within yourself- like blaming your partner for being controlling when you are the one who has the tendency to want control.


It is not only early childhood experiences that cause us to project our unacceptable feelings onto someone else. Friends can have the same effect, as can partners from out previous relationships. This is a process that happens throughout our lives. How many times have we heard someone say, “Treat me for who I am- I am not your former partner”?…
To Be Continued

The Elements of a Friendship



The following variables have been found to be associated with the establishment of a friendship.


Physical Proximity A person who lives near us, or with whom we have regular contact, may become a friend. In apartment buildings, people who live on the same floor are likelier to become friends than people who live on different floors, and the people who live near the mailbox or the stairs have the most friends of all. Our friends tend to be coworkers, classmates, and people we see regularly at the gym or in the elevator.


Frequency The more often we see a person, the more likely this person will become a friend. This, a person we see at work or in class everyday has the potential to be a friend.


Common Interests People who join groups based on a hobby or another interest are likely to make friends with other group members. They know and have an interest in the same information, and this prompts people to enter into conversations and engage in the same activities. For example, hiking clubs, gourmet food sharing groups, and reading groups attract people with a common interest- and friendships emerge from these groups.


Common Demographic Characteristics We tend to make friends most easily with people of the same general background in terms of age, gender, and socioeconomic status. Our shared backgrounds allow for comfort with the other person and a common general approach toward dealing with the world.


Self Disclosure The point at which an interaction moves from acquaintanceship to friendship is when one person starts to talk about his or her own life. Self disclosure has to be mutual and balanced between two people in order for friendship to start. It starts out with the exchange of minimal information and then moves into higher degrees of self disclosure as the friendship develops. If one person does all the talking and the other person has little to say, the balance between the two people is not achieved and a friendship is less likely to occur.


Reciprocity A healthy friendship carries with it a sense of equality between the two people. If you disclose personal information, you expect that the other person will reveal personal information at about the same rate that you do. In fact, we tend to “test” the other person to see if they talk about themselves to the same degree that we have. Reciprocity, however, goes further than self- disclosure. If we do a favor for a friend, we expect the same general behavior in return. If you drive to the group one night, you expect that your friend will drive another night- or at least repay the favor in another way that has equal value (although openly keeping a ledger of favors can doom a friendship). Friends are people who generally do as much for us as we do for them.

Intimacy Once self disclosure and reciprocity have been established in a friendship, the final variable is the ability of the two people to establish an appropriate level of intimacy between them. Intimacy involves emotional expression and ideally includes unconditional support of the other person. That is, we accept the other person without placing value judgments on him or her. A friendship with intimacy also includes trust and loyalty. An intimate friendship is one in which we feel that we can be ourselves. We’ll be valued and accepted just for being who we are. It makes us feel alive and warm. In other words, a good friendship depends less on who the other person is than on how they make us feel.

Friendship & Social Support: The Laws of Attraction

Since 1985, the number of people who say they have no one to talk to has doubled. The lack of social contacts and social support, despite our technological advances over the past decades, is one of the downsides to the huge transformations that have taken place in our society. Despite the advent of e-mail and cell phones, people today have fewer meaningful social contacts than they had in the past. We have traded our face-to-face contacts for technological forms of communication. We tend to drive alone, work alone, eat alone, and live alone more than we did in past years. Our public presentation may reflect less about whom we are on the inside than our ability to conform to the latest look that we pick up from the all-pervasive media. We go to the gym and work out alone to the beats stored in our iPods. We go for coffee and immerse ourselves in our laptops. And we don’t talk to strangers, who may, as many believe, pose danger to us. Yes, we’ve changed. Friendships are harder to come by. It is more difficult these days to get to know who another person really is, or for them to get to know whom we are.


Research studies have shown repeatedly that friendship and social support systems have many psychological benefits. Social support cuts off the dysfunction cycle of stress, which produces physiological responses such as increased heart rate, breathing, and blood pressure. Just having another person nearby will reduce stress when people perform difficult tasks. And it also takes a load off when you need help in doing some of your tasks of the day.


Spending time with a good, supportive friend will calm us and uplift our mood. We feel better when we talk things through with a trusted friend. When we hear ourselves talk, we can often get to the root of what is bothering us without the listener’s having to say a word. Social support validates us. We don’t feel so alone when there is a trusted friend nearby to say that the same things have happened to them, or merely says, “I understand.” Social connections help us to feel better about ourselves. Good friends make us feel good, and we feel that we’re part of a larger whole. When we have a supportive social network, we can face life’s everyday problems with the feeling that we have the backing of others who care about us.


Social support also has physical benefits. People who have social connections bounce back more quickly from surgeries and illnesses than those without support. A study of people with heart disease found that people with a good friend to confide in lived substantially longer than those who didn’t have a support network. Research has also found that social support can increase your body’s natural immunity. A well-known study found that women with advanced breast cancer who attended a weekly support group lived twice as long as those who did not. It has also been found that lonely people sleep less soundly, wake more frequently during the night, and had less regenerative deep sleep than those with good social support networks.

What are the characteristics of a friendship? Who is likely to become our friend? Stay tuned for an in depth analysis of the variables that have been found to be associated with the establishment of a friendship…


To Be Continued…

Experiencing Grief Pt.1



Grieving comes to most of us at some point in our lives. In fact, statistics show that each person can expect to experience the loss of a loved one once every nine to thirteen years. The resulting sadness may be the most painful of lifes experiences. Because it is painful, however, our eventual adaptation to the loss can bring meaning and integrity to our lives- and this, ultimately, is a gift to us from the one we have lost. It is a reminder to us that the circle is unbroken.


Our ability to adapt to loss is an important feature in the course of our lives. Change can instigate growth. Loss can give rise to gain. If we do not grieve the loss, however, it may drain us of energy and interfere with our living fully in the present. If we are not able to mourn at all, we may spend our lives under the spell of old issues and past relationships- living in the past and failing to connect with the experiences of the present.


Grieving is a process of experiencing our reactions to loss. It is similar to mourning. The term bereavement means the state, not the process, of suffering from a loss. Normal grieving is an expected part of the process of recuperating from a loss. The intensity of the process comes as a surprise to most people- and for many it becomes one of their most significant life experiences. People have their own individual grief responses. No two will experience the process in the same way.

The first reaction to the loss of a loved one, even when the loss is expected, is often times a sense of disbelief, shock, numbness, and bewilderment. The survivor may experience a period of denial in which the reality of the loss is put out of mind. This reaction provides the person some time to prepare to deal with the inevitable pain.


The feeling of numbness may then turn into intense suffering. The person feels empty. There are constant reminders of the one who has been lost. There may be periods of increased energy and anxiety followed by times of deep sadness, lethargy, and fatigue. There may be a period of prolonged despair as the person slowly begins to accept the loss. The one who grieves may find it difficult to feel pleasure and it may seem easier most of the time to avoid other people. The bereaved may dream repeatedly about the lost loved one- or hear their voice or even actually see them. The grieving survivor may adopt some mannerisms of the one who has left.


Sadness may be interspersed with times of intense anger. Many of us have difficulty in expressing anger toward one who has died. However, anger may enter into most of our relationships. We may reproach ourselves for not doing enough to prevent the death or for having treated the deceased badly in the past. The grieving person may become irritable and quarrelsome- and may interpret signs of good will from others as messages of rejection. Normal stressors may become triggers that set off periods of deep anger.


Physical symptoms commonly accompany grief. These include weakness, sleep disturbance, a change in appetite, shortness of breath, dizziness, headaches, back pain, gastric reflux, or heart palpitations.


Some people may show a “flight into health,” as if the loss was behind them and they had started to move on again. This pattern occurs frequently, especially in a society which encourages quick fixes, even though complete resolution of the grief process can take up to two or three years. To shorten the process by pretending that it has been completed can invite a prolongation of the symptoms…

“Worry” Pt. 3, Tips for Managing Worry


There are many practical methods for dealing with excessive worry, a few of which are listed below:


Find connectedness: when we feel connected to something larger than ourselves (a group of friends, our families, work, a religious faith) we are less likely to worry.


Seek Advice and Reassurance: We all need supportive feedback from others from time to time. Other people may have solutions to problems that we haven’t thought about. For reassurance, find people who know how to give it. Many of us spend a lifetime looking in all the wrong places for approval.


Understand the Difference Between Good Worry and Unproductive Worry: Good worry implies having a sense of control in solving life’s problems. It involves examining alternatives and then coming up with a systematic plan for meeting a challenge. Unproductive worry involves engaging in repetitively hashing over the same ideas time and time again, negative thoughts, and no real plan for meeting the challenge.


Try to Do the Right Thing: Maintain your sense of integrity whenever you do something. Tell the truth. Obey the law. Keep your promises. Let your conscience be your guide. Granted, we might tell an occasional lie or break a promise, and this is fairly common- but it also can set the stage for worry. We may think sometimes that we can get ahead in the world the easy way- but the price we pay could be excessive worry, among other penalties.


Sleep and Eat Properly: Lack of sleep and a nutritious diet can make us irritable, distracted, and anxious- all conditions that set the stage for worry. (Try to be mindful of the problem of overeating as a way of making your worries disappear.)


Exercise: Try to get at least half an hour of aerobic exercise every other day (this could be walking in your neighborhood). Exercise helps us dissipate the anxiety that often accompanies worry.


Avoid Substance Abuse: Drugs and alcohol may give the illusion of comfort for the time being, but using them has negative long-term consequences. They increase depression, cloud your judgment, and may give you something to really worry about later.


Add Structure to Your Life: Worry is often related to disorganization. Make a list of things to do each day and cross of tasks once they are completed. Leave early enough to make appointments on time. Put your keys in the same place every time you come home. Keep your house straightened up. When things are under control, there is less to worry about.


Minimize Catastrophic Thinking: Some people find it difficult to keep perspective when faced with even a minor stressor. Not every mole means cancer and not every bill is going to lead to bankruptcy. Test out the reality of these situations by talking them over with a trusted friend.


Keep a Pad by Your Bed and Make a Note of a Problem: Rather than tossing and turning all night as you worry about a problem, jot down a note about the problem and resolve to get to sleep- and then consider the problem in the light of the next day.


Limit Your Exposure to the News: Although there is value in keeping up with the latest news, understand that the media focuses on bad news since this tends to sell best. We seldom hear about the good news in the world on TV or newspapers. Constant exposure to negative events increases our tendency to worry. Instead, look for what is good in life.


Keep Yourself Financially Secure: Live below your means and put money into a savings account. Pay off credit card debts. Consider ways to live more comply as a way of managing your finances.


Learn the Value of Judicious Complaining: Sometimes it helps to talk your way though a problem by venting about it. Find a trusted friend and just let it all out. And then have a good laugh about it afterwards. If a friend is not available, write out your complaints.


Learn how to Let Go of Worries: This is a skill that might require some practice, and each of us will have our own way of doing it. Some people do this by allowing themselves perhaps half an hour a day of worry time- and at the end of the allotted time period, they will be free of worrying until the next day. Some people give up their worries by writing them down on a piece of paper and then tearing up the paper. Some people prefer to hand them over to a higher power. There are mindfulness meditation techniques for letting go of your worrisome thoughts- just decide not to participate in anxiety-provoking thinking. Let the thoughts go (this method takes practice and uses techniques that increase your awareness through meditation of prayer).


Don’t Sweat the Small Stuff: And, in a sense, if you think about it, it’s almost all small stuff.


“Worry” Pt. 2

Many treatable conditions are associated with worry. For some people, worry is simply a habit or an entrenched way of dealing with life’s conflicts. But for others, it is a symptom of an underlying condition which may be amendable to psychotherapeutic, medical, and holistic interventions, such as:



Ruminative worry, often with negative thinking, is one of the primary symptoms of depression, along with sleep and appetite changes, lethargy, isolation, and a loss of pleasure in every day life experiences. Fortunately, depression responds well to psychotherapy, sometimes with medical or holistic support.


Panic Disorder and Social Phobia

A panic attack is worry taken to the extreme- a feeling of terror accompanied by rapid heartbeat and fast breathing along with a need to run away from the situation. The person senses imminent doom. About 30 to 50 percent of the time, panic attacks are accompanied by agoraphobia, which is a fear of any public place where a dreaded panic attack might occur like crowds, driving, stores, restaurants, or elevators. Social phobia, on the other hand, involves a fear of being the center of attention, like speaking in public. These conditions can be treated with powerful psychotherapeutic tools, and sometimes antidepressant or antianxiety medications and holistic approaches can be a useful adjunct to therapy.


Obsessive-Compulsive Disorder

A person with OCD experiences unwanted and intrusive thoughts (obsessions) and may feel a compulsion to engage in rituals as a way of handling these unwanted thoughts. Strange thoughts are fairly common for most people, but when they are pervasive and seem uncontrollable and distressful, psychotherapeutic interventions combined with other therapies may help.


Generalized Anxiety Disorder

People with GAD lead fairly normal lives, but they worry about things that most of us can brush off. They find it difficult to let go of their worries and this may have a genetic or biological basis. For the person with GAD, any event can prompt an automatic response to interpret things in a negative and fearful way, and this can lead to a cascade of worry. Psychotherapy is very effective in helping a person learn to think positively and to let go of distressing thoughts, and sometimes an antianxiety medication can be used judiciously as an adjunct to therapy.  Current research is available on the positive aspects of holistic approaches.


Post-Traumatic Stress Disorder

Sometimes our old pain associated with tragic experiences is difficult to let go of, especially when these experiences have threatened our sense of integrity and safety. A trauma can set the stage for worry years after the original event. Coming to terms with PTSD in psychotherapy usually involves learning to talk about the trauma, grieving the losses associated with the event, and finding ways to forgive.

“Worry” Part 1

It’s a good thing that almost all of us worry. Think of worry as a built-in alarm device. When it is used wisely, it alerts us to danger and prompts us to navigate our way through a maze of solutions to life’s various problems.We need to think through our options when we are faced with problems, weighing the benefits and pitfalls of each alternative, and then come up with the best solution. From there we take action, which, we hope, solves the problem. Worry is helpful when it is used at the right time and at the right level for resolving our difficulties. Like many things in life, too little worry or too much of it can be harmful.


Too little worry can result in impulsive decisions, which may result in unfortunate consequences. Indeed, some people are high risk-takers who may not worry enough about problems, they may win, but just as often, they lose. Others avoid worry through substance abuse or other addictive behaviors and then lack the motivation and insight to deal realistically with life’s expected problems. Similarly, a laid-back, come-what-may approach, while it has some merits, sometimes suggests passivity and a lack of ability to participate in the complexity of life’s experiences.


As we all know, some people worry too much. Rather than solving a problem, too much worry becomes the problem. Not only does excessive worry create personal suffering, but it also affects the people around the worrier. Worry is a fairly common, but potentially serious, condition. A recent survey suggests that one-third of all office visits to primary care physicians are associated with some form of anxiety-related diagnosis. The stress that accompanies worry can have serious physical implications, including an increased risk for high blood pressure and heart ailments, immune system deficiencies, and cancer.


Most people who worry excessively are well aware of their tendencies, although some simply view it as their normal state of affairs. (Indeed, some people like to worry because they feel that their mind is more active and worry allows them to feel more in touch with their inner experience.) The worrier is one who feels in jeopardy but believes that he or she lacks the ability to take action in the real world to solve the problem. Some people who worry feel that if only they can think the problem through repetitively, sometimes day after day, the problem will magically disappear. And many people worry about things they have no control over anyway. In truth, excessive worry does not solve problems- which are actually cleared up by considering real options and then taking action. Worriers harbor their problems in their imagination and often cannot find a way to break free to the stage of taking action.