Category: Therapies

Why People Lie in Therapy

Mental Health, Therapies

People who lie in therapy do so because: 

  • They’re worried about being judged or that the therapist won’t like them.
  • They are embarrassed or feel shame about their actions or emotions.
  • If they suspect they have a problem with, say, substance use, they’re afraid that they’ll be expected to go to rehab or drug treatment.
  • They’re afraid the therapist will find that they have a serious problem such as an eating disorder or sex addiction. It should be noted that many people who engage in self-destructive behaviors also tend to withhold information (your therapist knows this by the way).
  • It’s difficult to stay in denial if you’re beginning to voice the truth out loud (and you may not be ready to deal with the consequences).
  • They’re afraid of being hospitalized.

Cure for Hysteria of Antiquity

History of Psychology, Hysteria, Medical, Therapies

In antiquity, women who had anxiety, mood swings and depression were sent by their husbands to the doctor, who diagnosed them with a disease called ′′hysteria.” Their treatment was based on a ′′pelvic massage” with the purpose of achieving hysterical paroxysm, now known as orgasm.

There were so many women who began to attend consultations to have their ′′treatment for hysteria′′ that doctors at the end of the workday were exhausted and their hands were shaky; that’s why they decided to invent a useful device that produced rhythmic vibrations and that hysterical paroxysm was achieved easier and faster in the patient without the need for the common manual massage: this is the origin of the vibrator. At that time it was seen as a healing artifact, even the wealthiest women had them in their homes for when they felt ′′bouts of hysteria.”

Sigmund Freud and Psychoanalysis

History of Psychology, Mental Health, Mental Illness Treatments, Therapies

Born Sigismund Schlomo Freud in Freiberg, Moravia, Freud was openly his mother’s favorite child; she called him “Golden Siggie.” When Freud was four years old, the family moved to Vienna and Sigismund became Sigmund. Sigmund completed a medical degree and in 1886 he opened a medical practice specializing in neurology, and married Martha Bernays. Eventually, he developed the “talking cure” that was to become an entirely new psychological approach: psychoanalysis.

In 1908, Freud established the Psychoanalytic Society, which ensured the future of his school of thought. During World War II, the Nazis publicly burned his work, and Freud moved to London. He died by assisted suicide, after enduring mouth cancer.

Key works
1900 The Interpretation of Dreams
1904 The Psychopathology of Everyday Life
1905 Three Essays on the Theory of Sexuality
1930 Civilization and Its Discontents”

Identify Your “Triggers”

Cognitive Behavioral Therapy (CBT), Coping Strategies, Mental Health, Therapies, Triggers

Each person has specific types of situations that set their automatic negative path in motion; these are their triggers. To address your problems, you need to know which situations are difficult and trigger your negative path.

While many people are aware of their triggers, some have trouble identifying their specific trigger situations. For example, a person may tell you that they are “always” sad, or “always” drink too much, and can’t identify specific problematic situations. Identifying your triggers helps you start to see patterns and then know what to focus on in therapy.

A helpful first step is to monitor your problematic feelings or behaviors and see if there are some situations where your feelings are stronger or your behavior is more extreme. For example, a person came to therapy because they were always angry. When asked for examples of specific situations, they responded that they were angry “all the time.” The first homework assignment was to monitor their angry feelings and see when they were strongest. They came back having discovered that they were the most angry when their teenage son didn’t do what they wanted him to do; for example, when he did his homework at 2 a.m., broke curfew, or did not do his chores. They discovered that their anger toward her son was spilling over into the rest of her life.

Frequently, people will describe their trigger situation in vague terms, and don’t really understand what happened. They need to become more specific and concrete. A specific and concrete description includes what happened, with whom, and the specific time and place it occurred. For example, a vague description of a situation would be “My partner doesn’t respect my work”; a more concrete and specific description would be “My partner told me that they thought their work was more important than mine.”

The more specific and concrete your description of the situation, the more you will be emotionally engaged with the situation, and the more you will have access to your feelings and thoughts. Think of someone you are a little annoyed with. Now, think of a specific situation when you were annoyed with this person. Try to remember the situation in detail. Chances are that as you thought about a specific situation, you became more annoyed and your feelings and thoughts became more immediate.

Sometimes your situation is a long, complicated story. In this case, consider the whole story and then ask what was the worst or most difficult part for you. It is helpful to identify a situation that lasts from a few seconds to three minutes, any longer and you will probably have a large variety of feelings and thoughts, and it will be hard to focus on the main ones.

Sources: CBT Made Simple

A Structured Cognitive Behavioral Therapy (CBT) Session

Cognitive Behavioral Therapy (CBT), Coping Strategies, Mental Health, Therapies

A structured session means that there is an order and organization to the therapy session. Here is a brief overview of the five basic components.

Check in. This is a quick update on what has happened since the previous session and includes a bridge to that session.

Set the agenda. You and your therapist decide together which problems to focus on in the current session. Homework from the previous session can be reviewed during the check-in or as part of the agenda-setting process.

Work the agenda. This involves addressing the identified problems on the agenda.

Homework. You and your therapist collaborate to develop homework for the following session.

Review. At the end of the session you briefly review with your therapist what was covered in the current session and give feedback.

Sources: CBT Made Simple

Humorism and the Four Personality Types

History of Psychology, Mental Health, Therapies

The Roman philosopher and physician Claudius Galen formulated a concept of personality types based on the ancient Greek theory of humorism, which attempted to explain the workings of the human body.

The roots of humorism go back to Empedocles (c.495–435 BCE), a Greek philosopher who suggested that different qualities of the four basic elements—earth (cold and dry), air (warm and wet), fire (warm and dry), and water (cold and wet)—could explain the existence of all known substances. Hippocrates (460–370 BCE), the “Father of Medicine,” developed a medical model based on these elements, attributing their qualities to four fluids within the body. These fluids were called “humors” (from the Latin umor, meaning body fluid).

Two hundred years later, Galen expanded the theory of humorism into one of personality; he saw a direct connection between the levels of the humors in the body and emotional and behavioral inclinations—or “temperaments.”

Galen’s four temperaments—sanguine, phlegmatic, choleric, and melancholic—are based on the balance of humors in the body. If one of the humors develops excessively, the corresponding personality type begins to dominate. A sanguine person has too much blood (sanguis in Latin) and is warm-hearted, cheerful, optimistic, and confident, but can be selfish. A phlegmatic person, suffering from excess phlegm (phlegmatikós in Greek), is quiet, kind, cool, rational, and consistent, but can be slow and shy. The choleric (from the Greek kholé, meaning bile) personality is fiery, suffering from excess yellow bile. Lastly, the melancholic (from the Greek melas kholé), who suffers from an excess of black bile, is recognized by poetic and artistic leanings, which are often also accompanied by sadness and fear.

According to Galen, some people are born predisposed to certain temperaments. However, since temperamental problems are caused by imbalances of the humors, he claimed they can be cured by diet and exercise. In more extreme cases, cures may include purging and blood-letting. For example, a person acting selfishly is overly sanguine, and has too much blood; this is remedied by cutting down on meat, or by making small cuts into the veins to release blood.

Galen’s doctrines dominated medicine until the Renaissance, when they began to decline in the light of better research. In 1543, the physician Andreas Vesalius (1514–1564), practicing in Italy, found more than 200 errors in Galen’s descriptions of anatomy, but although Galen’s medical ideas were discredited, he later influenced 20th-century psychologists. In 1947, Hans Eysenck concluded that temperament is biologically based, and noted that the two personality traits he identified—neuroticism and extraversion—echoed the ancient temperaments.

Sources: The Psychology Book (DK)

Communication Styles and Mental Health

Coping Strategies, Dialectical Behavioral Therapy (DBT), Mental Health

Passive Communication
Passive people often don’t communicate verbally. They tend to bottle up their emotions instead of expressing them, perhaps out of fear of hurting others or making them uncomfortable, or maybe because they don’t believe their feelings or opinions matter as much as those of others. People with a passive communication style usually fear confrontation and believe that voicing their opinions, beliefs, or emotions will cause conflict. Their goal is usually to keep the peace and not rock the boat, so they sit back and say little.

Aggressive Communication
Aggressive communicators attempt to control others. They’re concerned with getting their own way, regardless of the cost to others. Aggressive people are direct, but in a forceful, demanding, and perhaps even vicious way. They tend to leave others feeling resentful, hurt, and afraid. They might get what they want, but it’s usually at the expense of others, and sometimes at their own expense, as they may later feel guilty, regretful, or ashamed because of how they behaved.

Passive-Aggressive Communication
Like passive communicators, those who have a passive-aggressive style fear confrontation and don’t express themselves directly. However, because of their aggressive tendencies, their goal is to get their way, but they tend to use indirect techniques that more subtly express their emotions, such as sarcasm, the silent treatment, or saying they’ll do something for others but then “forgetting.”

Assertive Communication
Assertive people express their wishes, thoughts, feelings, and beliefs in a direct and honest way that’s respectful both of themselves and of others. They attempt to get their own needs met but also try to meet the needs of others as much as possible. They listen and negotiate, so others often choose to cooperate with them because they’re also getting something out of the interaction. Others tend to respect and value assertive communicators because this communication style makes them feel respected and valued.

Sources: DBT Made Simple

Watch Your Emotions

Coping Strategies, Dialectical Behavioral Therapy (DBT), Distractions, Mental Health

People often try to avoid their emotions because they find them too painful. When you haven’t learned how to regulate your emotions you are in a lot of pain, and you don’t have the skills to manage and tolerate your emotions. You can use the acronym WATCH to help summarize the skills that will help them reduce their avoidance of emotions and improve their ability to manage emotions:

Watch: Watch your emotions. Mentally note your experience of an emotion, acknowledging how it feels physically, the thoughts, memories, or images that accompany it, and so on.

Avoid acting: Don’t act immediately. Remember that it’s just an emotion, not a fact, and that you don’t necessarily need to do anything about it.

Think: Think of your emotion as a wave. Remember that it will recede naturally if you don’t try to push it away.

Choose: Choose to let yourself experience the emotion. Remind yourself that not avoiding the emotion is in your best interests and will help you work toward your long-term goals.

Helpers: Remember that emotions are helpers. They all serve a purpose and arise to tell you something important. Let them do their job!

Sources: DBT Made Simple

Three Levels of Self-Validation

Coping Strategies, Dialectical Behavioral Therapy (DBT), Distractions, Mental Health, Mental Illness Treatments

Acknowledging: The most basic level of self-validation is simply acknowledging the presence of the emotion rather than judging it; for example, telling yourself, I feel unhappy. Just acknowledging or naming the emotion and putting a period on the end of the sentence rather than going down the road of judging it validates the emotion.

Allowing: The second level of self-validation is allowing, which is essentially giving yourself permission to feel the feeling; for example, telling yourself, It’s okay that I feel unhappy. This takes not judging the feeling one step further, affirming that it’s okay to feel this way. This doesn’t mean liking the feeling or wanting it to hang around; it just means acknowledging that you’re allowed to feel the emotion.

Understanding: The highest (and hardest) level of self-validation is understanding. This level, which goes beyond not judging the emotion and saying it’s okay to feel it, involves having an understanding of it; for example, It makes sense that I feel unhappy, given the difficulties I have managing my emotions and the chaos this causes in my relationships and my life.

Source: DBT Made Simple

Crisis Prevention: Experience Intense Sensations

Coping Strategies, Dialectical Behavioral Therapy (DBT), Distractions, Mental Health

Experience Intense Sensations

Sometimes generating intense physical sensations can distract the mind from painful emotions. This helps explain why many people resort to cutting or hurting themselves in other ways: because it can actually help them feel better temporarily. Obviously, the key here is to help identify intense sensations that aren’t harmful. Think about physical sensations you can generate that might take your mind off a crisis. For people who engage in self-harm, try holding an ice cube in one hand. This can cause physical pain if held long enough, and the sensation is intense. For some people, this can take the place of self-harming behaviors. Here are some examples of other things you might do to get your mind off a crisis:

  • Take a hot or cold bath or shower.
  • Keep a rubber band on one wrist and snap it—not so hard that it causes a lot of physical pain, but hard enough to generate a sensation that will temporarily occupy the mind.
  • Chew on crushed ice or frozen fruit.
  • Go for a walk in cold or hot weather.
  • Lie in the hot sun (with sunscreen on!).

Again, add whatever intense sensations you can think of to your list of activities to help survive a crisis.

Sources: DBT Made Simple