THERAPY SHOULD NOT BE MYSTERIOUS…

Example: Unlocking Your Mind

Mary offered, “I just need to learn to say No.”  She felt that she was too often taken advantage of, and subsequently decided it was time to learn to be more assertive.  Easy, just learn to say No. 

Except there was an obvious contradiction.  Mary was intelligent, communicative and said No plenty of times in her life.  She sure didn’t need a doctor to tell her something she already knew; she even knew when she should say No, but she couldn’t, or worse, wouldn’t.  The real problem was that Mary was terrified of conflict. But Why?

WHAT SHOULD MARY DO?

FEELING BETTER IS WHAT YOU WANT.

Generally speaking we all want to feel great and fulfilled in life, not troubled by worries, insecurities, fears or depression. We know this, and even strive to be positive and moving forward. Yet curiously, a host of factors—both in our minds and from the outside world—create obstructions to our feeling great.

1) TALKING ABOUT IT, HOW COULD THAT HELP?

It starts with, as you might imagine, talking about your problems. Talking with your psychologist is much different than simply talking with a friend, in ways that are described as you read on. “I don’t see how just talking about my problems is going to help?” is not an uncommon statement for a doctor to hear. In part it is true! Talking will ultimately not be enough. Embedded in this question is the idea that therapy or “talking cures” lack the ability to help people make changes.

The act of talking to a psychologist can work in different ways. Typically, talking with the doctor starts by creating an incisive clarity about one’s problems. For example, an issue with anxiety may seem to be about personal or professional problems, like a bad relationship or being unappreciated at work. However, the real problem may be that you are extremely self-critical. Privately and even without conscious awareness you blame yourself, question your worth, or fear you don’t deserve better and thus wont make a necessary move or change. You may even make your personal standards unreachable—this apparent tool for motivation and improvement (I could’ve done better) is actually a form of self-punishment to make you constantly feel worried, inadequate, selfish or even lazy!

An issue with over-eating may actually be about the inability to manage feelings well—thus, food (like alcohol or drugs) is being used to manage feelings but never actually solves the problem. So what is the problem?

Talking helps to identify the Real problem.  And despite what many (friends, family, loved ones) think, the real problem is at times, actually difficulty to identify without unbiased professional help.

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Heard any of these before? You’re too sensitive… You’re in denial… Stop making excuses…

Think more carefully about what the word “defensive” means. When we are defensive (for example, denial is a defense) we are actually protecting ourselves against something that is deeply painful and hurtful.

And… When we employ our psychological defenses, we usually do this without intention or conscious awareness. We are not doing it on purpose; it happens automatically. We feel attacked, criticized or misunderstood, so we fight back. Our retaliation—or defense—is made of carefully but unconsciously constructed processes to protect ourselves.

Before you are quick to reject the idea that you may be defensive, let’s consider an example.

David is a kind and very thoughtful man. Sometimes he gives so much, that others take advantage of him. He doesn’t mind, he prides himself on his non-confrontational approach to seeing the best in others. Most adults described him as sweet, gentle, and deeply caring; he is even passive at times. David is a 4th grade teacher. This year, David was reprimanded because some of his students said that he was “being mean.” Of course, David’s superiors were stunned, but consistent reports from students’ complaints to their parents, resulted in some concern. It was discovered that David was intimidating to his students. David was appalled and voiced his innocence and good intentions as an educator. Nonetheless, students described him as having a menacing and judging look on his face. David also made his students feel dumb by asking leading questions that were belittling.

Could it be true? Or was David wrongly accused or judged. Well, it turns out it was true. And therapy revealed that David was using a few defenses in life, the most identifiable was SUBLIMATION. Under David’s gentle exterior, he had anger. His whole life he felt that others lacked moral compass, were selfish, and had wronged him. Because he believed that anger was a negative emotion and characteristic, his mind made him believe that he was not an angry person. He actively behaved in such a way to believe that he was never angry. However, his anger leaked and his choice of career served to allow an opportunity whereby he could express it. With time and great courage and honesty, David came to discover that he had chosen the profession of 4th grade teacher to feel powerful. He used (unconsciously) his position to express the anger he housed through intimidation of his students. Other defenses like DENIAL (David denied he was an angry man) also worked in concert with sublimation and DISPLACEMENT (defined on page 3).

Be respectful of your defenses

One of the most important parts of therapy can be an understanding of psychological defenses. We all have them, and we have them for essential reasons.

Have you ever heard, “You are just being defensive!” Or, “You are just in DENIAL.”

While the use of denial may be commonplace, understanding how and why we use psychological defenses can be essential for successful therapy.

List of the Most Common Defenses that surface through therapy:

Denial

the individual is completely unaware of a particular behavior, quality, belief, or characteristic. Example: a daily smoker denies that smoking causes cancer because acknowledging such a truth would be terrifying. Thus, she actually believes that the research on cancer and smoking is fabricated and false.

Externalization

easily stated, this is blaming others. Externalization is perhaps most clearly seen in small children (who are still in the process of defining right and wrong) when they are caught doing something they shouldn’t be doing, but blame a sibling or pet. When adults engage in the behavior, it can actually be quite convincing until a long pattern of failing to take responsibility for one’s actions is identified. Example: Steven performed poorly in school. But he explains that his teachers just never appreciated his learning style and artistic intelligence. So his failure in school is really their fault, not his. When this pattern is pervasive, it is very challenging because personal growth will not occur until a person takes responsibility for their own contribution to failures or problems. Steven could grow in therapy if he ultimately admitted, “I am sometimes lazy, and that was not only my problem in school, but that is the truth about why I’ve been fired three times…”

Sublimation

the individual has feelings, desires, or urges that are unlikable, or morally unacceptable by his or her mind (conscience). Because these are morally judged in the mind (i.e., wanting to be rich, admired and selfish), the person finds a way to satisfy the desires in another way. Example: Derek needs to see himself as a genuine and a sincere person. But he is also a star and celebrity Country singer. He denies that he is self-centered, and states that his immense popularity and adorning female fans are simply a result of his career. (His desires are sublimated, or concealed in his career choice). He gets to act and even feel modest, when privately he needs and loves the ability to use and manipulate women to feel special.

Displacement

the individual takes powerful destructive or troubling feelings that should be directed at an identifiable person (e.g., boss or spouse) or situation (work), and expresses it on another target or source. Ever heard, “bad day at work, kick the dog.” Another common example is marital frustration or conflict, resulting in moodiness with peers, siblings, or coworkers. Example: Steven is hurt because his marital sex life is unsatisfactory. He cannot confront his wife directly, so he is moody with his co-workers who find him edgy and difficult.

Reaction Formation

the individual is denying (another defense) strong feelings, urges, beliefs, and/or wants and needs, so takes a stand that demonstrates the opposite of his or her true feelings. Example: Bill secretly finds pornography and nude magazines exciting. He could never admit this because he fears he would be judged by others, and in fact he judges himself when he feels the desire. Consequently, Bill constantly talks about being respectful to women, is exceedingly polite and chivalrous, and never looks at attractive women in public. He demeans and judges those who are interested in pornography and even started a petition against pornographic magazines.

Projection

the individual has feelings, desires, or urges that are unlikable, or morally unacceptable by his or her mind (conscience). Because these experiences are judged by one’s conscience, they must be kept from conscious awareness, so they are “projected” (or sent) onto someone else—so ultimately they are seen in the other person, instead of one’s self. Example: Michelle can be selfish, moody, and demanding. Accepting these very unattractive characteristics in herself is painful, so she sees them in her boyfriend. When he purchases her a beautiful gift that she does not like, she finds a reason to make it his fault, i.e., “You [boyfriend] should know I don’t like green. You only bought this for me because YOU like green.”

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The Bottom Line

The good news is that therapy can make a real difference. Did you know that research shows that therapy is highly effective for anxiety? Fuel has a competent, professional, and superbly trained staff assembled to meet the needs of you or your loved one suffering with anxiety.

The treatment for an anxiety disorder depends on the severity and length of the problem. The client’s willingness to actively participate in treatment is also an important factor.

When a person with panic is motivated to try new behaviors and practice new skills and techniques, he or she can learn to change the way the brain responds to familiar thoughts and feelings that have previously caused anxiety.

There is no need to avoid your problems – you may simply be avoiding your own happiness!

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By Dr. Jason N. Camu

licensed clinical psychologist

dr.camu@fuelforemotionalhealth.com

In a field seen perhaps more for mystery and art than science, as psychologists we sometimes struggle to explain our methods and procedures. This is especially true when our own emotional experience is used as a less than scientific tool in the moment.

Our patients want to believe and trust that we can help and that we know how to help. Sometimes the notion that you are a very “intuitive” person is reassuring to a particular type of patient—maybe the person who needs to believe in something bigger and more impressive than the tested hypothesis. For others it means the doctor is not bound by reason and the rules of the social sciences, but rather is flakey and magical. After all, other professions like medicine and law make it clear; because it is in fact clear. I wanted an x-ray for my broken elbow, not the physician’s intuitive sense that it was shattered.

“Intuition” may conjure images of a well-timed intervention that freed a patient from his or her internal prison. Conversely it may sound imprecise, affected, and unskilled. Like any of our tools, if intuition is to be judged as useful, discussion of what it actually is may be beneficial.

What then does “intuitive” mean? I posit the following regarding intuition as it applies to clinical work. Many psychologists are remarkably sensitive people with wonderful gifts in terms of reflective capacity, observation, and detail. This natural or innate predisposition of strong affect is then sifted and structured through education and professional training. Consequently, in addition to all of our scientifically derived skills as psychologists we also aim to use of our own feelings and reactions to further understand people—for example, the confusion that occurs at a staff meeting regarding a psychotic patient (parallel-process), or the schoolgirl crush that is privately experienced by a female intern for the handsome and just charming enough young sociopath. These are examples of countertransference in some form or another. When we fail to acknowledge and explain the experience of countertransference or projective identification, the feelings may be priming the inevitable build up of something that becomes intuitive.

Thus the collision between projected material that is felt (identified with) and our own life experience that also results in an intuitive action by the psychologist, is unique because it escapes understanding or articulation, e.g., “I don’t know it just felt intuitive.”

Intuition in clinical practice may be defined as the following:

The accumulation of powerful emotional data gathered via profound sensitivity and attention to both verbal and non-verbal cues and all of the senses known and unknown, that simultaneously elicits feelings in the recipient that are not articulated or understood in the moment, yet may be translated to action or intervention.

The inability to clearly articulate the source of the intuition should spark interest for those of us in the business of introspection and insight. Action without understanding could be risky. Conversely, it could be just what a patient needed, or doctor ordered for that matter.

Dissection of these keen moments of emotional

By Dr. Jason N. Camu

licensed clinical psychologist

dr.camu@fuelforemotionalhealth.com

Ironically it seems obvious that our chosen profession is perhaps the greatest metaphor for the implementation of unconscious psychological defense. Over the years I am in the least let down, and at the most genuinely surprised, when a colleague says: “I really just wanted to help people and that’s why I became a psychologist.” We are indeed just as vulnerable to our own blind spots as are our patients.

The motivation to help others is as much a part of our own personal upbringing and biology as are the presenting problems and symptoms of our patients. Said differently, the choice to become a psychologist will include our own unresolved emotional issues and conflicts—this is certainly not a novel proposition. But the subsequent step of personal and professional introspection includes very difficult questions for the psychologist.

Why do we choose such an obviously masochistic profession? We listen to people’s problems for hours on end. We often complain about being overworked and underpaid. If one pays attention to our conversations amongst ourselves, we are also an exceedingly critical group. The role of psychologist could be viewed as not about working through our own personal issues, but about using the career and doctor position to deny, sublimate, and avoid issues while simultaneously acting out to gain pleasure.

Close examination yields more precisely these insecurities and vulnerabilities. Perhaps not surprisingly, one of our most troubled patient groups can provide a mirror reflection of our own painful inadequacies — the narcissistic patient. Our obvious identification with this patient, as evidenced by career choice, is the guarded secret. The result is a career choice that is the psychological defense. Of course we want to feel valued, loved, special, and powerful.

The helping professions provide a wonderful vehicle to solidify denial and avoidance while also providing a near perfect sublimation. Much like the attorney who is rewarded for reducing his adversary to spittle with guile, aggression and force, we too are rewarded. We help those in need, we are special in our suffering whilst also embodying the most revered qualities of human beings — we have compassion and empathy and put the needs of others before our own. At least it would seem so.

Speaking so highly of ourselves is a delicate exercise, because we must be careful to deny our pride as well. To be too impressed with one’s self is selfish, egocentric, and narcissistic. To indulge oneself in the hour of treatment is to take the attention from the patient to utilize the interaction for ourselves. Consequently we defend our modesty as indeed unrivaled. Perhaps.

Narcissism. The word is provocative and has multiple meanings for the clinical psychologist. Whatever the case, the narcissistic patient is often loathed by many in the helping professions. Why must we hate pride and selfishness so much? Because “we” are bigger than, of course. We mock the unsophisticated and transparent narcissistic defenses. We are so much smarter than the narcissist who must demean and diminish others to feel powerful. He or she makes others feel uncomfortable and small in the unconscious goal of feeling powerful. The insecurity is projected onto the object and often identified with when the receiver feels threatened or intimidated. When the treating clinician experiences the projection in a form of broadly defined

By Dr. Jason N. Camu

licensed clinical psychologist

dr.camu@fuelforemotionalhealth.com

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“Oh, he makes a big deal about boundaries, he’s so serious he won’t even hug her, she’s an old woman for God’s sakes.” The snickers suggest that my reticence about hugging a patient on the unit is based in my own character deficits, namely that I’m mean or overly rigid.

My reasons for refraining from indulging that patient in a hug were based in a comprehensive diagnostic impression of that patient. I posited that hugging her actually interfered with her treatment, and I could describe why. This syrupy sweet and caring old woman used hugs to deny her own hostility and project responsibility and rage onto the recipient of the unwanted hug; the patient was malodorous, disheveled, and had head-lice, yet was exceedingly bright with a high functioning history. Rather than admit to repulsion and rage, clinicians colluded with the patient in a myriad of unspoken issues of anger, dependency, and helplessness.

Knowing what you are doing and why you believe treatment to be effective differentiates you the psychologist from any layperson offering emotional support.

Not all treatment is the same. Selecting which treatment is appropriate is based in diagnosis.

The borderline diagnosis is rich with a peculiar excitement for clinicians. It arouses what seems to be a pathologizing tendency that allows us to feel separate from and consequently healthy unlike our troubled patients, while simultaneously reveling in our own masochism as we suffer to help a noble savage. The DSM classification while useful in some ways, is a simple grouping of symptoms/behaviors etc. that are often confounded in a co-morbid mess with multiple other character and mood disorders, and does little to inform treatment.

For some treating professionals, grounding in theory provides a sound base for determining treatment modality—and perhaps even more importantly identifying the psychologist’s limitations in treatment.

For those who rely upon psychoanalytic or structural theory, the difference between borderline and neurotic is essential in shaping treatment. It is unfortunate that this basically simple theoretical approach has become synonymous with sex and cigar myths, not only in the lay community but now commonly infiltrating our field.

The distinction between borderline and neurotic sets the groundwork for selecting a treatment modality. Often attacked as effusive and narcissistic, analytic theory (structural theory) is very concrete in this regard and can organize a clinician’s approach to treatment. Said succinctly, differentiating patient pathology is what drives treatment and modality. An illustrative example is the fledgling therapist with the best of intentions who walks blindly into an exploration of trauma and affect with the borderline patient. The ensuing fallout can include a destructive deluge of rage, suicidality, or if lucky the calm before the storm with the exalted idealization.

By Dr. Jason N. Camu

licensed clinical psychologist

dr.camu@fuelforemotionalhealth.com

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The term conjures a variety of different images of self-centered and troubled characters. Curiously, these may also be the patients we love to make important in our minds and in time with colleagues, reliving the therapeutic hour in a verbose parallel process.

Yet a closer examination of the term reveals widespread variation in what the term actually means to clinicians. I have found that for some, especially those that unknowingly identify with the projected feelings and inadequacy of the narcissistic patient (expanded upon later in the prose), the word is an opportunity to disparage the individual, differentiating oneself from this malignant form of self love.

It seems most often, that “narcissistic” unless explained in greater detail by the treating professional, is ambiguous and less than useful. And in fact the term appears to be a simple metaphor for a particular form of counter transference. The reaction I refer to is distaste for this patient’s unregulated self-aggrandizing braggadocio, and egocentric self-centered view of him or herself and the world. Even half a step back with an objective lens reveals this struggling person’s pathetic need for attention, acceptance and approval. Yet when you are the target of projected insignificance and used as a defensive object with whom to see unwanted parts of the self, finding compassion for this patient is more difficult. Complicating matters, the lay-public uses the terms “narcissist” or “narcissistic” to mean a multiplicity of other ambiguous characters, including sociopaths. As I have mentioned in other articles, our responsibility to our patients is to understand more than the layman.

It is the narcissistically damaged patients’ use of defenses that makes them so difficult (perhaps even feared), especially when they are highly intelligent and at times, smarter than the doctor, a fact that may be difficult to accept. Because of their keen awareness of threat, need to sustain their precious image, and sometimes finely tuned interpersonal skills, these patients may be affluent, attractive, articulate, and present other confounding variables to the therapist. These factors are also infuriatingly juxtaposed to the helping professional’s selfless image and prized modesty and humility.

Juvenile-like needs to engage the psychologist in competitions are just the first of so many challenges. Belittling, challenges to competence, aggressive highly personal observations and comments, and a persistent general picking at the therapist may make this fractured person difficult work, i.e., “I [patient] notice you [psychologist] always wear a suit and tie, I remember when I used to have to wear a monkey-suit.”

Narcissistic defenses are generally unattractive with a primitive sometimes almost assaultive quality. Thus,commonly when the narcissistic patient is being described or the term is being used it is the defenses that are being described not the state of the person For example, take the remarkably self-centered individual that demeans. As a very smart, preened, and mega-wealthy patient once said to me, “So you’re a psychologist, I have a number of those on my team, they are like whores to the court, they [psychologists] work great for us [lawyers].” While your reaction can reveal a lot about yourself, this “narcissist” is communicating in the only way he knows how. He must make himself feel bigger and better in a desperate attempt to feel adequate. He must make me as small as possible. Yet in doing so he will succeed in again avoiding his issues with his arsenal of defenses. Only competence will help this patient feel comfortable, safe, and able to use insight to face his greatest weaknesses. With multiple failed relationships he continues to hurt those he loves with immature acting out and cruel and insensitive insults. However, he does love and care for other people. This capacity to take another’s perspective is a fundamental differentiation diagnostic feature that is so important in his treatment. He uses people as objects to inflate the self, but with overwhelming hunger he also craves the very same objects’ respect, love and approval.

Yet like the ill-equipped adolescent, he will not let his image slip in favor of vulnerability. The narcissist acts compulsively and almost instinctively to hurt others. While most of us