All posts by Rune Moelbak

I am Rune Moelbak, Ph.D.: A clinical psychologist in Houston, Texas. I write articles on therapy, psychology, and cultural-philosophical critique, and publish my ideas in national and international journals. I am the owner of Better Therapy: A therapy practice for people who are looking for a more in-depth therapy experience.
image of psychodynamic therapist, Dr. Rune Moelbak

Why I am Not a CBT Therapist…

In today’s therapeutic landscape, people have to be aware of multiple competing approaches to dealing with life struggles and emotional pain.

Sometimes in the public eye, it would appear that an approach named CBT or Cognitive Behavioral Therapy is the only effective choice. That view at least is promoted by many psychiatrists, who in recent years have turned away from their psychoanalytic past, and have rebranded themselves as men and women of science.

It is also promoted by many psychology departments, who have been quick to embrace a more mechanical approach to therapy because of the ease with which such an approach can be studied using a scientific method.

However, despite this seemingly enthusiastic endorsement of CBT as the treatment technology of choice, it serves us well to revisit the history that accounts for why CBT became so popular. This will help us consider if CBT’s claim to superiority is really as justified as it would seem on the surface…

Why CBT Became Popular…

Jack Nicholson in “One Flew Over the Cuckoo’s Nest”

CBT was developed to fit a need that arose in the 1970s, when it was decided to deinstitutionalize the treatment of severe mental illness. The chronic institutionalization of the mentally ill, parodied in movies such as One Flew Over the Cuckoo’s Nest was no longer in political favor. Instead people were now to be treated in outpatient community settings that seemed less restrictive and more humane.

Thousands of community mental health settings now arose, typically understaffed and underfunded, and these centers were in need of some effective alternatives to the long-term treatments that had been offered when clients were in hospital care.

Most of the patients seen in community settings had severe problems functioning successfully in their day-to-day lives and might only be able to afford a few number of visits. Psychoanalysis, with its long term exploration of the root causes of people’s problems was therefore no longer a realistic or practical treatment option.

Luckily, through a series of accidental discoveries, new medications such as the SSRI’s, were now available to psychiatrists, and psychologists were quick to fill the remaining treatment vacuum with a toolbox of cognitive behavioral methods intended to bring about quick relief.

CBT had a market and an ally in community mental health and in a reinvented medication-based psychiatric profession. Clinicians in community mental health settings, scrambling to provide effective solutions to take the place of more structured long-term care, were happy to embrace practical skills they could teach their clients.

What is CBT?

If I were to simplify what CBT is, I would say that it consists of methods to help you: think straight, face your fears, and manage your problems.

In order to think straight, patients are taught to examine the realism of their emotion-driven and often unrealistic thoughts.

In order to face their fears, patients are helped to break down daunting goals to more manageable tasks, and are nudged by their therapist to take small risks and baby steps in the right direction.

In order to manage problems, patients are helped to think of “coping skills”, which consist of a tool box of practical activities, mental reminders, or things you can tell yourself to help you get through your day. These skills help you distract yourself or counteract negative emotions or thoughts that bring you down.

The Benefit of CBT:

Such CBT skills work wonders when you have grown up in invalidating environments without good role modeling or practical life management skills, and they are easy to dispense in a short amount of time. They help support and build problem-solving abilities and to encourage the discouraged through active coaching.

In community mental health settings where the goal was to increase people’s ability to function in their day-to-day lives, these techniques were just what the doctor ordered.

Furthermore, it is quite easy to study whether or not patients who receive these skill-boosting sessions actually manage to use them to live more functional lives, and research shows that they do. Hence CBT can be marketed as a scientifically validated or empirically supported treatment for life’s many problems.

This accomplishment helped cement both psychology and psychiatry as scientific disciplines, and was easy to brand to the public eager for an economical and quick fix for their problems. It also won the affection of third party insurance payers who demanded proof of effectiveness before reimbursing treatment providers, and who liked the promise of briefer and more targeted therapies.

So What is Wrong with CBT?

Most psychologists I talk with express at least some discomfort while learning CBT. It often feels infantilizing to teach people how to think or how to problem-solve, and it is hard to really believe in the effectiveness of such an approach, beyond some temporary boost of optimism and self-efficacy.

Clients, too, often feel like the suggestions, advice, and exercises offered to them through CBT are rather superficial.

Simply pointing out why a thought is irrational, doesn’t really alleviate the emotional attachment to a more irrational belief. People often end up challenging their own thoughts and replacing them with more rational ones without really believing in what they are telling themselves.

Furthermore, it is hard to believe that a simple toolbox of skills is really going to address the fundamental issues of your existence and really help you get to the root of your deep psychological issues. The ability to distract yourself, tolerate pain, calm yourself down, and so forth, seem at best a good set of tools to have when embarking on the real emotional work that is the hallmark of longer term therapy.

Problems of living and the experience of unpleasant or inhibiting emotions, such as excessive guilt, shame, and psychological pain, will at one point require a confrontation with one’s past, and will necessitate an emotional experience of working through this past. Simply functioning better or dealing more effectively with one’s emotions in the present, is a poor substitute for examining one’s life, and experiencing a real emotional transformation in how you feel about yourself.

This kind of emotional work that transforms you from within, is slower to unfold, and may not be the place to start if you are barely functioning in your life. But this does not mean that CBT should become the treatment of choice for everyone and anything. If you are ready to go beyond problem-solving to truly discover the emotional causes of your current distress, and if you want to confront the deeper question of how you became the person you are today, I would choose a different therapeutic approach.

Why I am a Psychodynamic Therapist:

Psychoanalysis may have been dethroned from psychiatry and may not be a practical therapy in mental health settings, but it still has a lot to offer for those who are willing to invest the time and money in a deeper experience of change.

Psychodynamic therapy, which is a briefer and modified form of psychoanalysis, is a very viable and cost-effective alternative to CBT that takes you beyond simplistic solutions to life’s problems.

The goal in psychodynamic therapy is a transformation in how you feel about yourself through greater self-understanding and a confrontation with your past. It is in my opinion the superior choice for someone who really wants to understand themselves, and who instinctively knows that their problems are not external issues to be managed, but something missing deep inside of them.

If you want to read more about psychodynamic therapy, read my earlier blog post: What is Psychodynamic Therapy?

To read about the effectiveness of psychodynamic therapy, check out Jonathan Shedler’s article from The Scientific American, dispelling some common myths about this type of therapy.

The Making of DSM-IIIFor more about the fall of psychoanalysis, and the rise of CBT and medication-management in psychiatry, have a look at the excellent book by Hannah Decker: The Making of DSM-III. A Diagnostic Manual’s Conquest of American Psychiatry.

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Dr. Rune MoelbakAbout Me: I am Rune Moelbak, Ph.D., a psychodynamic therapist in Houston, TX. I provide deep treatment of people’s issues. Click here to read more about my approach to therapy.

 

depressed woman

The Psychological Causes of Depression

Watch my new video on the psychological causes of depression:

Learn why depression should not be treated as one monolithic disorder, but should instead be unravelled by uncovering a person’s unique underlying struggles.

Depression is not a disorder that explains our symptoms, but is itself a symptom in need of explanation…

The Past Never Lasts

The Past Never Lasts: Changing the Past from the Future

The Past Never Lasts: Changing the Past from the Future

“The past never lasts”. Such was the slogan posted on a colleagues’ bulletin board, when I worked in a treatment center for traumatized adolescents. My colleague used it to remind her young clients that things might seem bad for now, but that any memory that brings pain is but a fleeting experience. Here today, gone tomorrow. The past, in other words, is always a viewpoint from the present.

However, there is another reason why the past never lasts, and that is that the past has not been written yet.

One of the hallmarks of being human is that events in time are not just something that happens to us. Their meaning has always yet to be determined, and that means that they are malleable.

If I look back at events in my life with regrets, wishing that they would never have happened, I do so from the perspective of today. However, something might happen tomorrow, or a year from now that will change the significance of those events or how I look at them.

Working with the Past in Therapy:

Sigmund Freud, the father of psychoanalysis, noticed this phenomenon in his work with therapy clients and referred to it as “nachtraeglichkeit”: Something that happens now changes what happened in the past. In English this is often referred to as “retroactive determination”.

To Freud this temporal phenomenon by which something that will happen changes what has happened is one of the key curative factors in therapy.

Therapy is not about rehashing old events. It is about encountering something new that you have not yet thought about or felt before. As your present awareness is enlarged or changed, new futures become possible. And with these different futures, the meaning of our past will change.

Changing the Past from the Future:

Existential philosopher, Martin Heidegger, believed that our future is defined by a “for the sake of which”, or a why:

Why do I get up in the morning? Why do I go to this particular job? To do what? To accomplish what?

When pursued to its end, this line of questioning will lead us through a series of “in order to’s” to an ultimate “for the sake of which” which gives us the final meaning to our existence: the reason why we do things..

Hence, I go to work to make a paycheck. I make a paycheck so I can pay my bills. I want to pay my bills so I can eat and have a roof over my head.

But wait…

Actually I make more money than what I really need to pay my bills. My work is also a status symbol, a testimony to my worth as a person. It is important to me to be a good provider, not just for me but for my wife or for my children. It matters to me that they respect me, that they are proud of me. Without that admiration I might not have anything to give them and I would feel terribly vulnerable. Perhaps my wife might leave me, or my children would think of me as a terrible father. I might not really have the personal qualities that suffice to keep my family happy, so I must provide a different kind of material value. At my core, am I really lovable? Am I really worth staying for? Do I really merit attention and respect?

Now we are getting somewhere!

Beneath all the practical reasons for why I have to do stuff, there is a hidden for-the-sake-of-which to which I am enthralled.

This for-the-sake-of-which colors my entire past. It keeps memories present in my mind of not fitting in and not being good enough during my high school years. It makes recollections relevant of harsh criticism of my personality received in childhood. It provides me with a common denominator to tie together past examples of being left or rejected. “I am not good enough, or interesting enough” is the past which I am living out of from the perspective of this particular future which guides my actions in the present.

If we can change this future, if you can arrive at a new for the-sake-of-which, these elements of the past might no longer be relevant. A different perspective on yourself and on your future, will make new aspects of your past present, and will let others fall into oblivion.

This is the work that gradually unfolds in therapy. Therapy helps you change the past by changing your future, or giving you a new for-the-sake-of-which. This is just yet another meaning to the words, “the past never lasts”.

image_book2TIP: For more information about an existential view of time, have a look at my article: “Meaning and Memory. A Heideggerian Analysis of Children’s First Memories”. In this article I use  the philosophy of Martin Heidegger to make sense of our relationship to time.

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Dr. Rune Moelbak

About me: I am Rune Moelbak, Ph.D., psychologist in Houston. Visit my website for more articles or to schedule a therapy appointment.  

 

 

couples insight blog logo

Couples Insight: A New Blog Exclusively for Couples

At this time I would like to thank all my blog readers who have chosen to subscribe to my psychotherapy blog:

Insight: A Blog for the Critical Consumer of Psychotherapy

What started about a year ago as a therapist’s dream to write about therapy and psychology from a human-centered and philosophical perspective, has grown more popular than I would have ever thought.

Over the past several months, however, I have found myself writing for several different audiences who might not necessarily be interested in the same things.

Every other blog post was directed at couples and was more practical and solution-oriented in focus. The others were directed at general reflections on psychotherapy and specific mental health issues, and aimed at other therapists as well as people interested in individual psychotherapy.

This is why I have decided to create an entirely new blog:

Couples Insight: A Blog about Making Relationships Work

Readers who are interested in more general, critical, and philosophical articles about therapy, life, and mental health, can still find those articles here on the regular ol’ blog.

Those, however, who have more of an interest in relationships and couples concerns, may wish to to subscribe to “Couples Insight” instead (or in addition to this blog). Those blog posts will no longer be posted here on Insight. 

On Couples Insight, I will continue the tradition of bringing you practical articles on how to thrive better in romantic relationships. The idea is to share some of the practical advice and insight gained from my work as a couples therapist and my exposure to the most current ideas in the couples therapy field.

Thank you all for continuing to read my blog posts. I hope to continue to dialogue with you either here on Insight, or on the new blog: Couples Insight. 

Best wishes,

Rune

Emotional Inhibition

The Causes of Depression: Emotional Inhibition

We live in a society that tells us a story of what depression really is; that wants us to believe that depression is an illness and that it is the result of a broken brain.

In a series of articles, which I have called “the causes of depression” I want to tell a different story. This story is the story of most therapists who get to know the person beneath the depression, and get a very clear understanding that depression is not an illness, but a symptom. A symptom of what? you ask. Well, it is the answer to this question that the therapy aims to discover.

In my last article, I focused on attachment traumas as one of the keys sources of depression. In this article I want to focus on emotional inhibition as a response to painful or shameful early life experiences.

The Root Cause of Emotional Inhibition:

When people don’t feel that they can be themselves, and can embrace every aspect of their own experience, they start to shrink from life. Like the lizard who loses its tail, to save its life, we humans also lose parts of ourselves when we feel threatened by other people’s judgments.

Depression is often an indication that we are no longer allowing ourselves to embrace vital aspects of the human experience; that we have become numb, stilted, inhibited, or cut off.

Book Cover for “Meeting the Shadow”

In the book “Meeting the Shadow”, poet Robert Bly speaks of life as a process of hiding ever more things in a bag we drag behind us. Over time the bag grows larger and larger. From having an initial 360-degree personality, we gradually discover that not all aspects of ourselves invite positive reactions. To keep our sense of being loved and liked, we therefore start stuffing our bag with all the parts that aren’t acceptable. Sadly, after we have gone through our childhood and adolescence, we end up with only a slice of ourselves out in the open.

As Bly states, “We spend our life until we’re twenty deciding what parts of ourselves to put in the bag, and we spend the rest of our lives trying to get them out again”

Why We Lose Touch with Our Emotions:

My own desire to understand this process of “bag-stuffing” or emotional inhibition, brought me to the writings of Diana Fosha, an emotion-focused therapist in New York City.

Book Cover for “The Transforming Power of Affect”

In her book “The Transforming Power of Affect” she gives a good overview of some the events that can happen in a person’s life to make them lose touch with the full scope of their emotions.

Generally speaking, our comfort with our own emotions stem from others being able to handle them. If others either fail to acknowledge our emotions, disapprove of them, or jump in to provide solutions prematurely, our emotions can become scary.

Without the support of another who can help us express and process our emotions, our emotions can feel unwieldy and overwhelming. They can also be felt as shameful or as weak. In either case our “bag” of unwanted emotions begins to grow.

  • A mother who is overly anxious about our desire to explore the world, can unwittingly convey the message that exploration is dangerous.
  • A father who becomes sullen when we express criticism, can convey the message that criticism is hurtful and should be avoided at all cost.
  • A peer who laughs at us for confiding in them, can make us feel weak or ashamed about sharing our vulnerabilities.

Over time, these events can take their toll, and we end up as only a shadow of our former self.

Depression as Symptom of Self-Protection:

Book Cover for A Farewell to Arms
Book Cover for “A Farewell to Arms”

In the novel, “A Farewell to Arms”, Ernest Hemingway at one point writes, “The world breaks everyone and afterward many are strong at the broken places” (Ernest Hemingway, A Farewell to Arms).

In real life, the broken parts do lead a person to become stronger, but not in a way that serves them well. To protect oneself from unbearable pain, loneliness, shame, or rejection, people develop defenses. Defenses are security measures that keep us away from unpleasant experiences, but at the price of shrinking from life, and becoming a lesser self.

  • We may develop a self-reliance so strong that we will never get hurt again by anyone, but may find ourselves lonely and unfulfilled.
  • We may disown our rightful indignation and anger and allow ourselves to be abused or mistreated.
  • We may rid ourselves of our ability to become excited because our fear of loss outweighs our courage to risk.

Each time we shrink from life or disavow a basic human emotion, we act against ourselves. The result of cutting off access to part of who we are will often lead to depression.

The solution to this depressed state does lie at the end of a pill bottle, but instead lies in a journey of once again becoming whole. We must remove our emotional inhibitions so we can reclaim our healthy life-affirming self.

Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D., a psychologist in Houston, Texas. I believe depression is a natural response to the adversities of life. If you would like to read more about the psychological treatment of depression, please visit my website.

Depressed Woman

The Causes of Depression: Attachment Trauma

As a psychologist, a question I often get asked is: What are the causes of depression?

The answer to this question is not one you will find in an encyclopedia or the latest research; it is one you will have to find within yourself.

Even though the causes of depression are multiple and highly specific to each individual, there are some common psychological causes of depression that often reveal themselves through the course of therapy.

In the coming months, I want to address these causes in a series of articles called “The causes of depression”.

In today’s article, I want to focus on attachment trauma as a frequent cause of depression. In future articles, I will address other causes, including: emotional inhibition, and unconscious conflict.

Why Am I Depressed?

Depression is a sign that you have become psychologically stuck and that some internal conflict or issue is halting your ability to deal with current life circumstances. Instead of meeting these challenges and feeling effective in your life, you are shrinking from them and feeling blocked.

The challenges you are shrinking from do not have to be conscious. Even if we may not be aware of the cause of our depression, and may not be able to point to a particular dilemma in our life, our body and psyche still keeps score. The answer to the question: why am I depressed? is thus always within me, hidden underneath layers of my more conscious understanding.

Causes of Depression: Attachment Trauma

A frequent cause of depression that I see a lot in my psychology practice is what could be referred to as an early attachment trauma.

Research is increasingly validating the idea that human beings are driven to maintain a secure connection to other people. We are not isolated individuals from birth, but highly relational beings.

When ruptures occur to our relational bonds, we react as if we are endangered.

Sometimes, in response to this threat, we may cling more to people in our surroundings. We  may abandon ourselves in order to become what we think others need us to be to make sure they want to be around us.

In other instances, we may go numb, lose contact with our feelings, and begin to live deprived and hollow lives to protect ourselves from the risk of rejection.

In both cases, we pay a heavy toll to protect ourselves from loss and rejection. The toll we pay is that we become depressed.

Avoidant attachment:

In the avoidant response to unsafe attachment, we deaden ourselves. We come to therapy complaining that we are just going through the motions or don’t feel much excitement in life. We may not even consciously feel that we need others in our life, because to feel the need is already too dangerous and threatening.

The unconscious life strategy in this avoidant attachment pattern seems to be:

“Life is not giving me what I want and I can’t do anything about it. My only option is therefore to cut out my needs for comfort and love and pretend that I don’t care about these things.”

Unfortunately, the body keeps score, and my depression is a reminder that my solution to life’s deprivations is not a satisfying one.

Anxious-Pursuing Attachment:

In the more actively pursuing response, we may come to therapy complaining that no one really knows us or appreciates us for who we are. Or, we may complain that we feel lonely even when we are with people.

In this unconscious strategy to secure love and affection, we may largely ignore our own needs. Because our main focus is to make sure that others don’t leave us, we focus mostly on them and not on us.

Of course this spells trouble because we never really feel that the other person loves us or likes us simply for us. Instead, we suspect that they only stick around as long as we cater to their needs.

In the lighter end of this spectrum, we may thus feel annoyed or deprived, or simply scared of being alone. In the more severe end of the spectrum, however, we may feel completely lost to ourselves, and be so alienated from our own needs and wishes that we don’t know what we want or who we really are anymore.

Because deep down, we don’t feel seen and don’t believe others care about us, we begin to feel depressed whenever others seem to confirm this fear. A missing phone call, a friend who is too busy, another’s desire for alone time can all activate our fears, and we may find ourselves confused about why these little slights can plummet us into the depths of a depression.

Getting to the Root of Our Depression:

In therapy, the root cause of these ways of living can often be found in early deprivations and insecurities related to our primary caregivers or early childhood experiences.

Maybe we had an inconsistent alcoholic father, who frequently let us down, or who could not consistently show his love.

Maybe our mother was not psychologically available due to prolonged periods of depression during which she would become despondent.

Or maybe we moved around a lot and found it distressing to lose our friends or to not know when emotional ties would have to suddenly be cut off.

Whatever the reason, therapy might help you discover ongoing or very specific attachment traumas that made you feel uncertain about the dependability of others and unsafe in your attachment to other people.

If this is the case for you, the recipe for overcoming your depression, will not be an anti-depressant. Instead it will be coming to terms with interpersonal disappointments, mourning your losses, and integrating a more positive view of yourself instead of viewing yourself as flawed, faulty, or undeserving of love.

A good starting point for your exploration, will be to read the book by Robert Karen : Becoming Attached. This book will help you understand the link between frustrated attachment needs and the development of depression.

 

Dr. Rune Moelbak

About Me: I am Rune Moelbak, Ph.D., a psychologist who help people discover the psychological causes of their depression. Click on link to read more about the psychological treatment of depression.

image of heart

How to Restore Love in Your Relationship

Romantic relationships tend to run a quite predictable course. Initially your partner can do nothing wrong. You are wearing rose-colored glasses. But over time, differences become annoyances and the novelty of your relationship wears off.

Most couples hit an impasse at the 2 or 3 year mark, when many couples end up breaking up or divorcing. Even those partners who stay together, may end up living emotionally disengaged lives and struggling to maintain their love connection.

This raises the question: Can couples really sustain love over time?

The Science of Love:

Couples researcher, Sue Johnson, brings us an optimistic message. She believes that we now understand why love and affection is so difficult to maintain over time, and that we now have the answers that can help us restore love when love begins to wane.

Love she says, is not some mystical feeling that we either feel or don’t feel, and we are not simply at the mercy of serendipity. Instead there is a science behind love and a predictable way to cultivate it.

This science is not new but goes all the way back to the 1950s when a man named John Bowlby began to study the interactions between mother and child.

Its name:  attachment theory.

The Lesson from Attachment Theory:

The science of adult attachment originated in Bowlby’s observations of what happens to children when their primary caregiver leaves them.

Based on these experiments, Bowlby made several observations that have relevance to understanding human motivation and adult relationship distress.

The first conclusion is that it is extremely distressing for a child to lose connection with a caregiver. The child needs the connection to feel safe, and when they lose it, they work hard to get the connection back. Bowlby, in other words, stumbled across a human need to feel connected that is so powerful that any threat to it is a real threat to our survival.

The second conclusion is that babies go through a series of predictable stages when trying to reconnect with a loved one: First they amp up their engagement level and fight for the connection. If this doesn’t work they actively protest by crying or screaming. Finally, if no response is forthcoming, they give up and numb themselves.

Have a look at this more recent experiment called “Still Face”:

Attachment Theory and Your Relationship:

So what does attachment theory help us understand about adult relationships?

Committed relationships are strong attachment bonds. We become interdependent to an extent that mimics the love between caregiver and child.

We need safety in order to risk commitment, and that safety comes from knowing that our partner is going to be there for us if or when we need them.

We need what Bowlby calls a secure attachment: a sense that we matter to our partner, that our partner thinks about us, or that we occupy a special role for our partner.

Only with this felt security, can we feel safe to be ourselves completely, to disagree, to express our needs, to let our guards down, and to show our partner our most tender feelings.

Why Couples Lose their Love Connection:

What happens in most adult relationships is that one or both partners begin to feel insecure about whether or not they really matter to each other. In this fearful state, they begin to react based on wired-in survival mechanisms.

Just like the child fearful of losing a connection with a caregiver, partners first try to fight for the connection, then protest against their partner’s lack of care or concern, and finally begin to withdraw emotionally.

Over time this corrodes the love in the relationship and replaces it with a fear-based struggle for survival.

Instead of risking vulnerability and sharing their more tender sides, partners now begin to see their partner as withholding, emotionally uninterested, demanding, or critical. The relationship becomes filled with dissatisfaction and the risk of being vulnerable becomes too dangerous.

Partners start doing a dance with each other, where one partner’s insecurities fuels the other partners insecurities in a never-ending cycle:

If you protest by complaining that I don’t care enough to do the dishes, I might withdraw emotionally to protect myself from feeling criticized in the relationship. This then fuels more of your angry protests, which makes me withdraw even more. And round and round we go…

How to Restore Love in Your Relationship:

When couples come to couples therapy, they often don’t know that fears have taken hold of their relationship. They are not aware of the underlying feelings of insecurity and lack of safety that are causing them to disengage or feel dissatisfied with their partner.

Couples therapy can help couples get in touch with their underlying vulnerabilities and longings that they have shut out in order to be strong and protect themselves.

It can help them reestablish safety in the relationship so that needs and feelings can be expressed directly without a fear of being “left hanging” or being “shot down”.

Building a Safe Attachment:

Only when safety is restored can love begin to flourish and grow.

As Sue Johnson, would say, we now know the steps needed to build a safer attachment between partners. And with this knowledge we know the recipe for restoring and maintaining a strong love relationship.

If you would like to read more about beginning the conversations that will lead you from an angry and unsafe attachment to a safe and loving attachment, read Sue Johnson’s book: Hold Me Tight. 7 Conversations for a Life-Time of Love.

You can also visit a therapist with training in attachment focused couples therapy. The most well-researched approach is Emotion Focused Couples Therapy or EFT.

Dr. Rune Moelbak

About me: I am Rune Moelbak, Ph.D., psychologist and couples therapist in Houston, Texas. I have received training in some of the most effective methods of couples therapy, including Gottman Method and EFT.

 

 

Should I Take Medication for My Anxiety and Depression?

the truth about medication for depression and anxiety

Questions You Should Ask Yourself about Psychiatric Drugs:

Psychiatry is in fashion these days. Increasingly people are choosing to “pop a pill” to rid themselves of their depression or their anxiety. Statistics show that every 10th adult in the United States is currently taking an anti-depressant as part of their daily routine.

Oftentimes, however, people are not that well informed about what this kind of psychiatric treatment really means for their long-term health.

The story we are being told in advertisements is that depression and anxiety are “disorders” with some supposed biological basis, and that anti-depressants are to depression, what antibiotics are to an infection.

Although I am not against medication for psychological issues by default, and do believe there are cases when medication should be considered, all too often in my work as a psychologist, I encounter people who have suffered terrible faiths by going down this path.

Before considering medication for your anxiety or depression, or for any other psychological issue, here are three questions I would ask myself…

Can We Trust Psychiatric Research?

Although research generally shows some efficacy for psychiatric medication for a variety of concerns, including anxiety or depression, there are many caveats that should weigh heavily in people’s decision to treat their anxiety or depression with medication.

The profession of psychiatry in the US has very unclear boundaries in relation to the interests of pharmaceutical companies.

The consequence of this is that what appears like objective science frequently crosses the boundary into rhetoric and marketing. Pharmaceutical money pervades some, if not much of psychiatric research. Many studies that show the effectiveness of a particular drug is bought and paid for with pharmaceutical money. The flip-side of this is that if no benefits are found then we simply won’t hear of the study. This slant toward publishing only results that confirm the interests of those who finance the studies has undermined my own faith in much of psychiatric research.

For more information about the ties between psychiatry and Big Pharma, read Daniel Carlat’s book Unhinged, which will give you a good overview of some of the unclear ties between truth and money in the field of psychiatry.

Do We Know the Long-Term Risks?

In addition, it is concerning that we don’t quite know what the long term effects are of taking psychiatric medication.

In some cases, the long-term effects are quite clear. It is well known that some anti-psychotic drugs cause diabetes, weight gain, and sometimes permanent brain damage that can result in weird tongue movements.

Why should this be of concern to people with depression and anxiety? Because advertisements are currently telling people to ask their doctor to add the anti-psychotic Abilify to treat their treatment-resistant depression.

Other sources indicate that the long-term use of many of the most common psychiatric medications, such as anti-depressants and anxiolytics (anti-anxiety agents like Xanax), change the person’s brain chemistry permanently and make you more susceptible to relapse, once you stop taking them. In other words, unless you want to take them for life, you may be better off not taking them at all.

Robert Whitaker’s book on “The Anatomy of an Illness” and Peter Breggin’s book “Toxic Psychiatry” both weigh in with some alarming arguments that cannot be taken too lightly.

Is it Philosophically Sound?

Finally, I think we have to question if it is philosophically sound to treat anxiety and depression as if they were simply ailments to be cured, rather than symptoms or signs of something that is not right in our lives. No matter if medication can indeed make us more numb to our pain, or help alleviate our anxiety, they are no substitute for introspection into our patterns of behaving.

It is human to struggle emotionally and to be caught in difficult dilemmas. We all feel down-trodden and incapable at times. We all have to struggle to create close ties with others, to risk love, to endure loss, and to face rejection. We all have childhood wounds and special sensitivities. Life is not easy, but we learn from it, and we develop strengths and wisdom through the insights taught to us by our emotional pain and struggles. There is no medication for life itself.

Should I Take Medication for My Depression or Anxiety?

Since we know psychotherapy is effective for helping people not just cope with their depression and anxiety, but make sense of it, and use it as a growth opportunity, why would anyone as a first choice choose to gamble with medication?

Psychiatric medication may sometimes be the best or the only option, but it should never be the first choice. I respect each client’s right to make their own free choice, but given the ambiguous picture of benefits and risks of taking medication for your anxiety or depression, I would be both cautious and conservative.

Unfortunately, many times we don’t get the opportunity to make this choice. Few people really know the literature that warns us of risks and dangers, and the general societal discourse, backed with pharmaceutical money, marketing, and pseudo-science tells us a propaganda story. Science is not so neutral after-all, and no profession is going to openly turn its back on its own bread and butter.

This is why in today’s society, it pays to be an informed consumer.

Dr. Rune Moelbak

About me: I am Rune Moelbak, a psychologist in Houston, TX, who treats people – not disorders. To read more about how I can help you with your anxiety or depression, visit my website: www.bettertherapy.com

 

Broken heart symbolizing divorce

4 Signs that Your Marriage is Headed for Divorce

Couples therapist John Gottman has identified 4 behaviors that are so destructive to relationships that they will almost certainly lead a married couple to divorce.

Due to their ominous nature, he calls them the “4 horsemen of the apocalypse” and because of their destructive nature, they must be stopped at all cost.

Although we almost inevitable end up engaging in these behaviors, it is important to be vigilant about their presence and make conscious efforts to reduce or minimize their impact on your marriage.

Want to know what the four horsemen are? Let’s go through them one at a time:

Criticism:

Couples who divorce often have an unfavorable ratio between complaints and appreciations. John Gottman has argued that about 2/3 issues that married couples fight about have to do with personality differences that are ultimately unresolvable. In strong marriages, couples find ways to develop a greater appreciation and understanding of these differences. They realize that we don’t marry a partner simply to be with a carbon copy of ourselves. In married couples who end up divorcing, however, differences instead turn into annoyances, and annoyances into fights. Instead of asking for constructive changes from one’s partner, or taking the time to understand each partner’s perspective, couples headed for divorce instead engage in a barrage of complaints. In many marriages that are close to the point of divorce, partners often feel that they are always being criticized or are never doing things right. After a while such a marriage becomes tiresome, and each partner begins to retreat in order to self-protect.

Defensiveness:

When you feel attacked and criticized, you defend. Defensiveness is one of the hallmarks of a flailing marriage. Instead of having conversations and being curious about each other, couples who are on their way to a divorce, tend to simply stick to their guns and play the blame game. Instead of listening for their partner’s feeling and showing that they care, they instead focus on telling their partner why their complaint is unreasonable or wrong. Over time, each partner becomes an island onto themselves, focused simply on proving their own point at the expense of their partner. In this kind of atmosphere, each partner ends up feeling not understood and this of course leads to emotional disconnection. When you are at war, you retreat behind a wall and stop making yourself vulnerable and receptive to your partner. With so much effort dedicated to defending, love dwindles, and both partners often end up feeling deprived and unhappy.

Contempt:

Being in an intimate relationship with a partner is not only a source of joy and love. We often also experience intense anger and even hatred. When our partner disappoints us, when we feel afraid of losing them, or when we don’t feel unconditionally cared for, intense anger is often evoked in us. Although the adult part of us realizes that love is never unconditional, the child within often has a fantasy that it is. When our inner child feels deprived, strong feelings can be evoked that can lead us call our partner names and make comments that undercut our partners’ self-esteem. However, it pays to think twice before saying such things. John Gottman found that couples who end up divorcing, tend to have a high rate of contempt and hostility toward each other. Whereas strong marriages are slanted toward interactions that serve to build each other up, couples who end up divorcing oftentimes end up in negative cycles of cutting each other down.

Stonewalling:

Although some couples think simply ignoring their spouse is a pathway toward peace, fact is, the absence of a response, can be like depriving your partner of oxygen. Researchers on human attachment have found a lack of response a much greater sign of danger than an angry response. For this reason, many couples actually pick fights or provoke their partner into feeling angry or jealous. At least, with this response, they know their partner “sees” them and that they more than likely care. When our partner simply ignores us, it is easy to feel that we don’t even exist. At the level of our “animal” instinct or mammalian brain this often gets interpreted as a danger signal that we are without support and that nobody cares about our existence. Since at our core we are social beings, such absence of love is a threat to our basic survival needs and can send us into panic. In certain partners who had parents who often were absent, any resemblance of this deprivation will evoke fear and anger at their partner for inducing this fear. John Gottman also found that couples who stop acknowledging their partners existence and start to live parallel lives are at the greatest risk for divorce. It is often much easier to restore connection in couples who fight a lot, than it is to restore it, in couples who have simply shut down their emotional response to each other. So the next time you give your spouse the cold shoulder or ignore their bids for connection, know that you are causing harm to your marriage, and try to find at least some way to engage.

Dr. Rune MoelbakAbout Me: I am Rune Moelbak, Ph.D., a couples therapist in Houston, Texas. I help couples develop better communication skills and restore emotional connection.                     To read more, visit my website: www.bettertherapy.com

therapy as a machine

What’s Wrong with Empirically Supported Treatments?

Psychologists in the field of psychotherapy like to engage in debates about scientific proof. Oftentimes this leads to arguments about which therapy has achieved the status of an “empirically supported treatment”…

An empirically supported treatment is a therapy that has been proven to work for a particular mental health condition. If you have received a diagnosis of social anxiety disorder, for example, an empirically supported treatment would be one that has been found to reduce social anxiety with a reliability higher than that of no treatment or an alternative treatment.

So what’s wrong with that?

To answer that question, we have to dig a little deeper…

The Mechanics of Empirically Supported Treatments:

The mindset that underlies the movement toward empirically supported treatments and the scientific quest for proof is a mechanistic one.

Therapy is perceived as a set of procedures the therapist “administers” to the client in order to achieve some predictable result.

For this to work, the therapist must agree to deliver interventions according to certain fixed procedures that show “fidelity” to the specific treatment that is being tested. The therapist, in other words, must simply become the tool or vessel for the treatment.

The client on the other hand must be reduced to the passive recipient of the “treatment”. It is not even clear that their subjective experience really matters. What matters is the “end result” or effect that the treatment produces. The client is, in other words, just a set of mental and physiological reactions that can be manipulated or caused in some predictable way.

In short, the philosophical underpinnings of the movement towards empirically supported treatments are mechanistic: The client becomes an object in the causal chain of action and reaction that makes up the physical world, and the therapist becomes the engineer who figures out how to induce change in the object.

Empirical proof in this model is found through observing or measuring mechanical changes in the client who after treatment may or may not feel anxious anymore, may or may not report feeling depressed, or may or may not function better in their relationship.

This kind of proof separates cause (treatment) and effect (results) and looks to some external reality for validation that the treatment has had a positive effect.

Why Therapy is not a Mechanical Process of Change:

In reality therapy is an interpersonal process where the therapist learns from the client, just as much as the client learns from the therapist.

The therapist will often entertain multiple hypotheses about the dynamics that could explain the client’s difficulties, but these can be overturned, altered, or refined based on what the client shares and how the client reacts to certain interventions.

The assumption that the therapist unilaterally administers treatment as some engineer aiming for a predictable result, is therefore flawed. Therapy is about learning, not about producing.

The sign of a good therapist is not the ability to be true to a certain therapy modality, but his or her ability to deviate and change course in response to what they learn from the client and jointly discover through the therapy itself.

This also means that the therapist cannot be guided by specific goals or predefined interventions, because what a client wants or needs, and what would be effective, changes depending on the moment and the context of each interpersonal encounter and each specific interaction.

Oftentimes what is therapeutic about therapy is precisely that it overturns previous knowledge and makes new possibilities and hypotheses appear.

A problem or disorder is thus not some “static” thing like a tumor or a bad tooth, but a temporary stopping point on a journey toward a much more complex understanding of various life issues that inevitably end up becoming the real “object” of the therapy.

Evidence of Change in Psychotherapy:

One of the biggest compliments I have gotten from a client was someone who told me, “the longer I keep coming here, the more uncertain I feel about what my problem really is”.

This client had initially defined their problem as a specific anxiety disorder, but was coming to the realization that anxiety is really shorthand for a host of unique and highly personal life experiences. It is not a “disorder” that calls for the administration of a specific empirically supported treatment, but a very personal sign of other life issues or problems which the person has yet to confront.

Good therapy helps clients dislodge themselves from preconceived notions of their problems and helps them discover needs and desires they were not aware of from the outset.

This also means that the empirical proof we are after is not some preconceived end goal to be measured only at the conclusion of the therapy.

When therapy goes well, goals and priorities change, problems get overturned, and new issues become salient. This dynamic process of change has to be allowed to unfold according to its own rhythm and logic, and should not be hijacked by a preconceived agenda or a heavy-handed attempt to steer the therapy in a predetermined direction.

The change in this kind of therapy is not external to the therapy, to be validated only by measurements or observations after the fact. Instead it happens as an immediate experience of something resonating in the here and now that changes the client’s view of themselves in a very real and irrefutable way.

This kind of therapy is not about fitting a client into a machine-like production of change, but about facilitating a personal journey where the benefits lie in the discoveries made on the journey itself.

Dr. Rune Moelbak

About me: I am Rune Moelbak, Ph.D., a clinical psychologist in Houston, Texas. I treat people, not problems. To read about my views on therapy, visit my “about me” page, where you can also schedule a therapy appointment.