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.
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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.

 

Two Sea Stars

Approaches to Couples Counseling: The Gottman Method

Gottman Method Couples Counseling is one of the most popular and contemporary approaches to couples counseling used by couples therapists today. What makes it so unique in the therapeutic landscape is that it is entirely based on research findings from couples researcher John Gottman’s own studies of married couples.

A Research-Based Approach to Couples Counseling:

John Gottman is a psychologist and researcher who has spent more than 40 years researching couples. Based on his research, he claims to be able to predict which married couples will divorce and which will stay married with 90 % accuracy.

One of the innovations of Gottman’s approach to research was that he observed how couples interacted in a live-in environment just like in the show Big Brother. Through the multiple cameras installed, he was able to see how couples interacted naturally. By studying hundreds of couples this way, he was able to catalogue the behaviors in people who stay married, as well as identify behaviors in those who get divorced.

Based on his research Gottman has constructed a theory of all the behaviors successful couples engage in, which today has become known as “The Sound Relationship House”

The Sound Relationship House:

Sound Relationship House

The Sound Relationship House contains all the elements found to predict relationship success in what is now called the Gottman Method of Couples Counseling.

First we have the pillars of the relationship: Trust and Commitment. These are fundamental to creating the boundaries for there to even be a relationship. They involve being faithful to each other and developing the trust needed to be emotionally vulnerable. According to Gottman, without these pillars in place, you cannot build a sound relationship.

Once the boundaries of the relationship have been established, couples can begin to focus on creating a house in which they want to live.

The foundation of a good relationship is what Gottman Method Couples Counselors refer to as “the friendship system”. The friendship system contains all the elements that make a marriage worthwhile.

In what Gottman calls “Build Love Maps”, the goal is for couples to develop a clear and accurate knowledge of what makes each other tick. You have to allocate “room” in you brain for the other person and to truly know who they are. You have to have a “map” of your partner’s world, otherwise, who are you really in a relationship with, but yourself?

In the Gottman Method of Couples Counseling, couples are also advised to build each other up through creating a culture of sharing their fondness and admiration for each other.

An interesting novelty of Gottman’s research is the idea of “turning towards”, which denotes all the little micro interactions we engage in where we drop what we are doing to respond to something our partner is interested in. They are little moments of connection that seem minor and insignificant, but start to wane when couples grow distant or begin to not like each other much.

Finally, Gottman advocates that partners find ways to laugh at disagreements, give their partners the benefit of the doubt, and otherwise a adopt a positive and lighthearted perspective.

Together these four elements create a strong friendship filled with love, affection, and intimacy.

Only when couples have a strong friendship as their base is there enough love in the “love tank” to make them endure the more difficult times and the many disagreements in values and preferences that are bound to happen over time.

The upper elements of the sound relationship house include conflict management skills, as well as creating shared meaning in the relationship. Conflict management is about learning to communicate with your partner in ways that do not make them defensive, and yet makes you feel heard. Creating shared meaning, refers to creating dialogue around each partner’s dreams and growth ambitions, and having conversations about where the relationship is headed.

How Can Gottman Method Couples Counseling Help Me?

The Gottman Method of Couples Counseling is about teaching couples the skills needed to build their own sound relationship house. The assumption is that couples can learn to emulate ways of interacting and doing things that have been observed in couples that end up staying together.

The Gottman Method is a skills-based approach to creating a strong relationship. By doing more of the right things, and doing less of the relationship-damaging things, you can make your relationship grow in the direction of greater intimacy and satisfaction.

A novelty in the Gottman Method of Couples Counseling is that the therapist acts as a coach or facilitator who helps couples interact with each other by using new rules and guidelines. The goal is for couples to become independent of the therapist and for the therapist to transfer his or her own skills to the couple.

Does the Gottman Method of Couples Counseling Work?

Learning some of the skills of successful couples communication and friendship building can be immensely useful to couples who are often turning to a couples therapist because they just don’t know what to do.

Making a relationship work definitely involves skill, and having some knowledge about what to do, can be very helpful.

One of the limitations of the approach is that it can seem very technical.

In my opinion, couples need more than skills to succeed in their relationships. They also need a deeper understanding of their own needs and desires, and an emotional experience of greater closeness with their partner.

There are simply times when the therapist has to stop being a coach who teaches skills, and has to become the facilitator of greater access to buried emotions and fears in each partner.

In my own couples therapy practice I therefore believe in combining multiple approaches to couples counseling. Although I have training in the Gottman Method and frequently teach my clients new skills, I also have a sound understanding of other more emotion-focused approaches.

Ultimately I believe couples need an emotional experience of change rather than simply a set of techniques.

If you would like to learn some of the techniques utilized by couples therapists, sign up for my free couples guide (click on image):

Couples Guide

Dr. Rune Moelbak

About Me: I am a psychologist and couples therapist in Houston Texas. I have received training in the Gottman Method as well as other couples therapy approaches. To schedule an appointment visit my website: www.bettertherapy.com

psychodynamic conflict

What is Psychodynamic Therapy?

For consumers contemplating seeing a therapist, there are many types of therapy to choose from. One of the most widely practiced forms of therapy, is psychodynamic therapy. But what does psychodynamic therapy really mean? 

What is Psychodynamic Therapy?

Psychodynamic therapy starts from the assumption that people are caught in multiple struggles between opposing demands, impulses, fears, and wishes.

A simple and humorous example of this can be found in the following cartoon, which illustrates the vicissitudes of the human psyche:

Mr. Lovenstein: Adult
Mr. Lovenstein: Adult

The person here is damned if he does – and damned if he doesn’t: A typical dilemma, in which we humans find ourselves…

  • He likes the freedom that comes with being an adult, and abhors the alternative, which would mean being a dependent child without autonomy and choice.
  • However with the pleasant realization that he is an adult, comes the unpleasant realization that freedom comes with responsibility. He is now parenting himself and has to set boundaries on his own desires. The price he pays if he transgresses is: guilt.
  • And yet, he fights back against his internal doubt and asserts his free will to do as he pleases…
  • But when he now chooses to eat his ice cream, he can no longer enjoy it without an intense feeling of shame for having done something wrong.

A Lesson in Psychodynamics:

This simple storyline, humorous as it may be, conveys very well what psychodynamic therapy is really about.

According to a psychodynamic viewpoint, we are often in internal battles with ourselves, having feelings, thoughts, and wishes that pull us in opposite directions all at once.

The result of being such a house divided against ourselves is a sense of anxiety and inner unrest, which only human beings can feel. Since this anxiety is such an aversive feeling to us, we will subsequently go to great extent to avoid it or to find some kind of solution that will silence the conflict within.

To solve our conflicts we will defend against one of the feelings so as to create psychological balance where there previously was none. The way we do this is by deploying psychological defenses that distort the facts of reality for the sake of keeping our inner peace.

Defenses against Internal Conflicts:

Our ice cream lover could attempt to defend against his anxiety in a number of different ways, each of which would reduce the conflict in some way:

  • He could subject himself to his own rigorous parental authority and create rules for how virtuous he has to be to truly earn his ice cream: “I will allow myself an ice cream only on my birthday, and only if I have achieved my goals at work”
  • He could take on the identity of a “rebel” and push away all respect for authority in an attempt to minimize his own “guilty boy” syndrome: “I am not going to follow any rules because authorities don’t know what they are talking about”
  • He could rationalize his sinful enjoyment, by looking only at the evidence against the validity of current research: “Health fanatics always change their mind about what’s healthy and what’s not. They will probably discover that ice cream is healthy in just a few years.”
  • He could also punish himself after enjoying his ice cream, so as to atone for his sin: “I am going to not eat for a week, in order to make up for my weight gain”

These are but some examples of how the human psyche works to help us resolve our internal conflicts.

The Price We Pay for our Defenses:

The bad thing about defense mechanisms is that they have to twist reality in order to make certain feelings, wishes, or thoughts go away. Hence, the more internal conflicts we experience, the more out-of-sync with reality we end up becoming. Gradually we come to live in a reality where certain feelings, wishes, or thoughts get dimmed, shunned, distorted, or repressed. We substitute a fictional reality for the real world in order to preserve our psychological safety.

Another bad thing about defense mechanisms is that if they are challenged in any way, the anxiety is looming right beneath them. This means that we often don’t really have a choice to act any differently than we do.  Hence, we are forced to punish ourselves after eating an ice cream, because if we don’t, our anxiety, our guilt, or our shame will return. We are thus not really in control of our life, but are controlled by our desire to escape from unpleasant feelings which threaten to besiege us.

Our Conflicts Are Often Unconscious:

Most people who come to therapy don’t enter the consulting room with the understanding that they have unresolved internal conflicts. Nor do they know that the symptoms they are experiencing might be the result of defense mechanisms that serve to keep anxiety at bay. Instead they simply feel depressed, anxious, unable to enjoy certain things in life, or besieged by feelings of guilt, shame, or inhibitions.

The goal of psychodynamic therapy is to help people understand the dynamics underlying their most troublesome symptoms so they can begin to make sense of why they feel compelled to starve themselves for a week, why they can’t enjoy having sex with their partner, or why they have become depressed in their marriage.

Often at the first therapy session, symptoms such as these do not make sense, and seem entirely arbitrary.

This is good news for the medical profession, which is quick to jump on this to suggest that the cause is purely biological or brain-based, a conclusion which can seem quite legitimate to the person who suffers without reason.

It is also good news for cognitive-behavior therapists  who can readily get buy-in for the idea that symptoms have no deeper meaning or logic, but should be treated as if they themselves were the problem.

Yet, when clients are helped to become curious about their life and begin the work of talking freely and openly about the full range of their experiences, more clues begin to appear that will eventually allow both client and therapist to discover an underlying logic of the distressing symptom.

An Example of Psychodynamics at Work:

A depressed immigrant from India initially entered psychodynamic therapy because his wife was not happy with him and was thinking about divorce. As his therapy progressed, it became clear that the client had defied his parents’ wish that he enter into an arranged marriage. Although the client initially experienced his choice for a love marriage as a victory for his own autonomy, it was as if another part of him continued to feel guilty about his choice and unconsciously acted in ways that sabotaged his love marriage.

From a psychodynamic perspective, the client was not simply being irrational or self-destructive. Instead he was trying to resolve an unconscious conflict between retaining autonomy and not upsetting his parents.

The solution he had found helped him equalize his guilt feelings, while at the same time preserving his conscious sense of autonomy. He was simultaneously choosing to be in a love marriage and choosing not to be in one, thus appeasing both himself and his parents.

To make this solution viable, of course, he had to deny that he was pleasing his parents in any way. However, he also had to turn a blind eye to the fact that he was acting in ways that were destined to make his marriage fail.

His depression was a defense mechanism in the sense that it protected him from looking at his own subjective agency in choosing whether or not to make his marriage work. His despondency and perceived powerlessness helped him avoid confronting an underlying conflict that would give him anxiety.

Psychodynamic Therapy Helps You Get to the Root of Your Problems:

Psychodynamic therapy helps people uncover the conflicts underneath their symptoms so they can reclaim control of their lives.

In the case of the Indian spouse, discovering the underlying conflict would make it possible for him to confront his guilt feelings so he wouldn’t have to unconsciously punish himself by making his marriage fail. By increasing insight into his psychodynamic conflicts, he would be able to address the real issue underlying his depression and his marital problems.

The Effectiveness of Psychodynamic Therapy:

Helping people get to the root of their problems, is precisely what makes psychodynamic therapy such a powerful treatment.

Research on psychodynamic therapy shows that not only is it effective in helping people resolve their problems, it even continues to increase its benefits after treatment ends. Because it does not only focus on immediate symptom relief, but allows people to confront what motivates their symptoms, psychodynamic therapy helps people gain control of what causes their distress.

By helping people gain insight into underlying causes that make it difficult for them to enjoy their life, psychodynamic therapy works much like the old proverb that says, “give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime”.

Rather than just feeding you a solution, psychodynamic therapy helps you get in touch with what produces the problem, so you can finally claim ownership of it rather than continue to pursue temporary “quick fixes” that only serve to cover the real problem up.

This is why I believe psychodynamic therapy.

Image_Moelbak_frontpage

About me: I am Rune Moelbak, Ph.D. a psychodynamic therapist in Houston, Texas. I help people get to the root of their issues. To book a therapy appointment, visit my website at: www.bettertherapy.com

image of couple arguing

How to Communicate with Your Partner without Starting a Fight

A frequent concern couples have is how to express their disagreements without starting a fight.

Learning how to communicate with your partner in a way that minimizes your partner’s defensiveness and makes it possible to have a conversation and not an argument is vital to the success of any relationship.

Having a conversation and having an argument are two very different things…

Argument:

In an argument, we try to convince our partner that we are right and that they are wrong. Oftentimes this leads to an escalation of conflict, because our partner is unlikely to simply agree that we are right, and is more likely to defend themselves or find convincing arguments why we are wrong. Even if our partner agrees with us, we may discover that it is a rather hollow victory: Our partner may simply have agreed with us to keep the peace, and may gradually end up becoming more distant from us, as they increasingly begin to feel that there is no room in the relationship for them to be who they are.

Conversation:

In a conversation, on the other hand, the focus shifts from convincing your partner that you are right to truly understanding your partner’s perspective. Even if you don’t agree about something, you can still attempt to understand what motivates each of your actions, and what feelings, beliefs, and perceptions underlie each of your complaints. The benefit of this approach, is that each partner can then feel heard and understood, and this typically brings partners closer to each other, and increases both partners tolerance and appreciation for each other’s differences.

How to Communicate without Starting a Fight: 

In the Gottman Method of couples therapy, couples are instructed to use the following guidelines in order to learn how to communicate without starting a fight:

Speaker:

  • Initiate a conversation in a soft rather than accusatory manner
  • Focus on your own experience, not on your partner
  • Focus on stating a positive need, instead of complaining about what your partner isn’t doing

Starting a conversation in a soft manner can be done in many ways. It can involve things like acknowledging that “you may or may not be right”, that “it is probably ridiculous to even bring this up, but…”, or that you don’t want to start a fight and you know that your partner is “doing many things right, but…” This is different from a more abrupt start up where you communicate that you feel entitled to your complaint and come across as self-rigtheous and accusatory.

Focusing on your experience means taking the focus off your partner, and sharing your own internal reactions, feelings, and interpretations. Instead of labeling your partner’s actions, or speaking about a situation in absolute terms, you turn the focus inward. Instead of saying things like, “it wasn’t right when you…” or “you were being very inconsiderate when you”, you instead look beneath your self-righteous anger and get in touch with your softer and more vulnerable emotions. Say something like, “I guess when you came home late again tonight (non-judgmental description), I started feeling lonely and started thinking that I wasn’t very important to you” Not something like, “you know you are always late, and I’m getting tired of sitting around waiting for you. It seems like you just don’t care about my feelings”

Focusing on stating a positive need instead of a criticism, means trying to pinpoint what it is you would like the two of you to do more of. In the example of your partner being late, the hidden need might be for the two of you to be closer with each other. Your sense of loneliness and disappointment when your partner is late, might be a clue that you have been feeling distant from your partner for a while. The trick now is to state what you want rather than what you don’t want. Instead of saying, “I’m tired of you being late”, you might instead say, “can we do more things together where we can connect with each other. I have been feeling rather lonely as of late”.

If you learn how to communicate with your partner using the three rules above, likelihood is that your partner will not feel attacked and will be able to actually listen and respond to your concern…

Listener:

If you are not the person voicing the complaint, but instead the one having to respond to your partner’s criticism, try to apply one of the following skills:

  • Don’t defend yourself or counter-attack
  • Validate your partner’s experience

Don’t defend yourself when your partner brings up a concern. Even if your partner may bring up an issue in an accusatory way, realize that underneath the anger, your partner likely feels hurt, rejected, or wounded in some way. Even if you notice yourself getting angry and ready to counter-attack, try to bite your tongue. Make a conscious decision to set your own issues to the side for the time being, and begin to listen for what your partner is really feeling and experiencing.

Validate your partner’s experience. You may not agree with how your partner interprets or sees things, and your partner’s feelings may seem quite irrational to you. This, however, is when you must make an effort to ask clarifying question to understand how your partner has arrived at his or her conclusions. You must try to find the logic in your partner’s perspective, so you can repeat your understanding back to them. Try to acknowledge and validate that if you were in their shoes, made the same kinds of interpretations, and had the same kind of values, you too would feel the way they do. Realize that by validating and saying that you understand, you are not saying that you agree, nor are you saying that your own feelings are invalid. In a relationship there is room for two valid perspectives on the same situation. The important thing is that both of you can feel that your perspectives are heard.

A Small Change Can Have a Large Effect:

Whether you are “the speaker” or “the listener”, it is important to realize that you can change an interaction by doing any of these 5 suggestions at any point in an interaction. Maybe your partner brings up a concern in an accusatory manner, and you decide to not respond in a defensive way, thus breaking the typical cycle of attack-defend. Or maybe you correct yourself in the middle of voicing your own complaint by making an effort to focus more on your own feelings than on labeling your partner’s. Each time you stop reacting to your partner and make a conscious decision to take control of the interaction, you increase the likelihood of turning an argument into a conversation. The benefits of learning how to communicate with your partner can be profound, so the next time you find yourself itching to let something off your chest, try using one of the five rules.

About me: I am Rune Moelbak, Ph.D. a couples therapist in Houston, Texas. I use a variety of proven methods to help couples get their relationships back on track. Visit my website to read more about my approach to couples therapy or to schedule an appointment.