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.
Good Will Hunting

Is Talking Disappearing from Depression Therapy? (Commentary)

This week, a story in Newsvalley, asked the question “Is talking disappearing from depression therapy?”

The question followed the death of beloved actor, Robin Williams, who was reported to have been seeing a therapist for his depression in the period preceding his eventual suicide.

Robin Williams himself starred as a therapist in the award-winning movie Good Will Hunting, where his character touched the heart and mind of a troubled young man through the kind of talk therapy the article is wondering if might be disappearing.

Talk in talk therapy is of course a lot more than talk. It is about facilitating the kind of speech that evokes forgotten or suppressed feelings, and may never have been spoken before. It is creative or novel speech, not simply the rehashing of old events or the telling of stories. In and through speech people discover what they really think, just as is suggested by the expression: “to know what I think, I must first see what I say”. Speech, when it is therapeutic, or spoken from the right place, is a lot more powerful than we give it credit for…

We Are a Culture of “Doers”:

Unfortunately we live in a culture that does not value speech. The expression, “she’s all talk and no action” communicates that what matters in life is to act, and that thinking and talking are simply pre-stages to actions.

When Democrat John Kerry ran for president a while back, I remember with amusement, how Fox News spun his trip to France as an indicator that he was an “intellectual” not a “doer”. In America we don’t sit around thinking lofty thoughts like the “French”, the newscasters suggested, we “get things done!” Ludicrous as this spin was, it likely struck an emotional cord with most Americans, who have been brought up in a highly competitive capitalist society and have been taught to value productivity and accomplishment above all.

This kind of action-orientation has also found its way into the field of mental health. The popular understanding of problems of living is that they can be mastered just like another work-assignment. Barnes and Noble is full of self-help books that promise amazing results through easy steps and suggestions for whipping oneself back into shape. They espouse the idea that thoughts can be “engineered” and that you can choose to act differently through various mind-tricks.

The Engineering of Depression Therapy:

This mentality has of course also found its way into the ranks of therapists who are quick to embrace this popular view of psychology as a toolbox of tips and tricks to master one’s issues. Undoubtedly driven by a popular demand for this kind of solution- and action-oriented approach to problems, therapists have been eager to adopt a new line of “technical” treatments for mental health problems.

CBT or Cognitive Behavior Therapy is quickly replacing the kind of relationship-based “talk therapy” that helped the character Will Hunting confront his depression. Therapists eager to meet the popular demand for quick solutions, and training programs eager to turn therapy into a technology, have rushed to embrace this newer more modern alternative to traditional talk therapy. Research studies are often touted as showing the superior benefits of CBT, and psychiatrists now prescribe it, like they prescribe a pill.

The Problem with CBT for Depression: 

Unfortunately, the kind of therapy that benefitted Will Hunting, would not have been accomplished through CBT. A person does not experience a transformation in how they feel about themselves by filling out worksheets, or approaching their problems by becoming more rational about them.

The cure of Will Hunting was an emotional cure. Robin Williams was attuned to Will Hunting and was able to work with him so that Will was able to speak new words, and speak them from a new place within.

This new place within has to be accessed and discovered in and through a gradual and unfolding process, where a person first has to become vulnerable. Will had to trust his therapist, not by some rational command to do so, but by having a new experience of relating to another human being.

In the process of deepening his trust, Will had to be made aware of all the barriers to letting his guards down, including his fears of his emotional pain, his anger at others, and a host of other feeling and reactions that this kind of therapy process evoked in him.

And of course, along the way, Will had to speak of these new or sometimes “old” (but forgotten) experiences so as to make them part of himself and part of his own spoken reality.

Our Reality is Made of Words:

As cultural beings, we live in our words. Our human reality is a spoken reality: a reality of meanings brought forth by words and ideas.

Existentialist philosopher, Martin Heidegger, talked about language as “the house of being”. By this, he meant that language gives our ambiguous reality a kind of permanency that we are able to live within. This kind of permanency can consist of a “common sense” understanding of the world, that we are not even aware of, but that we take for granted when we approach ourselves as a technical machine in need of a quick fix, or think of our problems as “issues” that should be managed, mastered, and controlled.

Will, however, needed to let go of control, not increase it, and he needed to speak from a place that was different from the place he inhabits in his day-to-day life. He did not need his issues to be turned into problems to be mastered like another work-assignment. He needed space and patience, so he could begin to hear the voices of his subdued and suppressed feelings. He needed therapy to be an experience, not a set of procedures or dictates convincing him to be more rational or act opposite to his feelings. He needed to stop “doing”, and start “listening”. He needed to let go of his need for mastery, so he could begin to receive a different wisdom from within.

The Best Therapy for Depression:

The kind of talk therapy provided to Will Hunting is in my opinion the superior therapy for depression.

Depression may temporarily be mastered through consciously challenging and rectifying irrational thoughts, but it cannot be cured until the emotions fuelling the irrational beliefs are experienced and reworked in and through the therapy.

What motivates us to act is not simply will-power and logical understanding. We are driven to act and to repeat patterns in our relationships by our feelings, not our thoughts.

CBT rests on the assumption that feelings are simply the bi-products of ways of thinking and that a conscious choice to think differently will also make us feel differently.

I believe this way of thinking is overly simplistic. Most times people can quite readily see that their depressive thoughts are quite irrational, but that does not change a thing. Simply telling somebody or telling oneself that one’s thoughts or feelings are not rational, or replacing them with a more rational alternative, does not have the power of conviction needed to truly transform how we feel about ourselves. The goal of therapy should therefore not be to increase mastery of our feelings through our reasoning. Instead it should be to bypass our reasoning altogether, so we can effect change directly at the emotional level.

Why Talking May Be Disappearing from Depression Therapy:

The problem with the kind of therapy “Will Hunting” received for his depression is that it is hard to sell to someone who has not yet experienced it. It is a bit like describing how great a hamburger tastes, or telling somebody how thrilling a roller-coaster ride will be, to somebody who has never tasted a hamburger or been on a roller-coaster ride. To truly understand it, you must experience it, and until you have, it won’t make much sense.

In addition, because people don’t understand talk therapy until they experience it, they don’t know to ask for it, nor do they even know they want it. This makes it a much harder sell than CBT, which readily fits with our common sense understanding that our problems are best solved by will power or by technique.

And yet at the end of the day, Will Hunting was transformed, not by doing, but by slowing down and getting in touch with something stirring within. His was a talking cure , not a technological intervention.

About me: I am Rune Moelbak, Ph.D., a psychologist in Houston, Texas. I am a therapist providing psychodynamic therapy for depression.

How to make up after a fight

Relationships: How to Make Up After a Fight (and Learn From It)

A sign of a strong relationship is not that you never fight or argue. Disagreements and arguments are inevitable when we are emotionally invested in someone. Contrary to popular wisdom, however, fights do not have to tear us apart, but can actually serve as pathways to greater intimacy… 

Couples who don’t fight can only avoid doing so by suppressing their feelings and withdrawing emotionally, and this is not a sign of a healthy relationship.

The secret to a fulfilling relationship is therefore not to avoid saying or doing things that will lead to a fight, but to be able to recover from  fights when they DO happen and to learn from them.

Unfortunately some couples never revisit each person’s complaints after the fight is over. Happy to be done with the disagreement, they table their concerns, not wanting to start another argument. The result is that the issues leading to the fight never really get resolved. Instead they will simmer in the background and become the cause of new fights in the future…

The Cause of Most Fights

Most couples think that what causes them to fight is the expression of their needs and feelings (saying what they really think and feel). In most cases, however, this is not true. Fights usually happen because needs and feelings have NOT been expressed. The fight often erupts because one partner has finally had it and can’t stuff their emotions anymore.

What many couples fail to see is that having an argument is not the same as having a conversation.

When we argue we hurl out accusations. We are tired and fed up. We want our partner to feel sorry. We say things out of anger.

Of course this rarely works to our advantage, because our partner now feels attacked and stops listening to what we are saying.

Having a conversation, on the other hand, is about expressing yourself in a non-accusatory manner that will allow your partner to listen, and for both of you to feel understood.

Most couples fear revisiting the fight they had yesterday because they are afraid that it will simply restart the fight. They don’t know HOW to have a conversation about their issues that doesn’t turn into a fight.

But issues don’t go away just because we don’t talk about them. This is why it is important for any couple to have the skills to have the conversation that never took place.

The Aftermath of a Fight:

Couples therapist and researcher John Gottman has developed a step-by-step exercise couples can use to revisit their fight when they are calm and address the real issues that fuelled the fight. When these conversations happen they can strengthen a relationship and even be a source of greater intimacy between partners. They also tend to decrease the build-up of frustrations that will otherwise lead to fights in the future.

5 Steps to How to Make Up After a Fight:

 Here is my own modified version of Gottman’s method for how to make up after a fight and use disagreements as a source of greater connection: Sit down when you have both calmed down and are not busy or distracted and agree to revisit what happened the day before. Each person will take turn expressing their side of the story and will follow each of the 5 steps below:

1. Identify and Share How You Felt

Yesterday you were angry, but did you really stop to think what emotions fuelled the anger or why you reacted so strongly to certain things your partner did or said? It is often the case that softer and more uncomfortable emotions are hidden underneath our self-righteous anger. Have a look at the following list of feelings, to see if any of them might have been true for you:

I felt…

  1. defensive
  2. not listened to
  3. feelings got hurt
  4. totally glooded
  5. angry
  6. sad
  7. unloved
  8. misunderstood
  9. criticized
  10. took a complaint personally
  11. like you didn’t even like me
  12. not cared about
  13. worried
  14. afraid
  15. unsafe
  16. tense
  17. I was right and you were wrong
  18. Both of us were partly right
  19. Out of control
  20. Frustrated
  21. Righteously indignant
  22. Morally justified
  23. Unfairly picked on
  24. Unappreciated
  25. Disliked
  26. Unattractive
  27. Stupid
  28. Morally outraged
  29. Taken for granted
  30. Like leaving
  31. Like staying and talking things through
  32. I was overwhelmed with emotion
  33. Not calm
  34. Stubborn
  35. Powerless
  36. I had no influence
  37. I wanted to win this one
  38. My opinion didn’t even matter
  39. There was a lot of give and take
  40. I had no feelings at all
  41. I had no idea what I was feeling
  42. Lonely
  43. Alienated
  44. Ashamed
  45. Guilty
  46. Culpable
  47. Abandoned
  48. Disloyal
  49. Exhausted
  50. Foolish
  51. Overwhelmed
  52. Remorseful
  53. Shocked
  54. Tired

2. Describe the series of events that led you to feel this way

Help your partner understand how you perceived the events unfolding the day before (what led up to the fight? what made you react? and how did the fight unfold?). It is important in this step to speak from your own point of view: Describe yourself and your perceptions from an objective and detached perspective, like a witness giving an account of what they observed on a crime scene. Don’t guess your partner’s intentions and don’t assign blame. Simply focus on your interactions and how you perceived or interpreted what you heard or what your partner did. Instead of saying “when you didn’t care how I felt”, say “when you walked out during our fight, it made me think you didn’t care”. In other words, focus on how YOU made sense of the events, acknowledging that another person might not have interpreted events the way you did or assigned the same meaning to them.

3. Identify and talk about sensitivities that might have been evoked and where these sensitivities might come from

This is your chance to reflect a little bit about why you might be particularly sensitive to certain feelings, fears, or beliefs. Did feeling unloved remind you of something in your childhood? Did your fear of your partner leaving, remind you of how lonely you felt as a child? Are there times in the past when you have felt similarly to how you felt in the fight? If so, why do think you react so strongly to this particular feeling? What memories do you have involving that feeling? Is there a particular story you can you tell of a time in the past when you felt that way? Help your partner understand the underlying meaning or importance of a particular thought or feeling that you are very sensitive to.

4. Validate you partner’s perspective

When one partner goes through these 3-steps, the other partner’s job is to listen, ask open-ended questions, and clarify to make sure they understand. The listener should not defend themselves, or argue against the other person, but simply try to “get” why the other person reacted how they did. Validating means conveying to your partner that you understand why they reacted the way they did. To validate your partner is not to agree that your partner is right, and you are wrong. It is simply to convey that given a similar set of circumstances, and a similar way of interpreting events, you too would feel the way your partner does. It is important for your partner to hear that you get them, even if you don’t see things their way.

5. What can You do to be Sensitive to Your partner’s Needs and Feelings in the Future?

A final step, which isn’t always necessary, is to have a conversation about what each of you might be able to do differently so as to take each other’s sensitivities and needs into account. I say it is not always necessary because when you truly understand your partner’s reactions and experiences, it naturally follows that you will be more caring towards your partner and more sensitive to their needs.

Next time you have a fight, try to follow this 5-step model of how to make up after a fight. You might discover that disagreements do not have to threaten your relationship, but can actually be a source of greater intimacy and connection. 

About me: I am Rune Moelbak, Ph.D., a couples therapist in Houston, Texas. If you would like more insight into how to communicate more effectively with your partner, click here to get your FREE copy of “The Secrets of Happy Couples: A User’s Guide to a More Fulfilling Relationship”

Book cover for Free couples guide

Man wondering if he has a personality disorder

Do I Have a Personality Disorder?

We all have personalities, but what does it mean to have a personality “disorder”?

What is a Personality?

A personality is a certain habitual way I deal with the world around me. When you think to yourself “boy, that person sure has a personality!”, what comes to mind is probably certain predictable characteristics that stand out about them and that don’t just blend in with the surroundings.

Our personality is a collection of enduring traits about ourselves that make us stand out as well as make us predictable. Hence, I might tend to be “the life of the party” or the “loner”, the eternal optimist or the perpetual worrier, the workaholic or the worka-phobic, the antagonist or the person who always tries to please.

Whatever the case, my personality uniquely equips me to deal with certain situations, while it puts me at a disadvantage for dealing with certain others. My greatest strength in one context – becomes my greatest weakness in another…

My personality serves as a kind of immune system that protects my own mental health from the challenges and demands of life. It consists of a collection of go-to coping mechanisms and thinking styles through which I confront the world.

My personality is my specific way of dealing with the demands of life, such as creating a satisfying social life, succeeding in my chosen career, collaborating with others, developing close relationships, and dealing with interpersonal conflicts.

When things go well in life, that is, when my traits or tendencies match with my environment, then I can likely live a symptom-free life. However, when there is not a good match, tensions will begin to rise within me, and I am likely to become depressed, anxious, angry, or otherwise unhappy.

John has a Personality Disorder:

John loves to be “the life of the party” and uses this trait to his great advantage. He becomes an actor so he can feel the thrill of being on stage, and has a very active social life that satisfies his need for attention. His personality helps him succeed in areas of his life that are important to him.

Yet John might begin to get in trouble if he ALWAYS has to be the life of the party, if he NEVER can be alone with himself, or if he ALWAYS relates to others as an entertainer, actor or performer.

He may for example meet a romantic partner he likes, but due to his chronic and excessive need for attention, may make every conversation about himself.

With his excessive focus on his own needs, John may not be able to be empathic with his partner’s needs and may not be able to maintain the mutuality required to create an intimate relationship.

When his partner begins to feel dissatisfied with John’s excessive attention-hoarding and demand that something changes, John may not be able to give in to the demand, since doing so would make him feel depressed, unloved, or empty.

He therefore instead turns the blame back on his partner whom he accuses of just not being that interesting and therefore being responsible for his own misery.

When his partner withdraws his interest in the relationship and in John, John does not have the flexibility in his personality to allow himself to notice this, so he instead “tells himself a story” and tries to convince himself and his friends that everything is fine.

When his relationship finally falls apart, John might at first become self-righteously indignant. He may seek out friends who can confirm his belief that his partner is to blame. He may also launch himself into a string of affairs to confirm to himself how lovable he is and therefore prove that “it is his partner’s loss” — not his

However, if these strategies fail, John may eventually have no way to maintain his fragile self-esteem and may finally have to engage in some painful soul-searching. At this point he is likely to become depressed, may begin to drink, or may not be able to maintain work obligations or friendships.

What is a Personality Disorder?

John would likely be diagnosed with a personality disorder.

His character traits are rigid. If people around him do not adapt to his preferred ways of dealing with situations, John cannot change his approach and adapt to the new situation.

As a result, John is bound to have many conflicts with people around him, and frequently be at odds with the demands placed on him by different tasks or role expectations.

In John’s situation, differences between personality style and environment are solved by devaluing the environment or changing the environment, which works as long as other people are ready to accommodate him.

In other personality types, such as in people with strong dependency needs or excessive fearfulness, differences may be solved by acquiescing, letting go of healthy assertiveness, or abandoning oneself.

In either case, the environment threatens the integrity of the person’s self-esteem and makes it impossible for them to learn from the situation and master a greater repertoire of skills. The person tends to always respond the same way regardless of circumstance and is thus locked into a cycle of repeating the same failed outcomes.

John, for example, may fall in love again, but his next relationship will likely have the same ending, since the need for admiration is the only way John knows to raise himself out of an ever-looming depression.

This then leads to another hallmark of people with personality disorders: They tend to run into the same problems time and again. Depending on their personality style they may show patterns of getting fired due to having trouble taking orders from a boss, falling out with friends due to inability to deal with conflicts, getting divorced on multiple occasions due to the same complaints by their spouses, and so on and so forth…

Personality Disorders are Dimensional:

We all have certain rigid and unbendable traits that can get us in trouble in life and can make it difficult to deal with the demands of particular situations. With each personality comes certain advantages and disadvantages. This is to be expected. Most of us reduce tension and discomfort by creating a life that maximizes our advantages and reduces the need to be someone we are not. This does not mean that we have a personality disorder.

Our personality only becomes a severe liability when we feel chronically deficient in the many aspects needed to live a fulfilling life. We may for example not be able to tolerate intimacy regardless of circumstances, or may not be able to EVER relax or be spontaneous, or may not be able to enter into ANY relationship without sexualizing it. It is in these cases that assigning the label of a personality disorder may be appropriate.

Having a personality disorder is therefore not simply about having a personality trait or habit that gets us in trouble. This trait must be so rigid, so exclusionary of other ways of doing things and perceiving the world, that it severely limits our ability to function effectively in life. Hence there is a difference between being perfectionistic, and not being able to complete a work assignment because one is never satisfied with the result.

Many traits only become dysfunctional when taken to a certain level of intensity or severity. In the first case, perfectionism might help me win awards for my attention to detail, while in the latter, my perfectionism might end up getting me fired.

Therapy for Personality Disorders:

If your personality prevents you from getting along with others, functioning well at work, or getting enjoyment out of life, the treatment of choice is not simply to force yourself to act differently. The rigidity of particular personality traits is often the result of bruises to self-esteem, or early developmental traumas. Particular ways of dealing with tension, psychic pain, and threats to self-esteem developed as a kind of protective armor needed to deal with threats to one’s psychological safety.

Psychodynamic therapy is particularly effective in helping people access these early experiences and traumas so they can be begin to grow from life, rather than remain stuck in the need to protect themselves from it…

About Me: I am Rune Moelbak, Ph.D., a psychodynamic therapist in Houston, TX, who helps people get to the root of their problems. Visit my website to schedule an appointment.

picture of therapy couch

Psychotherapy: Does Therapy Work?

Many people who are considering therapy for their psychological difficulties, may wonder how effective talking about their problems is really going to be… So let’s examine the question: Does therapy work?

What’s Wrong with Talk Therapy?

The concern about whether or not therapy works, might not be assuaged by reading a recent Time Magazine opinion piece, that questions the legitimacy of longer term talk therapy. In the piece, entitled “The Trouble with Talk Therapy”,  neuroscience journalist and author, Maia Szalvitz, argues that most therapists have no clue about the latest and most effective treatments for common psychological problems. Instead they want to “go deep” to uncover unconscious feelings and motivations, which she says, has not been found to be effective in treating problems like Obsessive Compulsive Disorder, Depression, Anxiety, and Post Traumatic Stress.

The problem, she says, is not that effective treatments don’t exist for these problems, but that therapists either don’t know of them, or choose not to make use of them.  She cites Alan Kazdin, who is the former president of the American Psychological Association, for saying that “Most of the treatments used in clinical practice have not been evaluated in research.  Also, many of the treatments that have been well established are not being used.”

As a result, Szalavitz claims, she has a hard time knowing where to refer herself or her friends for effective treatment, for as she concludes, talk therapy has an “evidence” problem…

What’s Wrong with Szalavitz’s and Kazdin’s Argument? 

Psychological distress cannot be separated from who you are as a person:

Szalavitz and Kazdin are asking the right questions, but on the basis of a wrong understanding. Their assumption is that psychological problems are “disorders”, and that “disorders” can be treated like one treats a medical illness. Hence there should be one best treatment for depression, one best treatment for OCD, one best treatment for anxiety, and so forth.

The problem with that understanding is that it is based on ignoring the subjective meaning and function of our psychological distress. What makes a problem psychological is precisely that it involves the life of the person. This means that I can be depressed for different reasons than you and that your obsessions and compulsions can serve a different function in your life than they do in mine. OCD and depression are therefore not phenomena that exist in some objective reality where they can be treated using some standard method that gets applied the same way to each person. Instead they are surface manifestations of underlying psychological conflicts and issues that are highly particular to each individual. If we want to get to the root of the problem, we must therefore make these particular conflicts and issues the real focus of the therapy.

Psychological issues are intertwined, not separate from each other:

Szalavitz and Kazdin also make another mistaken assumption. They believe that problems like anxiety, depression, obsessions, and compulsions exist independently from each other, making it the case that one can focus treatment on a single problem and select the best treatment technique for each problem.

In actuality, however, most people who come to therapy have a variety of psychological issues that cut across identifiable “disorders”. They bring their life to the therapy, not an illness. Any therapist is likely to agree that the longer one works with a client in therapy, the harder it becomes to provide a diagnosis. As the complexity of our understanding of our clients increase, so does the inadequacy of any particular label or diagnosis. People are first and foremost people and as they expand their own understanding of the interconnections between their symptoms and themselves, the need to localize and separate their problems from who they are as people tends to disappear. As the now deceased Dutch psychologist, J.H. Van den Berg, has pointed out, people come as wholes, not as fragments, and one cannot focus on a single area of a person’s life without implicating all the others. One cannot lift the corner of a carpet, without lifting the whole carpet…  

Psychotherapy focuses on subjective truth, not objective knowledge: 

A third mistake Szalavitz and Kazdin make is that they fail to appreciate that there are two different truths and realities in life. Science deals with objective truth and objective reality. It deals with “facts” based on unbiased observations and treats these facts as universal truths rather than contextual truths.

Psychotherapy, however, deals with subjective truth and subjective reality. Subjective truth and subjective reality are not a lesser truth or lesser reality. In fact, our subjective experience is often what is most instrumental in motivating our behaviors.

To illustrate the difference, let me provide an example: If a male client can’t grieve the death of a close friend, this is not because he is objectively incapable of grieving or crying, but may be because he subjectively believes that “real men don’t cry”. This subjective reality, which he may or may not be aware of at the start of the therapy, can explain his lack of ability to grieve. It also provides “evidence” for why he may objectively present as depressed. Natural grief that is being suppressed may turn into a heaviness that cannot be released and may lead to a lack of contact with vital emotions that manifests  as symptoms of depression.

In therapy, however, the client may not initially be aware of this subjective belief, nor would the therapist know of it simply by looking at the client’s objective symptoms. The secret to understanding the client’s depression thus lies in a subjective truth that must be discovered, not in an objective knowledge that can be said to be universally applicable each time somebody shows up as depressed.

Why Psychotherapy Cannot be Standardized… 

What Szalavitz and Kazdin don’t understand is that therapy is not factory work and is not about providing prefabricated treatments of objective problems. It is about understanding the unique subjective causes that motivate and explain surface level symptoms that may look the same, but have widely discrepant reasons for being. This means treating the “person”, not the “disorder”, for the person explains the disorder and not the other way around.

So Back to Our Original Question: Does Therapy Work?

I believe the answer is yes, but it works in a very different way than a coffee maker works to make coffee or an oven toaster works to make toast. It helps people discover their own subjective truths, and not simply to change a behavior. Following Szalavitz’s and Kazdin’s advise is to apply a logic that may very well work in the realm of machines and objective cause and effect, but is very ill suited for the likes of us

About me: I am Rune Moelbak, Ph.D.,  a psychodynamic therapist in Houston, Texas. If you are interested in learning more about how a psychodynamic approach can help you get to the root of your problems, click here.

image of people having an affair

Extra-Marital Affairs: Why Do People Cheat?

Infidelity and Cheating is Widespread:

Statistics show that between 35-50% of all women or men in a relationship have had an affair. With such widespread occurrence of infidelity, affairs cannot only be attributed to some act of deviance or amorality, but must be looked at as a normal fact of life.

This begs the question “why do so many people cheat?” And, “What are the challenges to staying faithful and monogamous in a relationship?”

Is There Something Wrong with Cheating?

Over the years psychologists and sociologists have advanced many viewpoints on this matter. The current stance of many couples therapists seems almost naively moralistic and judgmental, focusing mostly on the “victim’s” right to feel angry and the perpetrator’s need to atone. They implicitly turn cheating into a simple selfish act, a violation of social norms, and a sign of immaturity.

And yet, aren’t we all fascinated by the forbidden? Doesn’t the forbidden actually enhance our eroticism? Have we not all been tempted by the lure of what might exist on the other side of the fence?

If we dig deeper into our unconscious we will find that most people, whether they admit to it or not, have been tempted to cheat, have fantasized about somebody else than their spouse, and have found secret emotional fulfillment with others without wanting their spouses to know.

Judging Our Desires Can Lead to Cheating

Oftentimes what propels a person into an affair is ironically their lack of ability to talk to their spouse about their deepest darkest fantasies. The prohibition against having an affair is thus often what makes it happen. The affair becomes the actual outlet, for what cannot be talked about within the existing relationship. What gets denied, goes underground, only to become expressed through actions and impulses in another setting.

A chronic problem in intimate relationships is the inability to openly admit to and share fantasies and urges that are not considered “right” or “proper”, and that one does not feel a decent human being “should” have. Because there is then no room for it within the relationship, there is also no room for a part of the person. This part is then forced to exist in secret and to be siphoned off to a parallel reality, whether it be internet porn, a secret lover, or a clandestine emotional encounter. People’s fears of confessing and being a 100% themselves within a relationship thus leads to a pressing need for more than one relationship to contain all parts of oneself.

In some relationships, this fact of life is openly embraced. Hence we have communities of swingers, people who agree to have open relationships, or people who agree to have threesomes. Some report that this greatly spices up their life and reduces the need for their partner to secretly cheat, but others suggest it comes with its own dangers, and leads to unmanageable jealousy that tends to ultimately break people apart.

Why Do People Have Affairs?

People who have been cheated on and have felt the betrayal of an extra-marital affair, may end up blaming themselves, thinking that they were deficient in some way. Oftentimes, however, partners who cheat are struggling with their own issues (like all of us), which make it difficult for them to get all their needs met with one partner, no matter who that partner is.

A common problem encountered by men is the “Madonna – Whore” complex, by which tender feelings originally felt toward a person’s mother, cannot be reconciled with a person’s “dirty” sexual desires. In this case, a person will thus have a need to relate to their spouse as a good friend and revered mother, and live out their sexual fantasies with a “lover” whose only function is to serve as a sexual outlet for these unaccepted desires. It is for example not uncommon for someone to not be able to have great sex with a person they respect, and to have great sex with someone whom they don’t really respect much as a person.

Another common situation is for a person to recreate a relationship with their spouse that makes them feel trapped, stifled, and in need of an escape. A person may for example unknowingly contribute to a relationship where they feel lonely and unloved, and find themselves in need of getting those needs met elsewhere. It is thus not uncommon to find that the person feeling lonely has withdrawn themselves and stopped sharing the personal thoughts and feelings that would have made them feel more loved and intimate. At the end of the day, we therefore sometimes unconsciously create the very types of relationships, which we then find insufferable. A true test of this is whether or not the next relationship tends to end in the same situation, making break-ups and infidelity a sort of coping mechanism that substitutes for dealing with one’s own barriers to establishing a fulfilling intimate partnership with someone.

A Common Factor that Leads to Infidelity:

The list of why we cheat is long and often involves complicated personal and interpersonal dynamics. But one thing seems to be true across the board: Cheating seems to happen when a part of the person cannot be expressed within the confines of a single relationship. There are many reasons why this cannot happen, but the root cause is often the lack of ability to create, and tolerate, intimacy, and the inability to be completely oneself within one’s existing relationship…

About Me: I am Rune Moelbak, Ph.D., a psychologist in Houston, Texas. I use a non-shaming and non-blaming approach to working with individuals who feel guilty about having an affair, and couples who are struggling with issues of infidelity. Click on this link to read more about my approach to couples therapy…

heart symbolizing intimacy

5 Easy Ways to Improve Intimacy in Your Marriage

Do you sometimes feel you have very little in common with your partner or spouse? Do you often feel lonely in your relationship or marriage? Do you silently ask yourself if you and your partner are slowly growing apart?

If so, you are not alone. Many couples struggle to maintain intimacy and stay emotionally connected over time. The good news is, connection and intimacy in your marriage or relationship is something you can build. Here are five ways to improve intimacy in your marriage or relationship:

1. Empathize – Don’t Problem-Solve:

When your partner opens up to you about a concern they are having at work or elsewhere, don’t try to solve their problem. Instead, try to connect with their feelings. Show that you understand what your partner must be going through, how difficult it must be to be in their shoes. Encourage your partner to tell you more about what bothers them; show interest. Have your partner tell you enough about their feelings, opinions, and thoughts so that if your friend asked you to tell them why your partner is upset, you would be able to give them an accurate summary. Sometimes, all we want from each other is someone who will hear us out without being judgmental, without siding with “the enemy”, and without giving us advise based on their own perspective. Feeling understood rather than evaluated, can greatly increase our sense of intimacy and connection with our partner.

2. Create Rituals of Connection:

Do you really know what is going on with your partner at work? Do you know what worries are on their mind? Instead of leaving these kinds of questions unanswered, why not build in a ritual of sitting down for dinner or for late evening tea, to check in about each other’s day? Turn off the TV and cell phone and make this your daily together-time. Maybe set aside 15 minutes for each person to share about their day. When focus is on your partner, make it all about them, and don’t redirect the conversation to yourself. The goal is not to bring up concerns about each other, but to discuss all the external stressors and successes that are going on at work or with other people. The goal is to strengthen the conviction that you have an ally in each other and are facing the world together. This sense of togetherness and support is one of the best ways to improve intimacy in your marriage over time.

3. Share Your Spontaneous Reactions:

Famous couples researcher, John Gottman, discovered that healthy couples share many more of their spontaneous reactions with each other than couples who are disconnected. Couples who complain that they just don’t have anything to talk to each other about anymore, forget that connection is not always about depth of conversation. Get in the habit of sharing your reactions to even mundane things. Did you like your cup of coffee this morning? Share it. Did you laugh at a Facebook post? Let your partner know. These little invitations to connect are important to the health and intimacy of your relationship. In relationships where partners feel disconnected, Gottman found that not only are these little “bids for connection” few and far between, they are also often met with lack of interest from the partner. If your partner makes a bid for connection, be sure not to turn them down or ignore them. If you routinely do, they will soon stop sharing and your level of intimacy will slowly wither away.

4. Invite Deeper Conversations:

Sometimes when couples get into the doldrum of things, they may interact with each other in routine-like ways that can become  deadening or boring and can decrease the sense of intimacy. Couples may start to feel like they are out of things to talk about or that they already know their partners position on different topics. In such cases, it usually pays to ask more philosophical or personal questions, to get at your partner’s deeper underlying thoughts and feelings. Your partner likes to travel: Why is this so important to them? How might this relate to their background or childhood history in some way? It’s important to your partner to be on time: Why do they attach importance to punctuality? Where does that value stem from? What feelings do they have about this issue? Learn to become interested in the deeper motivations, desires, and values of your partner. It is one of the best ways to improve intimacy in your marriage and have more meaningful conversations with your partner.

5. Get Away from the Everyday:

Sometimes what couples really need to rediscover their connection and improve their intimacy is to create new experiences and memories together. It often pays to plan a trip or take time away from the everyday routine. If you always go for dinner and a movie on Fridays, shake it up a little. Try something new. Stay overnight at a hotel in a different city. Take turns planning an outing, by looking up events in the local newspaper. Agree to be open-minded about your partner’s suggestions and try out an event your partner is interested in without judging or dragging your feet. A relationship is a living thing, and new experiences can help give new life to your shared existence and improve intimacy in your marriage.

About me: I am Rune Moelbak, Ph.D. a couples therapist in Houston, Texas. I help couples reconnect and improve intimacy in their relationship or marriage. Read more about my approach to couples therapy.

man facing countless choices

Low Self-Esteem and the Flight from Self

Many people in our society live lives that are not fully their own. They try to become their ideal self – an image of who they SHOULD be – rather than to be who they truly are.

Although there is nothing wrong with striving to be better at something, sometimes these strivings secretly function as judgments on ourselves. We want to be better, not as a function of our natural striving for self-actualization, but to make up for our low self-esteem and a lack of ability to accept ourselves for who we are…

The student who always MUST have straight A-s on their report card may for example have an ideal self that dictates that they always be the best at what they do. If they fall short of this unrealistic standard, they may harshly criticize themselves for falling short and being a “loser”.

Underneath our high standards of self-worth, we may thus often find a harsh critical voice that condemns us as chronically deficient.

We may, in other words, be stuck in a chronic cycle of unrealistic expectations that lead to inevitable failure and periods of low self-esteem.

We may have set up what psychoanalyst Karen Horney calls a “Pride System”, where we are either chasing a self that we want to be (our ideal self), or angry with ourselves for not being who we want to be (our actual self).

The Pride System:

Pride denotes a falsely inflated virtue that has sprung up to take the place of a perceived vulnerability. I may, for example, pride myself of being all-loving and selfless in order to make up for a sensitivity I have to being accused of not being a good or morally virtuous person. At the core of my prideful pursuit of my all-loving ideal, thus lies a wound or bruise to my self-esteem that it is intended to cover or make up for.

I know that my values or virtues are really part of my pride system, rather than a sign of healthy self-esteem, if I need relentless confirmation of their veracity from the external world. For example, if I am only worthwhile if I get an A, or lovable if others praise me for my selflessness. Another sign that my pursuits are prideful is that I pursue them compulsively and inflexibly, and that my failure to be a particular kind of self produces a crisis in my self-worth and self-esteem.

What Karen Horney rightly points out is that neither the ideal self nor the self I am when I fall short of my ideals, should be confused with my true self. Both the ideal and the failure to embody one’s ideal are two side of the same failed project. In setting up my impossible ideal, I also set up my flawed self. Both go to together like night and day.

The unfortunate thing is that many people live their entire lives within their pride system and never get in touch with who they really are.

Ideals as Defenses Against Low Self-Esteem:

Most of the time, unrealistic ideals emerge early on in life as a form of protection against low self-esteem. They are frequently attempts to ward off feelings of vulnerability, anxiety, or shame.

Karen Horney  talks about a “fundamental anxiety” people can experience when growing up. Fundamental anxiety is an anxiety about being who I am. It is the experience that something about me is flawed or unacceptable.

It may be, for example, that I depended on others but felt let down, or that it was unsafe to assert my needs and express anger in my family. The result of such experiences may have been that I learned to disavow my dependency needs or my healthy assertiveness, and instead decided to dedicate my life to never needing anyone or never expressing dissension.

The ideal self therefore emerges as an alternative self I can strive to be, which would be more acceptable, more admired, and will rise above the frailties and insufficiencies of my more vulnerable self.

The Ideal Selves in American Beauty:

The movie American Beauty is an excellent illustration of the extent to which we will go to flee from fundamental anxiety in an attempt to make up for low self-esteem. While very humorous, the movie is also a tragic commentary on the ways people will bend themselves to obtain praise from others, paying the price of becoming alienated from themselves in return.

Caroline:

… We meet Caroline, the self-contemptuous mother who spends her life making up for her childhood shame of being poor by adopting a workaholic lifestyle and having periodic break-downs when she falls short of meeting her ambitious goals…

Frank:

… We meet Colonel Frank Fitts, a father who spends his life pursuing military structure and discipline to ward off acknowledgement of the impulse to give in to his homosexual desires and the shame he feels about having them…

Angela:

… And we meet Angela, a flamboyant attention-seeking teenager who brags about her sexual experiences to cover up her fundamental shame of feeling boring and uninteresting…

All of these characters illustrate the price many people pay for unacknowledged low self-esteem that is relentlessly hidden underneath the pursuits of a different, better ME.

The Strategies We Use to Ward Off Low Self-Esteem:

In her excellent books on fundamental anxiety and the pride system, Our Inner Conflicts, and Neurosis and Human Growth, Karen Horney describes the various ways in which our energy and growth get diverted from our real self toward our ideal self.

Karen Horney: Our Inner Conflicts

Click image to read about book

Karen Horney: Neurosis and Human Growth

Click on image to read about book

 

 

 

 

 

 

 

In Our Inner Conflicts, she identifies several typical strategies people use to make up for their low self-esteem and secret self-contempt.

In the strategy of moving away, a person disavows any dependency needs or needs for love, to pursue an ideal of independence, self-reliance, and freedom from commitments.

In the strategy of moving towards, a person disavows any self-focus, any assertiveness of one’s needs, and any expression of dissension in order to preserve a self-mage of an all-loving, self-sacrificing, good natured human being.

In the strategy of moving against, life becomes about winning, being better than, and always being on top, but the price one pays is the inability to collaborate, to learn from others, and to be vulnerable.

Each strategy becomes pathological only in so far as it becomes rigid and unbendable. For example: I may end up in an emotionally abusive relationship with a controlling partner and not be able to stand up for myself because I have made a virtue out of always putting others first or being “self-less”, or I may become a world-traveller who idealizes my freedom from constraints, but really live a life to protect myself from my inability to be intimate and close with others.

The challenge for many people who, like the characters in American Beauty, find themselves the victims of impossible ideals, is to come to terms with the initial wounds that made them abandon themselves on the altar of their ideals.

People must realize that their ideal self is a protective device to overcome an underlying shame, anxiety, or vulnerability. They must realize they will never redeem themselves by trying to become different from their real self, but must get to the root of their underlying low self-esteem and learn to accept and embrace who they truly are.

They must embark on the process of finding compassion for themselves, so they can allow themselves to be human again, rather than aspire to live the life of a God.

About me: I am Rune Moelbak, Ph.D., a psychologist in Houston, Texas who has helped hundreds of people regain their authentic self and feel more at peace with themselves. Visit my website to learn more about my my approach to anxiety and low self-esteem. 

Picture of 5 post-it notes

5 Common Things People Say to Avoid Seeing a Therapist

The vast majority of people who are contemplating seeing a therapist will be marred by doubts and reservations that may ultimately get in the way of following through. Some of these concerns may be quite rational and practical, but others are typically roadblocks we put in our own way because we are afraid…

Resistances to Therapy:

Therapists have long referred to these rationalizations in defense of our fears as “resistances”. Resistance is an expected part of every therapeutic journey. What Freud determined quite early on is that people want change from a distressing situation, but are also deeply afraid of change and of the process that is going to get them there. A part of each person therefore actively – albeit often unknowingly -resists the process of therapy. These resistances often start before the person has even walked in the door and may prevent them from ever picking up the phone and scheduling that first appointment…

Here are five of the most common resistances people have to seeing a therapist and some reasons why they might be rationalizations that cover up underlying fears: 

1. I Should Be Able to Solve My Own Problems…

This resistance to seeing a therapist is quite common. Many people have learned that the hallmark of skillful and confident people is that they are able to manage life without relying on anybody else. They think they must be weak or inadequate if they have to see a therapist; that this means that they are not competent or skillful like everybody else, or that they can’t cope with life.

Fact is that underneath an overly self-reliant attitude are often deep-seated fears about depending on others. Many people develop the attitude that they must manage life on their own, because they are afraid that others would ultimately not be there for them in their hour of need. Reaching out to others and admitting that you need them can sometimes activate the feeling of becoming a child again who cannot fend for him or herself and who is utterly at other people’s mercy. Although we all have deep seated wishes to return to a state of being taken care of again, such wishes have often had to be squelched as part of growing up, and we may now judge ourselves as “childish” or “immature” for having them. And yet when we fall in love and develop strong relationships with others, we are confronted with the fact that these needs never went away. The ability to endure the vulnerability of depending on others is thus a necessary skill to have in order to form strong bonds and feel intimate with others.

It is now easy to see why some people may not allow themselves to even contemplate therapy. They don’t feel comfortable getting in touch with the child within and enduring the risk of rejection and let-down that comes with having to depend on others.

 2. Therapy is Too Expensive – I Can’t Afford It…

Finances are often used as a prime reason why therapy is not an option for a person. Sometimes embarking on therapy would truly be a bad financial decision, especially if you are struggling to meet your many financial obligations. At other times, however, concerns about finances may serve as a convenient way to appease certain underlying fears about the therapeutic endeavor itself. It is for example not uncommon to find that people will go on expensive vacations or remodel their kitchen, but not feel they can spare the expense to see a therapist.

Many times, a concern with financial means to pay for therapy conceals a variety of underlying concerns. These can include: guilt feelings about making yourself a priority, minimizing and deprioritizing your mental health, or resentments about the idea of having to pay for someone to listen. Many people are okay spending money on others, but feel uncomfortable with making themselves a priority. Therapy for them is the ultimate self-indulgence and may feel like a selfish need. Others, who feel quite okay spending money on material possessions like a new car, a new kitchen, or expensive jewelry, may not feel that spiritual things like their own mental health is of equal value. Finally, whether people admit to it or not, there is often some anger or resentments that people experience for having to depart with a treasured belonging (money) in order to get somebody to care or to listen. Rather than examine the variety of these concerns, it is often easier to chalk them up to the statement that therapy is simply too expensive.

 3. Seeing a Therapist Means I’m Crazy…

Many people find it difficult to square the idea of going to therapy with their need to feel normal. We have a very powerful social instinct that wants nothing more than to blend in with everybody else. We are afraid to stand out from the crowd in any negative way and we convince ourselves that therapy means that something about us is wrong or defective; that we have stepped outside of the acceptable limits of our society.

This resistance to the idea of therapy and what it must mean about ME or my self-concept is based on the illusion that “normal” people don’t need therapy. Fact is that every human being develops certain bruises to their self-esteem, experiences certain personal limitations in their interactions with others, and don’t know how to cope at various points in their life. Psychoanalyst, Nancy McWilliams, quips in her famous textbook to therapists, that the question to ask oneself is not: Am I nuts? But: How nuts am I? And nuts in what way?

People who go through life adhering to an illusion of normalcy can only do so by pushing their struggles to the side and pretending that everything is fine. Over the long term this actually produces more psychological distress than dealing with your issues head-on. Ironically, trying hard to be normal can be crazy-making, and allowing yourself to confront your irrationalities and “craziness” can make you feel normal again. Dismissing therapy as something that is only for “crazy” people is thus a way to express discomfort with who you are, and not acknowledging that it is human to suffer.

 4. It is Weird to Air My Dirty Laundry to a Stranger…

It is not uncommon for people to convince themselves that talking to a therapist will feel too awkward or uncomfortable. They might say to themselves that it is unnatural to talk to a professional about your problems, and that a therapist really offers nothing that a friend or family member couldn’t offer. In addition, they say, it is not comfortable to share their deepest darkest secrets with someone they hardly know and who doesn’t reciprocate by sharing something about their own personal life.

These resistances to embarking on a therapeutic journey serve as  deterrents to having to face one’s fears of opening up and becoming fully known to someone. One naturally feels quite “naked” and exposed when one is asked to divulge thoughts and feelings to someone who is not responding in kind. However, discomfort about opening up to a therapist is often about confronting one’s own shame about admitting to the full scope of one’s human emotions, thoughts, needs, and wishes.

The same qualities about the therapist that are often cited as deterrents to opening up, are also the qualities that ultimately allow people to go deeper into their issues and be more honest than they can be with a friend:

  • Because the therapist does not divulge much about their own personal problems, the client is free to focus exclusively on their own issues without having to be concerned about taking care of someone else.
  • Because the therapist is not part of the client’s life, a client can feel safe to genuinely express themselves without fear of repercussion for their everyday relationships.
  • Because the therapist is not a friend or family member, and has no self-interest in the client choosing particular actions over others, a client can discuss concerns without feeling an implicit pull to make particular decisions.

At the end of the day, the therapeutic set-up, while initially a foreign concept, actually ends up making it easier rather than harder for a person to share their thoughts and feelings freely.

 5. It Will Be Awkward if I Don’t Like My Therapist

Some people may hold themselves back from scheduling an appointment because they don’t want to get themselves into a situation they can’t get out of. They may be concerned that a therapist won’t be right for them and that it’s going to be uncomfortable to tell their therapist that they would prefer not to come back.

These kinds of fears of getting stuck in a bad situation often hide over discomfort with assertiveness and ultimately with anger and aggression. Some people feel that they would hurt their therapist’s feelings if they truly expressed their mind and feel like their only choice is to go along with whatever their therapist is telling them so as to not incur their therapist’s wrath. This of course leads to fears of being swallowed up in the relationship and losing one’s autonomy and independence.

It may be of great comfort to such people to know that therapists receive training in how to manage a client’s negative reactions, and that working through negative reactions is part and parcel of good therapy. Therapy is about creating space for clients to be themselves fully, which means creating space for negative as well as positive emotions. No therapy can ever be completely successful if a person has not been able to express and work through their anger, disappointment, fears, and frustrations as they pertain to their therapist as well as significant others. It is quite liberating to have the experience that one’s therapist can withstand one’s fury without retaliating or rescinding their support.

About me: I am Rune Moelbak, Ph.D., a psychologist in Houston Texas. I help people confront their fears and live more genuine lives. If you have fears and concerns about therapy that I have not addressed in this article, please feel free to send me an e-mail with your questions. For more information about the process of individual therapy click here.  

What's your story?

The Power of Story-Telling in Therapy and in Life

On my recent trip to Nicaragua, I learned at least two things: 1. That when looked at from a Venezuelan/ Nicaraguan socialist perspective, the US is a country of police brutality and moral decay, and that, 2. Spirit Airlines are not stingy with their amenities, they are just engaging in “frill control”. Funny how reality changes when you tell a story differently…

A Cultural Lesson on the Power of Story-Telling:

Nicaragua is currently a country that receives a lot of financial aid from the Venezuelan government, due to their mutual sympathies toward a kind of socialism practiced by the now deceased political leader, Hugo Chavez. For that reason, you can find posters that pay homage to the former Venezuelan in places all over Nicaragua. You can also, I discovered, watch unadulterated TV transmitted straight from Venezuela.

When I would settle in at night after a long day of sightseeing in the tropical heat, I would turn on the TV in my air-conditioned hotel room, and would find myself fascinated by one particular Venezuelan station and the entirely different world-view presented there.

The US was on this channel depicted as quite morally depraved. The evening’s news included a segment on police brutality against civilians in various places in the US, presented as if it were breaking news.

The news was followed by a theme show featuring all the wonderful socialist initiatives of the Venezuelan government: First you saw how many modernized apartments were being built through the decree of the government, and then coverage followed of other government initiatives: workers would now be able to pay fair prices on everyday goods due to government intervention, the environment was now being saved through nation-wide programs to plant trees…. The initiatives were seemingly never-ending…

Every segment introduced one hopeful initiative after another, and the clips were always of people doing things together – collectively – making political decisions about what kind of society and destiny they wanted. This was a society that valued people and community over and above raw capitalism, and it reminded me a little bit of the Obama campaign’s “Yes, we can!”, which had that same kind of optimist spirit, before it lost its fizzle.

After watching this Venezuelan station for just 30 minutes I was left with an indelible impression of optimism, although a part of me of course knew that this was quite a different spin on reality than the one I had typically been presented with. From a North American perspective, Chavez was always depicted as somewhat of a selfish dictator, and socialism, of course, always depicted as bad.

However, crossing cultural boundaries, not just geographically, but mentally, is quite eye-opening. It made me think of the power of stories as a mediator of the reality we experience, the emotions we feel, and the actions that become conceivable. It also made me think of the tendency of stories to hide their story-like nature behind a presentation of facts.

The Venezuelan news station was not consciously telling stories, but merely reporting facts, and many of the stories we tell in the US media, to ourselves, and to others, have that same pretension to transcend their story like nature.

The Story of Psychological Disorders

The idea of the unadulterated fact is, however, itself the product of a story: the story of the enlightenment or of science. According to this story, we can access reality purely as it is in itself outside of the logic of a certain story line and pre-understanding. And yet, as hermeneutic philosopher Hans Georg Gadamer has pointed out, even science takes place within a prior understanding of the world. There is never such a thing as approaching the world without making certain pre-judgments or assumptions about it.

A research study about the effectiveness of a certain therapy for Bipolar Disorder for example, may seem like it is only reporting facts (looking at quantifiable variables and measurements of probability), but it is assuming an illness model of psychological distress which is not itself part of what is studied. An illness model, of course, is a story about why people suffer that attributes the suffering to a disease process or cause underneath the actual life of the person, and is by no means the only possible story.

The medical or biological view of psychological distress has a particular strong-hold in our current North American and European zeitgeist. People are always wondering: Do I have ADHD? Am I Borderline? Do I have a psychological disorder? …As if assigning a label and naming one’s suffering as a generic underlying “thing”, solves the problem, and alleviates the discomfort of figuring out why I suffer in some more human or existential sense.

And yet, these “entities” which we like to label ourselves with are themselves largely the product of stories. What appears to be science and is presented in an officially sanctioned diagnostic manual (DSM) as if it were, is really the product of a political process of debating different research studies, naming conventions, and inclusion criteria. Psychological Disorders are voted into existence. The other side of a disorder is all the contentious opinions that had to be tabled in order for the construct to appear as an independently existing noun.

Therapy as Story-Telling

Rather than try to fit people into categories of a medical story, therapy offers a space where alternative stories can be told. Therapy as a “talking cure” is really about telling your own unique story. A person is helped to unearth memories, feelings, and experiences that sometimes pose challenges to existing stories, and require the reorganization of one’s understanding of oneself and of the world. The medical narrative is here often a hindrance that disallows people from pondering the idea that symptoms exist for a reason, that feelings contain useful messages, and that our bodies express that which we cannot yet say.

* * *

And so it is that a trip to Nicaragua made me wiser about the power of the stories we tell and about the need to examine the stories we live as our own personal and cultural truths.

The Venezuelan government has their story…

Spirit Airlines has theirs…

What’s your story?

About me: I am a psychologist in Houston, Texas who likes to think outside the box and is committed to helping people find their unique personal truths. Read more by visiting my website.

Lady Smoking Cigar

The Psychological Meaning of Drug and Alcohol Addiction

An addiction to drugs and alcohol is not really an addiction to the drugs or to the alcohol. Rather we become addicted to a way of life. Our drug of choice, for better or for worse, helps us find our bearing in the world, and it is much more difficult to let go of a way of existing than it is to let go of a simple physiological enjoyment… 

My Own Sweet Addiction:

Recently I tried to break my own addiction to coffee. Over a period of time I felt that my daily dose of mocha served more to keep me afloat than to enhance my well-being. Instead of giving me a pleasant kick, coffee had started to become my daily crutch; a simple means to not feel utterly exhausted. After two years of gradually increasing my daily fix to simply stay alert, I finally found the resolve to kick my habit.

The first days after quitting, were horrible, of course. I felt quite down, my body started aching, and I had trouble staying awake during important meetings. Gradually, however, the withdrawal symptoms started wearing away, and life started to get back to a new normal. And just when I was feeling the wonderful clarity that comes with a sober mind, I started realizing that I am not the kind of person who wants to live a life without coffee.

Coffee for me is more than just a kick in the morning or a tool to stay awake. It is the enjoyment of sitting on my sun-bathed patio reading a book while treating myself to an aroma filled cappuccino. It is the satisfaction of sharing laughs with friends after a well-deserved meal that needs just that finishing touch which only coffee can provide. It is a reason to go out on a Sunday afternoon  and spend a couple of hours in a coffee shop for a slight change of ambience… It is not just a cup of coffee, but a lifestyle. Its effects go far beyond the simple physiological kick…

What this tells me is that: The addiction to coffee, just as the addiction to alcohol, cannabis, or any other drug or habit, is mainly a psychological addiction.

Addiction as a Love Affair with Life

It is easy (relatively speaking) to beat the physiological part of an addiction, but it is a monumental task to rid oneself of the addiction to life as we know it and enjoy it WITH our cherished addiction.

In the addiction literature, this psychological component of addiction is often minimized. It is referred to as the secondary gain or the reinforcement enhancing effect of addiction. And yet, it is this psychological, social, and contextual significance of the habits we form that is most likely to make us return time and time again to that cigarette, scotch on the rock, or sweet cup of Joe…

If there is any doubt in your mind about the power of our psychological needs in shaping our behavior, lets turn to an episode of the TV-show Frasier for support. In the episode “Where There’s Smoke There’s Fired”, Frasier agrees to use his psychiatric expertise to help his “manager” Bebe, break her smoking addiction. At one point, as Frasier and Bebe are sitting at the dinner table, Frasier asks her “What do you like so much about smoking?” Bebe’s answer, although fictional, is quite illuminating of the psychological impact a drug can have:

I like the way a fresh firm pack feels in my hand. I like peeling away that little piece of cellophane and seeing it twinkle in the light. I like coaxing that first sweet round cylinder out of its hiding place and bringing it slowly up to my lips, striking a match, watching it burst into a perfect little flame and knowing that soon that flame will be inside me. I love the first puff, bringing it into my lungs. Little fingers of smoke filling me, caressing me, feeling that warmth penetrate me deeper and deeper till I think I’m going to burst. Then whoosh!… watching it flow out of me in a lovely sinuous cloud, no two ever quite the same.

After hearing Bebe’s monologue, we are bound to wonder: Is this an addiction or a love affair with life? Surely giving up smoking will for Bebe not simply be about giving up on cigarettes, but about letting go of a very meaningful engagement with life…

Treatment of Drug Addiction is Treatment of a Lifestyle

The problem with many of our understandings of psychological phenomena, not least in the field of addiction, is that we are mired in a dualistic understanding of the world. What this means is that we separate objects in so-called objective reality, from our subjective experiences and the lives we live. This often creates a barrage of treatment approaches and techniques intended to target the physiological or brain-based components of our psychological experience, or that focus squarely on our behaviors and not the motivations, intentions, and meanings of our behaviors.

And yet, a cup of coffee, a cigarette, or a glass of wine never really exists outside of a life context of real people who fill their lives with experiences of a meaningful nature. An alcoholic beverage is never just that, but is always in some way a meaningful activity. It is a drink I have as a part of feeling included when I am out having a good time with my friends. It is a drink I need in order to deal with emotions or stress, which would otherwise eat me alive. It is a symbol of living the high life, a way to protest against lack of meaning in another area of life, or an enjoyable ritual in its own right. Regardless of whether or not the drink helps fulfill a healthy or unhealthy need, it is never just a drink, but a slice of life.

Coming to terms with addiction is therefore always about coming to terms with the psychological choices and meanings of the particular existence I live. Treatment of drug addiction is not the treatment of a drug, but the treatment of a life. Beating the physiological part of addiction is the easiest part. Creating a new life, and finding new ways to organize what one finds enjoyable and meaningful about life is by far the hardest.

At the end of the day, this is one of the reasons why the desire to change a habit, frequently requires a change in self or a new outlook on life. Therapy, of course, is one way to facilitate this process…

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Want more? To read more about my meaning-based take on the treatment of drug and alcohol addiction, download my article: The Value of Adopting a Human Science Approach in the Management and Treatment of AddictionYou can also read an interview with me on a Humanistic Approach to Addiction published by Sociedad Iberoamericana de Informacion Cientifica (SIIC) in both English and Spanish

About me: I am Rune Moelbak, a psychologist in Houston, TX, providing individual and couples therapy for people who want to get to the root of their problems. To read more, visit my website: www.bettertherapy.com