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.
anger management

What Do I Do with My Anger?

Anger is an uncomfortable emotion for most people. We often wonder what to do with it when we feel it, or want desperately to get rid of it because we associate it with being out-of-control, find it to be destructive, or are afraid it. 

The Benefits of Anger:

Anger has gotten a bad reputation, but like any emotion can be quite useful and adaptive at times.

Just imagine the life of someone who cannot feel angry. Such a person will likely feel compelled to make their life all about other people’s needs. He or she will have a hard time saying “no” to other people, because to do so requires the ability to feel inside of oneself where one’s boundaries are, and to assess what is fair and just, and therefore what one will do and not do.

Anger is that initial alert that things are out of balance or that a boundary has been crossed. It calls upon us to be assertive: To say what we want or need even when it goes against what somebody else might want or need.

A person who is out of touch with themselves and therefore does not experience this “alarm” could therefore easily become stuck in a series of one-sided relationships. They might become a perpetual care-taker, but have nobody there to take care of them. Or they may attract a series of people who do not know how to set limits on their own desires, or might purposely take advantage of the self-sacrificing nature of the unassertive person.

Ultimately without access to what we could call righteous anger, we would not be able to build or sustain healthy relationships based on give and take, and would find ourselves becoming like a chameleon who adapts and changes to each situation, because we wouldn’t really know how we are different from others. Many people who are uncomfortable with anger therefore end up living rather passive lives and have a hard time defining who they are outside of the use or value they have for others.

Read: In another article I have described how this lack of access to righteous anger is one of the key issues involved in Borderline Personality Disorder

Isn’t Anger Destructive?

The problem is that people confuse the feeling of anger with the expression of anger, and may have images in their mind of anger as an explosive and destructive emotion that is quite dangerous and out of control. They may be thinking of the anger that led to domestic violence at home, or the anger that got them fired from a job because they told their boss off. If they were the recipient of this kind of anger, they may be reminded of fear, or if they were the one’s who lost control of their temper, they may be reminded of the sense of shame or remorse they felt after “letting someone have it”.

Ironically, these kinds of violent or exaggerated expressions of anger, are often the result of not paying sufficient attention to anger in the first place.

Don’t Ignore Your Anger:

Anger is one word, but covers a whole spectrum of angry emotions on a continuum from annoyance and irritability on the one end to murderous rage on the other.

Oftentimes, a person will have signs of irritability or annoyance long before they simply become irate. But if they are ashamed of past outbursts or afraid of the experience of anger in themselves or others, they will try their best to ignore these early signs.

This means that they will not have the opportunity to assess what their anger is really about, and will not have the opportunity to address whatever feels boundary violating with an appropriate assertive response. The anger therefore has nowhere to go and may become bottled up until it erupts in a moment of out-of-control behavior.

Why Am I Angry?

At other times, a person may experience intense anger very quickly, and may bypass the feeling of frustration, annoyance, and irritation altogether. In these cases, it often pays to step back to examine what the anger is really about…

If a person is able to be curious about why they feel so angry all of a sudden, they will often discover that their anger is a response to a more vulnerable emotion, and that that this more vulnerable emotion was triggered, causing anger to arise as a natural defense.

Anger mobilizes a person to defend themselves or demarcate a territory. But what is that thing that needs defending? Or what is that territory that is threatened?

Is it my self-esteem that has plummeted, making me feel like I want to hurt this person who doesn’t seem to respect or value me? Or is the territory that is threatened my sense of having a place in my relationship, having a voice, having a role to play, mattering?

Anger often offers us valuable insights into ways in which we feel wounded, rejected, unappreciated, afraid of losing someone, or unable to be ourselves.

It is an alert system that calls for rapid action to restore an equilibrium, or right a wrong. But like any alert system, we have to first examine what set it off, before we can know what action steps to take.

Anger as Path to Self-Understanding:

If we can allow ourselves to feel our anger, we will be able to examine why we feel angry, and will be able to have more control over when and how to express it.

Then we can realize, for example, that the anger we feel at our friend for calling out a flaw in us, is really about embarrassment or shame, of finding it humiliating to agree, of not being able to maintain a positive view of self while taking a critical view of an aspect of ourselves, of having our feelings hurt, or not quite knowing if we are still valuable, likable, and acceptable to our friend or to others at large. In fact, it may protect us from feeling sad or down, or shameful or worthless.

If we can decipher the full message of our experience of anger, then we are free to respond in a more accurate and balanced manner to the perceived threat or violation of our boundaries. We will not have to erupt in rage, but can better express what is really going on within us.

Sometimes this may mean deciding against expressing our anger because we know the anger is really more about us than the perceived threat. At other times this may mean expressing our anger at what we have assessed to be a legitimate concern. And at yet other times, it may mean expressing the actual feelings underneath the anger, and letting people in on the vulnerabilities or sore spots that the anger is simply there to protect ourselves from.

First step in managing our anger is therefore never to suppress it, but to feel it. Sometimes this means working through the fears and shame that makes us uncomfortable accepting this most natural emotion into our repertoire of feelings. At other times, it means undoing cultural messages that make us feel weak or pathetic if we admit to vulnerabilities and mistakes, and make us unable to express what is really causing our anger because it would be too shameful or humiliating to do so.

image of psychodynamic therapist, Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D., a psychologist in Houston Texas, who can help you discover the underlying causes of your anger, so you will gain more control of your emotions and feel more effective in your dealings with others. Visit my website to read more about my approach to psychotherapy.

depressed woman

A 1001 Depressions: Which One is Yours?

When we generally think of depression, we think of it as the same phenomenon. People sometimes call it clinical depression, and professionals often call it major depressive disorder. However, depression is not really ONE thing, and there are as many variations of being depressed as there are people who are depressed.

Why is that? Because, in the majority of cases, depression is the individualized expression of a life struggle. It is simply like a fever that tells us there is something we need to look at or something about the way we live our life we need to resolve.

Sure, we cannot exclude the possibility that depression is once in a while the symptom of a brain in disarray, but this type of more biologically based depression is only a small subset of a much more diverse landscape of causes.

There are indeed a 1001 different depressions…

A 1001 Varieties of Depression:

Insecure Attachment:

One of the more common forms of depression is rooted in what we now have come to know as insecure attachments in childhood. Growing up with uncertainty about the availability and dependability of key people in one’s life robs a person of a secure core of knowing they will always exist and will always matter to others around them. As a result, this kind of person is perpetually fighting a sense of frightening loneliness, which they are always trying to distract themselves from. The frightening loneliness is the same kind of fear a child has who gets lost in the grocery store and isn’t sure if she will ever find her parents again. It rears its head when important relationships are severed or when the person feels abandoned. At such times this person may become severely depressed and lose any kind of hope for the future. They get lost in their sense of not mattering to anyone and find it hard to carry on  when they feel their life has lost its meaning.

Loss of Self:

Revolutionary Road is an excellent illustration of how a person can get caught in an empty life and get lost to oneself in the process

Another kind of depression happens as a result of the emptiness that follows from a loss of clearly defined self. People with this kind of depression have become so accustomed to adapt to their circumstances, that they have lost touch with what they really need or want. For far too long, their agenda has been to keep others happy or avoid upsetting anyone, and now they feel empty and hollow because they have completely lost touch with their needs, wants, and passions. Their life starts to feel like it is just a performance. Many people lose themselves this way in their marriages or at work, where it feels like they are just filling a role, and not really living their life. You can find a good illustration of this kind of depression in the movie: Revolutionary Road.

Avoidant lifestyle:

Then there is the avoidant kind of depression, brought about by living a fear-drive life. This kind of person cuts off too many areas of their life to avoid failure or anxiety. Maybe they avoid risking altogether, and therefore also do not get the rewards of those who conquer their fears and face their challenges. This leads to a dull life robbed of excitement and thrills that come with being fully alive. This kind of person may shy away from the risk of rejection and therefore never experience romantic intimacy with another person. Or, they may avoid truly pursuing their career dreams because they are afraid of failing. The end result is an impoverished life and chronic sense of dysthymia.

Shame about Self:

Then of course we have the people who are too ashamed of themselves to fully let themselves be known and seen by another person. These people have mistaken unkind acts by others as a sign that they deserved mistreatment and are blemished, broken, damaged, or bad. Histories of sexual or physical abuse can often lead this kind of damaged view of oneself and the price of this view is depression. Such people end up not really relating to others fully. They may be afraid that others will reject them if they truly know them, or may ward off love from others, which they discredit or believe to be disingenuous. They cannot be nurtured by love because they cannot love themselves, and the result, of course, is a chronic sense of dissatisfaction with life and with oneself.

Internal Conflict:

Karen Horney’s book “Our Inner Conflicts” is an excellent resource for people wanting to know more about potential conflicts that can lead to depression

Another common variety of depression is the one caused by an internal conflict that leads a person to become stuck in an unresolvable dilemma. A person may for example feel guilty or fearful of choosing a career not condoned by their parents, but may also feel lack of motivation and lack of passion if they pursue the path laid out for them. Oftentimes these conflicts that lead to action paralysis or a sense being damned if I do and damned if I don’t, are entirely unconscious. A person may simply show up to their therapist and complain of feeling depressed without knowing why. Depression can in other words take the place of fully dealing with an uncomfortable dilemma that may involve making others unhappy, or may threaten a person’s established sense of self.

996 Other Depressions:

Add to this catalogue, hundreds of other varieties of depression and you will get the point that depression is not ONE illness, nor is it reducible to a simple catchall diagnosis that must be dealt with the exact same way. In fact, for different people, different life events can trigger a depression. If your life is built around security needs, the ending of a relationship may be the trigger. If you gain your self-esteem from being the life of the party, losing favor with certain friends may be the trigger. If your life is about achievement, getting fired might do the trick. It is therefore important to not get lost in the diagnosis, but to see what the diagnosis reveals about the person beneath the diagnosis.

Heeding the Message of Depression:

Depression is not simply a problem to be treated with anti-depressants. It is a starting point for self-examination. It tells us we are “stuck” in some area of life, cut-off from our true feelings and needs, or unable move on from traumatic experiences of our past. It tells us we must get our life back, and reclaim it from whatever forces are keeping us back.

In the short term we may be able to medicate the problem away, but rest assured, the depression will return until its message has been received. No one in the history of mankind has ever been able to run away from themselves.

About me: I am Rune Moelbak, Ph.D., a psychologist in Houston Texas, specializing in the psychodynamic treatment of depression. To learn more about my approach to depression, please visit my website, where you can access additional resources.

unpleasant emotions

Why Should I Feel My Unpleasant Emotions?

One of the most frequent objections I hear as a therapist, is the objection by clients who don’t see what the point is of re-experiencing unpleasant memories and emotions from the past.

How is feeling sad going to help me?” they ask.

Or: “How is getting angry at people in my life who mistreated me really going to serve me?”

Here is my answer to their concerns…

The Desire to Be Rid of Negative Emotions:

Anger, sadness, loneliness, emptiness, despair, grief; these are all emotions that many people don’t know what to do with, and would most of all like to dump in a dumpster or bury deep underground.

And so they typically do…

They try to quarantine pockets of unpleasant experiences from the rest of their life, and spend much of their time trying to actively repress, ignore, rationalize, or minimize how they really feel.

Why Emotions Should Not Be Pushed Away

Of course emotions don’t go anywhere just because we don’t want to feel them. The more we fight them, the more havoc they generally wreck on our lives:

  • You don’t want to be overcome by grief at the passing of your beloved mother, so you push your grief away. Now the grief instead becomes a depression and the loss, which can never be mourned, a perpetual companion rather than a passageway to a better place.
  • You don’t want to feel angry at your parents for the mistreatment you felt as a child, so you tell yourself it really wasn’t that bad. Now instead your unexpressed anger interferes with your ability to have a REAL relationship with your parents, or gets pushed down so far that when it finally erupts, it erupts as rage.
  • You don’t want to get in touch with the loneliness and emptiness that haunts your marriage, so you try to distract yourself by going on expensive trips, redecorating your house,  or having another child. Now instead the emptiness becomes a perpetual hollowness, and the lack of satisfaction in your marriage the cause  of a manic frenzy of activity that never quite fills the underlying void.

The Price We Pay for Ignoring Our Emotions:

As a general rule the more we fight our emotions, the bigger and “badder” they become. If we don’t allow ourselves to feel them and to hear what they have to tell us, they will keep haunting us until we finally get their message. Fighting them is a losing battle and we always pay a price for denying their reality.

As long as we are not at peace with ourselves, but must deny aspects of our emotional reality in order to feel good, a sense of genuine happiness, calmness, and self-acceptance can never take root.

By getting rid of the “bad”, we also ironically get rid of the “good”.

Why? Because we divert our energy from a path of genuinely accepting ourselves, and replace it with a perpetual fight to deny the realness of our own experiences, which means denying the reality of who we are. Happiness constructed on such as a deceitful basis is not real happiness, but a flight from ourselves that can only lead to perpetual unrest.

The Benefits of Our Negative Emotions:

Contrary to what many people think, all emotions are adaptive and purposeful when experienced accurately and expressed appropriately.

Anger, which to many people can feel scary and unsafe to express, is a signal to us that our boundaries have been violated or that we feel mistreated in some way. If we allow ourselves to experience our anger, examine what boundaries might have been crossed, assess the accuracy of our evaluation of the situation, and express our concerns in a calm and constructive manner, our anger will have served its purpose. Our needs can now become known to others, disagreements can be resolved, relationships can be repaired, and we can command respect even when relationships need to be severed.

Sadness also serves a purpose. It tells us what matters to us, or alerts us to what we are missing. If we can allow ourselves to feel it, we will become wiser about our needs and longings, or the things we missed when growing up. Sadness can lead to self-examination, and can lead to greater acceptance of that which we cannot change. It can also lead to greater clarity about what we really value in life and how we should move ahead. When expressed to others in an appropriate way it can bring others closer to us, invite comfort and caring, and make us feel that we are less alone.

Emotions are Really Movements not States:

The myth about unpleasant emotions is that they are rather static experiences that simply take us over, dominate us, and keep us stuck. However, emotion is really more accurately described as a process or a movement. It is derived from the Latin verb “movere” which means “to move”.

Emotions help move us or motivate us, they give us direction, help us to clarify our thoughts and priorities, and serve as vehicles for making changes to our life. Only when we do not allow ourselves to move with them, do they become static road blocks: obstacles rather than passageways.

So to those clients who wonder, “why should I feel my unpleasant emotions?”, my answer is, “to let them move you to a different place”.

By moving into them, you move through them, and by moving through them, they move you to a different place.

By not fighting your negative emotions, you will be transported to the other side, where they no longer bother you, because they have now served their purpose and set you free.

Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D. a psychologist in Houston, TX who believes good therapy involves a transformation through your emotions. To read more about the process of therapy, visit my website.

 

 

picture of plants sprouting

Growing Strong in Your Weak Places

“The world breaks everyone and afterward many are strong at the broken places” (Ernest Hemingway)

Ernest Hemingway spoke of a universal psychological truth, when in A Farewell to Arms, he suggested that you grow stronger in your broken places, much like a wound that heals itself by growing a protective scab.

Those who suffer through difficult experiences and invalidating environments have to find within themselves a strength that others don’t necessarily have to. They grow stronger in their weak places.

Strengths through Suffering:

If my family was abusive, my psychological survival would demand of me that I stretch myself beyond the normal requirements for human development.

I might have to develop special abilities to numb my feelings, get into my head, or depend on myself, in order to survive such an upbringing. As a result, these facets of my human capacities will become more developed in me than they will in others, and might give me special advantages, in spite of their drawbacks.

If I become skilled at numbing, suppressing, or silencing my feelings, I might be particularly skilled at working in professions that are too emotionally intense for others. I might handle the job of a paramedic, that would make others queasy, with an even keel, or I might keep calm in a crisis situation when others lose their ability to think or to act.

The Need to Rise Above our Vulnerabilities

The world is filled with people, who due to their trials and tribulations in life, have developed unique facets of themselves that have propelled them into successful endeavors: Comedians who learned that laughter was the best medicine to cheer up their depressed mothers, business men who vowed to never lack money in order to overcome the suffering endured by their parents, and world travelers who came to embrace freedom and independence to deal with the anxieties of getting too close to others.

Alfred Adler, one of the early psychoanalysts, developed the idea that human beings have an inherent need to rise above their weaknesses and excel at something.

Oftentimes our particular hardships become the driving force that propels us to succeed, or that supplies us with a mission for our life and a reason to get out of bed in the morning.

The Desire to Be Super-Human

A colleague of mine recently finished his dissertation on what he calls the “Superwoman Schema”. This is a mindset originally found in a subset of African-American women. These women develop a belief that they must be strong at all times, never show their vulnerable emotions, never allow themselves to depend on others to have their needs met, and always set their own needs aside to take care of others.

This Superwoman schema, helps such women develop the thick skin that allows them to keep afloat in tough environments, and not let their personal feelings get in the way of what they need to do.

Although disavowing one’s own needs and setting one’s feelings aside comes at a price, it is undoubtedly also what has propelled some women like these to achieve great success.

If you have watched the Real Housewives of Atlanta, you will know what I mean. These ladies do not easily let their vulnerabilities show. Having a thick skin has helped many of them rise above tough upbringings, feelings of abandonment and histories of abuse.

Attending to the Underlying Wound:

Of course, the strengths that are born out of weaknesses, also tend to have their downsides. The more one tends to pursue life goals out of an underlying wound, the more these goals tend to take on a compulsive quality: I MUST be strong at all times, I can NEVER allow myself to depend on others, I NEED to ALWAYS be smarter than the next person, I can NEVER make enough money. These dictates soon become tyrannical and perpetuate a judgment of oneself as never quite good enough.

Being human for such people is a dangerous reminder of the past they are trying to leave behind. They therefore spend their lives aspiring to rid themselves of their human frailties. Of course such endeavors are ultimately futile since one can never become what one is not.

Instead of dealing with their pain, and grieving the nurturing they didn’t receive, such people instead disavow their feelings, hoping that they can out-run them. With each accomplishment, however, they only alienate themselves further from who they truly are, and remove themselves one step more from the self-acceptance they ultimately long for.

As long as we cannot accept all of our human experience, including the full gamut of human emotions, from assertive anger, to the pain of disappointment, from the sadness of loss, to our need for closeness, we will always fall short of realizing our most precious project: to become who we are, not more than who we are.

Dr. Rune Moelbak

 

About Me: I am Rune Moelbak, Ph.D., clinical psychologist in Houston, Texas. I help people attend to their emotional wounds so they don’t have to spend their entire life running away from their pasts.

change in therapy

At the Edge of Your Experience: How Therapy Creates Change

What happens in good therapy is hard to explain to someone who has not yet experienced it.

Why is that? Because the person who enters the therapy room often isn’t the person therapy will reveal her to be. Her very goals and definitions of who she is belongs to her pre-therapy self.

If she is like most people she is used to the idea that life consists of a series of problems to be solved. She views herself as a kind of processing machine that takes in information or challenges, uses logic and planning to tackle these challenges, and produces an output or performance. Her score card is life. She asks herself: Am I married? Do I have a good job? Can I deal with stress at work? Am I happy in my relationship? And if the answer is no, she extrapolates, it must be because she isn’t doing things right, isn’t using the right logic, doesn’t have the right attitude.

She feels like a machine that is broken; a person who cannot deal as effectively with life’s problems as the the next person. She feels deficient, lacking skills that others seem to have, and needing knowledge that will help her deal with life in ways that will make her feel effective and successful again. She needs to get fixed!

However, this is the person’s ego speaking: the ego who believes she is the queen of her own castle, who problem-solves, who plans, and who thinks she is in control.

Therapy, however, is not for the ego.

Encountering a Different Self:

Therapy does not focus on who you are and what you want. Instead it seeks to give you an experience of who you do not know that you are and what you did not know that you wanted.

Instead of focusing on providing knowledge about well-defined problems, therapy seeks to take you to the unclear edge of what you do not yet know. Here at the edge, your own experience can teach you something new. Here you can access feelings you had not previously been aware of, or rediscover fragments of your experience which you had previously forgotten.

Here at the edge of your own experience, you encounter a different you; a “you” that is larger and more complex than your well-defined ego, or image of self. And as you bridge this abyss between who you have been thinking about yourself as, and what you are becoming, change happens to you: Therapy becomes therapeutic.

Will You Trust Me?

It is hard to explain this process of metamorphosis to someone who thinks the solution to their problems lies in techniques, knowledge, or wisdom that they can receive and implement in some rational and planful manner. Because what I am saying, this part of the self cannot understand.

And so you must trust me enough to dare to leave your preconceived notions to the side. You must take me up on my invitation to speak freely, to speak what you do not want to say, to speak about that for which you have no words, that which is farfetched, childish, has no form, makes no sense, or is slightly beyond reach. And here at the edge, is where new experiences take shape; where the self is in the making.

The Role of the Therapist:

Your therapist is there to help you stretch beyond your own capacity, push you towards insights that is slightly beyond reach, notice where the body betrays a consciously held view, where the voice stammers, where emotion hides, or where novelty lurks.

Therapy is not the doing of the therapist, nor the doing of the client. It is the happening of the unseen, the unsaid, and the unfelt from a place “between” the two; the arising of something that neither could have produced on their own.

Therapy is also not the linear execution of a solution to a predefined problem. Change in therapy is not something you implement, it is something that happens to you. And it happens to you always from a place that was initially outside your awareness.

What is Good Therapy?

Therapy is therefore about welcoming in experiences that lead to a revision of previously held understandings or that help you discover something about yourself from a place that was not previously accessible.

Therapy is about growth, revision, becoming. It is about gaining contact with an aliveness and self-evidence in your own experiential depths that will change how you feel about yourself and who you can become.

We don’t know the answers, nor the outcome, before you enter therapy. Therapy itself is the pursuit of these answers. It is through therapy that the mysteries of your existence, of your choices, and of your hang-ups shall be unraveled. Not from a place of universal knowledge, but from an experience of your own personal truth.

Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D., a psychodynamic therapist in Houston, Texas. To read more about my approach to therapy, visit my website: www.bettertherapy.com.

 

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Finding Your Way Out of Obsessive-Compulsive Disorder (OCD)

Are obsessions and compulsions the result of your brain going haywire, or could they have a meaning and a function, which can be addressed through psychological therapies?

Although there is some evidence that severe forms of obsessions and compulsions, such as excessive cleaning rituals or time-consuming fears about contaminating others, might best be treated with medication, we should not rule out alternatives to pharmacological therapies for less severe forms of OCD.

Behavior Therapies for OCD:

One such form of therapy which has been well-established as the psychological treatment of choice for OCD is Exposure and Response Prevention. Exposure and Response Prevention is a behavior therapy that focuses on exposing the person to the very thing they are anxious about and preventing them from engaging in rituals intended to ward off their anxiety.

If somebody, for example, has an excessive fear of being dirtied or contaminated, believing that they might contract a deadly disease from any contact with a soiled surface, they may be instructed to deliberately touch all door knobs in a public office space, and then tolerate the spike in their anxiety that ensues without engaging in any cleaning rituals to rid themselves of dirt and germs. Over time this exercise retrains the brain to not fear, and leads you to “habituate” to the anxiety, which slowly decreases without any need for rituals.

Behavior therapies can be an excellent alternative or adjunct to pharmacological treatments for OCD. They often reduce distress and increase your sense of control over your life, and they don’t come with all the side-effects of anti-depressants and anti-anxiety agents (which are often the drugs of choice in the treatment of OCD).

In the Houston area, you can contact the following providers, to learn more about this approach to treatment of OCD:

Going Beyond Behavior Therapies:

If you want to not simply experience relief, but to find out if deeper underlying issues may be causing your obsessions and compulsions, then psychodynamic therapy might be a good next step.

According to a psychodynamic viewpoint, obsessions and compulsions are defenses against underlying feelings or conflicts of which the person is unaware.

In this kind of therapy the content of a person’s obsessions is not simply treated as arbitrary or irrelevant, but is seen as a meaningful and significant clue that will help unlock the larger unconscious struggles in which the person is caught.

What Obsessions and Compulsions Mean:

If a person is having fears of their own aggressive impulses, such as fretting about the perceived likelihood that they will run somebody over when they are driving their car, this could indicate that anger is not a comfortable emotion for them.

The exaggerated fear that one has the potential to kill another person may here be an outward expression of the inward experience of guilt or shame one feels about one’s anger.

A person may develop guilt or shame about feeling and expressing anger for a variety of reasons.

Further analysis may reveal that:

  • The person feels intense anger at their deceased mother, who was never really there for them when growing up, but whom they feel they need to love and respect
  • The person may hate their boss, but may have learned that it is bad to challenge people in authority.
  • The person knows in their heart of hearts that they really want to divorce the person they are married to, but cannot bring themselves to admit this to themselves or to their spouse.

In each of these scenarios, the outward expression of anger or dissent in their rightful situations has been blocked.

The result is the manifestation of a symptom that displaces their conflict to another arena that is perceived to be psychologically “safer”.

The exaggerated fear that one might run a person over is here a displaced fear of the calamities what would happen if one were to be honest with oneself and admit to feelings of anger directed at actual people in ones life.

The obsessional nature of the fear of hurting a stranger is fueled by energy from the original dilemma which must be defended against at all cost. The obsession represents a fear of the danger of the truth erupting.

As a consequence, the obsession is likely to intensify at times when the actual conflict is threatening to erupt. The person may for example become particularly paralyzed after being told to handle job responsibilities that are not in their job description. This kind of experience threatens to bring anger at the boss to the surface, thus necessitating a greater degree of mental control to keep the truth from breaking forth into the person’s reality.

The trick here is that the person who experiences the OCD symptoms are not themselves able to discover the logic that keeps their obsessions and compulsions in place. Their truth is hidden from themselves precisely to avoid the shame and guilt they need to defend against. It is for this reason that seeing a psychodynamic therapist can be useful and sometimes necessary.

Benefit of Psychodynamic Therapy for OCD:

Psychodynamic therapy is about helping people figure out why they are experiencing the symptoms that are making it difficult for them to live a good life. It is about discovering the meaning in the seemingly meaningless. It is about gaining control, not just of your behaviors, but of your psychological life.

The benefit of this goes beyond simply resolving or dissolving a particular symptom.

When a person realizes that they have unresolved issues related to the expression of anger, they are able to not just stop the ruminations and rituals, but to address the guilt or shame that blocks them from having healthy access to their assertive emotions. They can then be helped to grieve the love they did not receive, or to feel better able to express their needs without feeling guilty or ashamed.

The  treatment of the symptoms of OCD, now gives way to the treatment of the person. Obsessions and compulsions are now no longer the focus of the therapy. Instead they are the starting point for understanding something deeper about a person’s life.

Dr. Rune Moelbak

About me: I am Rune Moelbak, Ph.D., a psychodynamic therapist in Houston, TX. I help people discover the causes of their symptoms. Visit my website for more information.

 

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What Causes Psychological Disorders?

Although there are some psychological disorders that have a clear biological or genetic component, many if not most are responses to life’s adversities and quite treatable through therapy.

What is a Psychological Disorder?

A psychological disorder is often not really an illness such as one would define diabetes or multiple sclerosis. Instead it is simply a name given to a collection of distressing symptoms that frequently go together and thus would appear to refer to the same underlying phenomenon.

Major Depressive Disorder, for example, is the name we give to the symptom of persistent low mood or lack of excitement that is accompanied by a minimum of 5 other symptoms such as: hopelessness, low self-esteem, changes in sleep and appetite, low energy, low motivation, decreased concentration, and possibly suicidal thoughts.

Unlike an illness, however, most psychological disorders have no singular defining cause and therefore do not refer to an underlying disease process. What we call psychological disorders are therefore simply descriptions of surface-level similarities in how psychological problems can manifest themselves.

To truly understand why a person is depressed, or what causes the depression, we must move beyond the symptoms to the origin of the symptoms. When we do this we often find that your depression and my depression are not really the same. They are not defined by the same underlying cause, but are simply like the fever or the cough that can hide over widely divergent underlying issues.

The Causes of Psychological Disorders:

When we look at the internal functioning of most people, we often find that psychological symptoms such as depression and anxiety are the result of ways of protecting ourselves from painful or unpleasant emotions.

Somewhere, at some point, we developed negative emotional responses to our primary emotions and longings: Those healthy and natural feelings that a child expresses spontaneously without guilt or shame.

For example, we may have developed guilt about our sexual desire, shame about needing other people, anxiety about expressing our anger, or unbearable pain associated with the experience of loss or rejection.

These secondary aversive reactions to our primary emotions taint these natural emotions and needs, and lead us to shut them out, inhibit them, or engage in all kinds of self-protective behaviors intended to keep us safe from our own unpleasant experiences.

  • To protect ourselves from guilt about sexual feelings, we may for example develop a life strategy of never really dating.
  • To avoid feeling shame about our longing for closeness, we may live a life of always helping others and not being able to receive help from others.
  • To not feel anxious about our anger, we may become a people pleaser, ignore our own needs, and not be able to assert ourselves.
  • To not feel overwhelmed with pain associated with losses, we may bury ourselves in work and live a life of always being on the go and always distracting ourselves.

In each case we may become depressed or anxious as a result of cutting ourselves off from a natural source of vitality and living a life that is at odds with itself or impoverished in some way.

Depression and anxiety are here not referring to a cause. Instead they are the symptoms that have resulted from conflicted experiences and our failed strategies of dealing with these experiences.

Psychological Disorders as Defenses:

Other psychological disorders can be explained in a similar way…

Intrusive obsessions about one’s own destructive impulses (OCD), can in some cases be a way to protect oneself from dealing with guilt about the rightful expression of assertive needs, which one fears would destroy others or be too much to handle.

Social anxiety and the avoidance of social interaction can in some cases find an explanation in the attempt to avoid feeling the shame of rejection, which has been magnified to mean the destruction of one’s self-worth.

In this way, most of what we call psychological disorders can be unraveled and explained as symptoms of underlying conflicts that are specific to each person’s life experiences.

Resolving Psychological Disorders:

A psychological disorder usually makes perfect sense once we understand the full picture of the person’s psychological reality.

The goal of therapy is therefore to locate within a person’s life, the experiences or moments that have led to secondary reactions of guilt, shame, pain, or anxiety to normal, human, healthy emotions, needs, or expectations.

People must unlearn the fear, shame, or guilt that has become associated with being fully themselves. They must be able to fully get in touch with yearnings and feelings that have been considered too dangerous and have therefore been shut out. By thus regaining access to hidden parts of themselves, they can stop being at war with themselves and can become free to respond in more life-affirming ways to life’s many challenges.

Simply slapping a label on someone and classifying someone as having a particular disorder, tells us nothing about the journey each person has to go through in order to undo their disordered ways of dealing with life’s dilemmas.

Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D., a psychologist in Houston Texas. I help people get to the root of their problems so they can experience real change rather than temporary gains.

image of psychodynamic therapist, Dr. Rune Moelbak

Why I am Not a CBT Therapist…

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

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

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

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

Why CBT Became Popular…

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

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

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

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

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

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

What is CBT?

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

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

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

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

The Benefit of CBT:

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

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

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

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

So What is Wrong with CBT?

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

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

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

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

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

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

Why I am a Psychodynamic Therapist:

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

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

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

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

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

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

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

 

depressed woman

The Psychological Causes of Depression

Watch my new video on the psychological causes of depression:

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

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

The Past Never Lasts

The Past Never Lasts: Changing the Past from the Future

The Past Never Lasts: Changing the Past from the Future

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

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

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

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

Working with the Past in Therapy:

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

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

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

Changing the Past from the Future:

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

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

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

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

But wait…

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

Now we are getting somewhere!

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

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

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

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

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

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Dr. Rune Moelbak

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