Category Archives: Anxiety

Generalized Anxiety Disorder: How to Stop Worrying and Start Living

Generalized Anxiety Disorder (GAD) is a label often given to people who worry excessively about many different things. They worry both to the point of making themselves significantly distressed and to the point where others start to get exasperated because they really don’t find the anxious person’s worries to be justified or realistic.

Why Do People Worry?

The first step in understanding the tendency to worry is to acknowledge that worrying is generally intended to be a helpful mechanism that reminds us of things to watch out for. Its purpose is to keep us from getting in trouble.

Worrying in itself is therefore not a problem. It is what makes me move my car from an area with unclear signage to avoid getting a parking ticket, and what makes me arrive 30 minutes early for a job interview just in case there would be an unexpected accident that would slow me down on my way. These kinds of anticipations of bad things happening generally serve me well. They help me plan for eventualities that could harm me and make me feel more in control of my life circumstances.

When Do We Worry Too Much?

In the life of someone with generalized anxiety disorder, however, worrying no longer serves it’s intended function to help us adapt well to genuine risks and challenges in our environment.

Here the worries have a number of characteristics that make them more burdensome than helpful. This is because the nature of the worries frequently includes a number of different exaggerations that distort the true risks involved.

These exaggerations fall into a number of different categories, which it will be helpful to understand so we know what we are dealing with…

Here they are one by one…:

Frequent Worries of Highly Anxious People:

“I take too much responsibility for others instead of setting healthy boundaries:” 

This kind of worry places excessive blame on myself if something were to happen to someone else. For example: “If my friend feels alone or depressed, it is probably because I am not doing nearly enough to hang out with them” or “if my boss gets annoyed or frustrated with me, it is probably because I am too lazy or unintelligent, or because I am a bad employee”. Not only does this kind of worry tend to turn to self-blame and excessive guilt, it also makes me feel that I constantly have to prove myself to others in order to be a good friend, good employee, good spouse and so on. It is therefore not unusual for people with generalized anxiety to overextend themselves, to take too much onto their plates, and to leave very little room for themselves and their own needs.

“I look to others for answers rather than trusting my own intuition:”

People with generalized anxiety often have a fundamental mistrust of their own decision-making. They fear that they would be unable to cope, or would be responsible for other people’s suffering, if they were to make a wrong decision. For this reason, people with generalized anxiety will often seek expert advice rather than consult with their own intuition, or they will defer to others about which restaurant to go to instead of feeling within what they are really in the mood for. This other-oriented living is just another way that the person with generalized anxiety silences their own voice and lives in hiding from their own needs, rights, wishes, and feelings.

“I externalize my anxiety rather than looking for the cause within:”

People with generalized anxiety live in constant anticipation of bad things happening around them that they think they would have prevented if only they were proactive enough or paid enough attention. Their constant attention to dangers in the environment conceals the fact that the real danger in generalized anxiety is often a danger from within. Clinical wisdom tells us that the fears that underlie my worries in GAD are really fears related to the eruption of emotions such as sadness, anger, or insecurity that I feel within myself and that I don’t think I can cope with. People with generalized anxiety often have an unconscious fear of disintegration, helplessness, and emotional overwhelm, which makes them live in fear of their own emotions and makes them want focus their attention outward instead of inward. Instead of dealing with their fears of their own emotions, they instead worry about physical symptoms in their body which they mistake for possible illnesses, or about other people for whom they feel responsible, or about eventualities in the future they can plan for or try to control.

“I blame myself rather than feel angry at others:”

People with generalized anxiety often have a hard time standing up for themselves, saying “no” to others, or feeling justified for having their feelings. Anger, which is the emotion that alerts us to boundary violations, injustice, and unfair treatment often evokes anxiety or feelings of guilt in people with generalized anxiety. As a result, the anger often gets converted into excessive people-pleasing and excessive self-blame. If someone gets mad at me, I internalize their anger and use it to beat myself up for my wrong-doings, or if someone offers a negative opinion about something I did, I take it to mean that I have inner defects or short-comings that I need to make up for. The lack of comfort with anger makes me invalidate my own perspective or right to self-define, and leaves me vulnerable and exposed to criticism from others.

How to Overcome Debilitating Anxiety:

The first step in overcoming generalized anxiety and excessive worry is to make the different kinds of excessive, unfair, or unrealistic patterns of self-protection which I have described above problematic to the anxious worrier. The person with generalized anxiety has to be helped to disentangle themselves from the part of them that worries or scares them. They have to realize that worrying and feeling anxious is something they do to themselves rather than who they are.

This differentiation of themselves from their worries is best facilitated by a therapist who can help them name both the ways in which they worry themselves and what it feels like to be on the receiving end of these worries. The outcome of this kind of differentiation is that they can begin to understand the needs and fears of the “worrier”, as well as the feelings of helplessness, inadequacy, and plight of the part of them that can never get a break from the “worrier”.

Helping the Worrier Turn Attention Inward:

Instead of the therapist simply joining with the more dominant worrier voice and helping this part of the person find the reassurance that it constantly wants but can never find, the therapist instead helps both parts of the person address the underlying emotional needs that never get tended to as long as the worrier simply pursues its agenda of finding reassurance outside of the anxious self.

The solution to the worrier’s problems is not to be found in getting reassurance or advice from the therapist, or finding ways to be better, stronger, smarter, more accomplished, more likable, or more in control. These are the pseudo-solutions the worrier tries to pursue to avoid addressing the source of their own vulnerability, and are ultimately very hurtful and damaging to the part of them that has to live underneath the weight of these responsibilities.

The Real Cause of Generalized Anxiety:

Once the person with generalized anxiety stops looking for solutions in never-ending self-improvement or never ending pursuit of more control, he or she is finally able to address the real issues at the heart of their worries. They can now gradually come to face the earlier life experiences that have made them feel too frail, too vulnerable, too unsupported, or too overwhelmed.

To do so, the person with generalized anxiety needs to be helped to turn their attention inward toward the pain they have avoided confronting, so they can become more comfortable with their own emotions and more grounded within themselves.

One reason that this has not been possible so far is that the person with generalized anxiety has learned to dismiss those feelings inside of them that were to uncomfortable or distressing to others around them .

The worrier came to be dismissive of their own feelings and needs because others were not there for them the way they should have been or because others could not handle or tolerate their emotions.

It is this original or ongoing rupture in compassionate understanding from others that often needs to be addressed in therapy so the person with generalized anxiety no longer needs to shut themselves down or turn their gaze outward.

The solution to generalized anxiety is therefore not to increase the effort to control situations and become ever more perfect. It is to become ever more comfortable with acknowledging your own vulnerabilities and learning to find ways to soothe and comfort the part of you that did not feel safe, supported, or reassured when growing up.


emotion-focused therapy for generalized anxietyFor more information about the underlying causes of generalized anxiety disorder, I highly recommend the book:  Emotion-Focused Therapy for Generalized Anxiety by Jeanne Watson and Leslie Greenberg

 


Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D., a psychologist in Houston Texas who offers a deeper approach to working with generalized anxiety. To learn more about anxiety visit my therapy website.

 

The Illness is the Cure: The Forgotten Wisdom of Our Psychological Symptoms

I always liked the saying “The illness is the cure”. Why? Because in the area of mental health, it alerts us to something profoundly insightful about the nature of the psychological and emotional problems most people struggle with.

Whether we feel depressed, have panic attacks, or generally feel weak, bad, or inadequate, these kinds of problematic states and ways of suffering are rarely ever simply problems to be removed or eradicated. They are NOT the illness, but like a fever or a cough, a symptom that alerts us to something about our life or our approach to life that is off-kilter, wrong, or in need of change.

Like the red lamps on the dashboard of a car, they alert us to the problem, but are not themselves the problem.

The Fallacy of Treating the Symptom as the Cause:

There is a real fallacy here that many people fall into if they do not realize this nature of their psychological distress.

If they simply think of their anxiety or their depression as the problem, then they might try to medicate the symptom to the exclusion of finding out why the symptom is really there.

In some sense this approach would be tantamount to attempting to solve a car issue by smashing the red light on the dashboard.

However, when you realize that the psyche uses the symptom of depression or anxiety to alert us to the fact that it is ill or that something in our life needs to change, our symptom becomes more of a friend than a foe. It now serves as a calling to resolve an issue which we may have been avoiding or which has stumped us in some way.

As in the saying “the illness is the cure” it serves merely as the first step toward the cure, and as such it is in fact the first step toward a transformation and reorganization that needs to occur for balance and health to be restored.

Way too often, we short-circuit this natural healing process because we get frightened by the calling and can’t see the road ahead. We mistake the symptom for the cause, and the burgeoning cure for the illness itself.

Discovering the Truth of Our Symptoms:

There is a depth of understanding that has gotten lost in our current search for quick fixes and immediate happiness, but was always there in the minds of the founders of the craft we now call psychotherapy.

A psychiatrist like Carl Jung, for example, beautifully wrote about heeding our symptoms as a calling:

“Depression”, he said, “is like a woman in black. If she turns up, don’t shoo her away. Invite her in, offer her a seat, treat her like a guest and listen to what she wants to say.”

Carl Jung
Carl Jung

Even poets have alerted us to the fact that our distress is merely a signpost toward making necessary changes. As Rainer Marie Rilke writes:

“Why do you want to shut out of your life any uneasiness, any misery, any depression, since after all you don’t know what work these conditions are doing inside you? … If there is anything unhealthy in your reactions, just bear in mind that sickness is the means by which an organism frees itself from what is alien; so one must simply help it to be sick, to have its whole sickness and to break out with it, since that is the way it gets better.”

Rainer Maria Rilke
Rainer Maria Rilke

Sigmund Freud, too, reminded us of the danger of not listening to our symptoms, for as he rightly warns us:

“Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways”

Sigmund Freud
Sigmund Freud

The Calling of Symptoms is to “Know Thyself”:

So much gets lost when we don’t heed the advice to listen to our symptoms and pursue them as the first step toward a cure.

Depression, anxiety, badness, and upset, cures itself once its truth is understood and its emotional conflicts disentangled.

The calling of mental illness is to “know thyself”.

The calling is not for a dimming of your awareness through medication, quick fixes, or a rush to premature action, but for an expansion of your consciousness, so you can reap the benefits of your psyche’s own wisdom, and find out more about what is meaningful and central to you at your core.

Illness is not a destination, but a way-station, and those who dare to unlock its message will be amply rewarded and transformed in the process.

image of psychodynamic therapist, Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D. psychologist in Houston, TX. I help people work through their symptoms of anxiety and depression to achieve a transformation to a better, lighter, and more centered self. Visit my website for more information. 

How to Overcome Excessive Guilt Feelings

Many people feel marred by guilt feelings that are preventing them from fully enjoying their lives.

Sometimes, of course, guilt is a useful signal to ourselves that we have done something we can’t really be proud of or have done something we shouldn’t have. It allows us to to seek forgiveness and correct a wrong. Without this kind of experience, we would not be able to become remorseful, and would end up not caring about other people’s needs, thoughts, and feelings.

When Does Guilt Become Excessive?

Many times, however, guilt becomes attached to a wide variety of healthy feelings, thoughts, or behaviors, and starts to work against us rather than for us.

We may for example feel like we have done something wrong after having sex, or we may feel like we made a transgression by standing up for ourselves when we really needed to.

Because the feeling of being guilty of a wrong is so unpleasant, it is likely that we end up avoiding situations that would make us feel this way, or that we become apologetic and remorseful in situations where we should really stand our ground.

In this way, our guilt feelings can begin to control us, and can make us cut off pieces of ourselves and live restricted lives.

The Woman Who Was Consumed by Guilt:

One woman, for example, had the propensity to feel guilty about asking for what she needed in her marriage. She would not be able to enjoy a movie if her husband didn’t pick it, and would not be able to tell him “no”, if he asked her to take on responsibilities, which severely encroached on her other commitments and plans. On her birthday when she chose a restaurant for her birthday celebration, she could not enjoy the dinner because she was too worried about others not liking the restaurant she picked. In situation after situation, she would therefore avoid making a decision, or avoid telling others no.

At the end of the day she paid for her guilt-ridden existence by feeling “trapped” in her obligations and responsibilities. Her conscience had turned against her. Rather than being a source of good, it had become a cross to bear. She was living a life of repentance of sins she had never committed and had become imprisoned by the prohibition against making any demands or stating any wishes. Being herself had become guilt-inducing.

Neurotic Guilt

In this situation the woman’s guilt had become “neurotic”.

Neurotic guilt is guilt that has stopped serving as a useful moral compass, and has started to become aggression turned against oneself.

The voices of adults we internalized when growing up, and which helped shape us into a moral human being with empathy and consideration for others, has in these instances begun to over-function.

What is Guilt?

Guilt is in its essence the experience of remorse for having done harm to others by our actions, feelings, or thoughts.

In a supportive environment, we learn that even though we hit our little sister, we can seek forgiveness and can repair the situation. But if for some reason, the repair was not an option, or if others seemed to be excessively hurt by our expression of a thought, or our display of a particular emotion, the experience of guilt can find no release, and instead become traumatic.

One woman expressed how her father during a time of depression, had told her that the reason why he became suicidal is that he thought she did not love him. The woman internalized this message as a perpetual guilt about her actions and omissions. She started to feel that there was something destructive about expressing her needs or feelings, and that she had the power to destroy the people she loved, by the mere expression of her thoughts.

Other situations that can lead to excessive guilt are early messages that you will go to hell, or that mommy and daddy won’t love you anymore, or any other message that communicates the lack of possibility of redemption, or the withdrawal of needed love and affection. The guilt in these situations can become overwhelming, and so aversive that life itself, with its spontaneous desires and wishes, has to be inhibited.

The Cure for Excessive Guilt:

In the examples stated above, guilt in its natural state has really been corrupted by the experience of intense anxiety and fear, or by excessive pain, or even self-loathing.

To remove the excessive guilt is therefore to come to terms with these feelings or fears. In many situations, guilt or the anxiety associated with asserting one’s needs or wishes, are really rooted in a fear of one’s own aggression and the erroneous belief that there is something destructive about one’s needs and feelings.

Only when a person gets in touch with these underlying realizations and learns to undo the false impressions of their needs and feelings, can these feelings be transformed. A person can then be released from the chains of their excessive guilt and find peace and comfort in being who they are.

image of psychodynamic therapist, Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D., psychologist in Houston, TX. I help people undo negative learning from their past that has led to excessive guilt, shame, or anxiety. Visit my website to learn more.

 

 

The Truth about Pathological Lying

The line between telling the truth and telling a lie has always been the central theme of psychotherapy.

The real self (an acceptance of one’s real feelings and motivations) and the reality principle (a sober assessment of the world as it really is) has always been considered the hallmark of health or good adjustment. 

Various forms of lying, on the other hand, have been the hallmark of what we consider to be pathology or maladjustment.

When we tell a lie, we make reality conform to our ideas rather than adjust our ideas to fit reality. 

In neurosis, for example, the truth gets distorted (minimized or magnified) in the service of maintaining a certain level of psychological safety. We need reality to BE a certain way in order to feel okay with ourselves and comfortable in the world.

In psychosis, on the other hand, our lies become fully-fledged fantasies without any basis in external facts.

Pathological Lying:

Although we all need some modicum of fantasy and untruth in order to make our lives and our view of ourselves more tolerable, for a certain group of people, lying becomes the central mechanism by which they interact with others.

We can call these people pathological or compulsive liars, although in many cases, pathological lying is really more of a symptom than a definition of who I am. 

The compulsivity of pathological liars means that these are not people who choose to lie. Lying here becomes automatic. It is a mechanism for maintaining psychological safety and reducing interpersonal anxiety.

Pathological Lying as Reaction to Trauma:

In my own work with compulsive liars I have generally found that the lying is a reaction to trauma.

One person, for example, was in a physically abusive relationship where he learned that he needed to say or do things more out of a concern for maintaining the other person’s happiness, than out of a need to express his true thoughts and feelings. The truth became associated with danger and became hijacked by the more primordial need for safety. Who I am, in this scenario, becomes who I need to be in order to be liked or accepted by others. Being myself becomes a dangerous proposition, a luxury which I cannot afford. Instead my truth becomes a self-presentation I can adapt to what I think others want from me.

Another person was helped to discover that at the root of her lies was a profound fear of being abandoned if she were to be herself. Vivid examples stood out about not having been picked up after soccer practice, and otherwise being forgotten about or neglected by caregivers in many situations. Now, she had come to think of herself as mostly a burden and as someone who could only count on others to be there for her as long as she provided a benefit to them. Most of this woman’s life thus became a frantic effort to be who others needed her to be so she would not be rejected and plunged into a deep dark hole of feeling worthless and dispensable.

Truth is Only Possible When We Feel Safe:

In both of these examples, the compulsion to lie was driven by a compulsion to stay safe, and a perceived risk involved in being and expressing one’s more genuine self.

Both examples reveal to us that telling the truth is always only possible on the basis of a fundamental sense of safety in one’s relationships with others. The ability to be real with oneself and with others requires validation that one is good enough as is, and certainty that others will be able to tolerate and care for one’s unembellished unadulterated self.

In this sense, pathological lying is really just like any other neurotic defense mechanism. It serves to ward off shame, lack of self worth, and a fear of abandonment and rejection.  

image of psychodynamic therapist, Dr. Rune MoelbakAbout Me: I am Rune Moelbak, Ph.D., a psychologist who helps people get in touch with their personal truths. If you have been hurt or shaken up by the lies of someone you love, or find it difficult to relate to others without lying to them, psychotherapy can help.

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.

 

Should I Take Medication for My Anxiety and Depression?

the truth about medication for depression and anxiety

Questions You Should Ask Yourself about Psychiatric Drugs:

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

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

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

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

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

Can We Trust Psychiatric Research?

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

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

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

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

Do We Know the Long-Term Risks?

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

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

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

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

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

Is it Philosophically Sound?

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

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

Should I Take Medication for My Depression or Anxiety?

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

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

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

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

Dr. Rune Moelbak

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

 

What is Psychodynamic Therapy?

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

What is Psychodynamic Therapy?

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

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

Mr. Lovenstein: Adult
Mr. Lovenstein: Adult

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

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

A Lesson in Psychodynamics:

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

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

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

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

Defenses against Internal Conflicts:

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

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

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

The Price We Pay for our Defenses:

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

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

Our Conflicts Are Often Unconscious:

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

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

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

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

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

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

An Example of Psychodynamics at Work:

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

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

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

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

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

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

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

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

The Effectiveness of Psychodynamic Therapy:

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

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

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

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

This is why I believe psychodynamic therapy.

Image_Moelbak_frontpage

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

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. 

Borderline Personality Disorder and the Fear of Becoming Oneself

The concept of Borderline Personality Disorder is often understood as being synonymous with an impossible individual who acts out in the most ostentatious ways. The concept conjures up images of suicidal threats and acts, as well as intense anger and aggression. However, there is a more subtle kind of borderline anxiety that is less “in your face” and yet quite widespread in many romantic relationships. This kind of borderline phenomenon is not the kind that would require hospitalization, but it nevertheless has its own insidious and very destructive effects on the health of a relationship…

The kind of borderline anxiety I am talking about is different from your common garden-variety of anxiety. It is not related to the fear we can all feel sometimes of messing up an important presentation at work, or the existential fear that comes naturally when having to make an important decision about our life direction. Nor is it related to the everyday anxieties of getting a parking ticket in an area with unclear signage, or the worries about things going wrong that are outside of our control.

These kinds of anxieties are adaptive in the sense that they help us prepare better and consider risks, so that we may make better decisions. Even when these anxieties and worries become excessive and unrealistic, they are still in some sense about external things, and in this sense never pose a danger or threat so fundamental as to reach the level of the anxiety of someone with a borderline personality.

Losing Oneself to Gain Love:

Borderline Personality is in my opinion a fear of being oneself. Not the kind of fear experienced by someone with social anxiety, who may in many instances like themselves when alone and even develop a preference to spend time by themselves.

Unlike the socially phobic individual, the borderline fear of being oneself is paired with a need for others that is as fundamental as the need for oxygen.

This conflict between the need to be close and the fear of being oneself plays itself out in very destructive ways that involve not just the person who experiences these anxieties, but also their partner, who may in many instances end up suffering just as much.

For the person with borderline personality disorder or borderline anxieties, individual expression or being oneself equals loss of love and affection. The fundamental belief here is that “I am unlovable” as myself, therefore to attract and keep the love I need, I must become the object the other person needs or desires. I must obtain love by becoming a chameleon who changes and adapts to become exactly what the other person wants.

Unfortunately, this strategy, although temporarily eliminating the anxiety of being rejected, also leads to built-up of anger and resentment. The person with borderline anxiety soon starts to get annoyed, angry, and frustrated with the lack of love they ultimately receive. They feel loved not for who they are, but for who they have become to please their partner. Although their partner might enjoy having found someone who likes the very things they like or who always wants to go to the restaurants they themselves enjoy eating at, they will soon experience the anger and frustration of their partner who feels chronically love deprived.

Borderline Personality and the Fear of Choosing:

The dilemma, however, is often an impossible one, for if one were to ask the person with borderline anxieties to make a choice about where to go for dinner or where they would like to go on a day retreat, you would soon bump up against the fear of self-expression. To the person with borderline anxieties, making a decision means being exposed and risking rejection. Afterall, we are defined as people by the choices we make, and it is in the freedom of choosing that we cease being an object for another person and start to become a subject or a person in our own right.

The outcome of this dilemma is usually as follows: The person with a borderline personality makes a tentative choice, but now becomes acutely aware of any sign of disapproval. He or she scans the facial expressions and actions of their partner for signs of the loss of love, just like a person who was just robbed, would scan the environment for suspicious people.

The partner is thus often up against a certain paranoia that leads the person with borderline anxieties to attribute motivations, thoughts, and feelings to them on the basis of unfounded fears rather than facts. The borderline is always ready with interpretations such as: he’s just doing it to please me, or she really doesn’t want to be here. And ultimately jumps to the conclusion: He doesn’t care about me! OR she doesn’t love me!

The Impossible Dilemma of the Borderline’s Partner:

A movie night where the person with borderline anxieties has chosen which movie to watch might thus quickly turn into a fight: The anxious person who is already feeling guilty and bad for having made the “choice”, might quickly find a reason to think that the partner is not enjoying the movie, is not paying enough attention, or is using a tone of voice that indicates annoyance with the movie. When accused of this, however, the non-borderline partner cannot persuade their borderline partner otherwise. The conclusion has already been made in the mind of the borderline who now walks up and turns off the video, furious at the partner for the lack of interest shown.

The non-borderline partner is now left with his or her own impossible choice: to insist on watching the movie is to be accused of just humoring the other person, while to do nothing is to prove that every time the other person chooses something, the partner shows no interest.

This kind of scenario where the partner is accused and sentenced on the basis of borderline fears, and feels damned if I do and damned if I don’t, gradually conditions the partner to become fearful or anxious him or herself. He or she may now start to limit their own choices and fear their own self-expression, since it is quite unpredictable when they will incur the wrath of their borderline partner for saying the wrong thing, or making the wrong decision. It is as if by living with someone with borderline anxieties, one has to always walk on eggshells, which by the way, is the title of a popular self-help book for partners who find themselves in these dilemmas:

Stop Walking on Eggshells Book Cover
Click on book cover to read description of book

Borderline Personality and the Fight to Exist:

These kinds of impossible dilemmas, which are now transmitted to the partner, exactly mirror the impossible dilemmas at the heart of borderline pathology: I can’t be myself (without losing love) and I can’t not be myself (without feeling that I don’t exist and am not loved for who I am). I am stuck in the borderland where no choice can be made. My life is an impossible existence, where I am always teetering on the edge of disaster no matter what choice I make.

Borderline personality is thus in most cases a fight to exist, and the emotion that is most symbolic of this fight is: Anger. The person with borderline personality is angry at having to always accommodate others, and angry at having the right to their own existence stolen from them. But they are also angry that if they dare to assert themselves, make choices, and be themselves, the other person likely will lose interest in them or stop loving them.

Anger is here in some sense a sign of health, even if the situation one is angry about is created on the basis of anxiety rather than facts. The anger is a protest. It communicates a desire to be oneself, to have one’s own needs met, and to come into existence as an individual in one’s own right.

About Me: I am Rune Moelbak, a psychologist in Houston, Texas. I provide psychodynamic therapy for people who want to get to the root of their problems.