Category Archives: psychodynamic therapy

Why Is It So Difficult to Change?

When people come to therapy it is usually because they have identified some behavior, some feeling, or some aspect of their life which they find problematic and want to change.

Yet psychotherapists have long known that clients usually resist the very changes which they consciously claim they want.

For example, I know I should not procrastinate in school or at work, but even though I can list all the rational reasons why procrastination works against me, I still cannot simply make a rational decision not to procrastinate anymore.

Resistance to Change:

In therapy this force within me that is working against myself is referred to as my resistance.

My resistance confronts me with the fact that I am not always the master of my own house. It tells me that all the logic, reason, and will-power in the world often isn’t enough to bring about change. It reveals to me the presence of motivations within me that do not fall under the purview of my rational self.

These motivations that work against me oftentimes do their work outside my conscious awareness. They are not parts of my personality, which I identify with. It is this that makes them my most formidable adversary, for how can I win a battle against forces that are mostly invisible to me?

The Benefits We Derive from Symptoms:

The part within a person that resists change is considered by psychodynamic therapists to be motivated by secondary gain. It derives comfort from the very symptom the rational part of me wants to get rid of.

When looked at from the perspective of the rational mind this of course does not make any sense. Why would I for example not want to stop procrastinating? What possible benefit could I get from sabotaging myself?

The secret to understanding this conundrum is to begin to unlock the unconscious logic that makes procrastinating a successful bulwark against greater fears or threats to a person’s psychological safety.

Could it be that I am afraid to succeed because I at some level don’t believe I am worthy of success? Could it be that I am afraid that if I truly try and ultimately fail, I will get affirmation of this fact? Or could it be that a part of me resents the fact that I have taken on a career or a field of study which I thought would make my parents proud, a fact that I cannot openly acknowledge to myself, or which would require me to live with the guilt of openly disappointing my parents?

From the perspective of the unconscious, these would all be excellent reasons to procrastinate. My resistance to change is here the last bulwark against an unconscious and unacknowledged conflict, which must be kept out of my awareness to spare me much psychological turmoil and anxiety.

Keeping Unconscious Conflicts at Bay:

Oftentimes when we seem to not be able to wrest ourselves free of a depression, or change a self-destructive habit that keeps us stuck, it is because of the presence of an underlying unconscious conflict, which motivates us to resist a change to the current status quo.

Although being depressed, for example, is pretty miserable, it is often unconsciously preferable to being assertive and risking other people’s rejections or wrath, or confronting the realization that I need to change career or get a divorce. Depression sometimes keeps me from drawing the unpleasant conclusion of a realization that would cause too great of an upset to myself or to others.

It is often safer to stick with the devil we know.

And so it is that approaches to change that only address the conscious rational side of a person are almost always destined to fail. Although willpower and logical reasoning can get us far in life, they cannot win the battle over our secret fears and unacknowledged conflicts. To truly change oneself is thus ironically to first truly accept oneself: to honor our resistance and let our resistance reveal its logic to us, which means to become more aware of who we truly are and what is truly motivating us not to change.

Perhaps we should become a little more like Soeren Kierkegaard who instead of declaring warfare on his symptoms, acknowledged with a degree of self-compassion: “My depression is the most faithful mistress I have known — no wonder, then, that I return the love”.

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

 

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.

 

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.

 

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.

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…

Cover of One Flew Over the Cuckoo's Nest
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.

 

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…

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.

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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

Psychotherapy: What is the Goal of Therapy?

Good psychotherapy is not about offering solutions to people’s problems. It is about helping people understand what their problem really is… 

Meet Joe…

Joe is depressed. His wife just declared that she is going through with her divorce. Having built his past 20 years around the idea of being her husband, Joe now feels as if he is left with nothing. His entire psychological existence feels empty, and it is hard to face this brave new world of bachelorhood without a sense of hopelessness and despair. Can he ever re-find the sense of comfort and acceptance he had with his wife? Will he forever be alone? Can he ever reestablish himself in a life with meaning and purpose? Joe finds himself in the midst of an existential crisis, so he does what most people would, he decides to go to therapy…

To Joe the goal is clear: He wants to not feel depressed, to regain passion for life, to want to live another day… In short, he wants to feel better.

With this goal, most therapists would probably agree. Where they won’t agree, however, is how to get him there…

Therapy Goal A: Fixing What is Broken

If Joe were simply broken, there would be a way to fix him. Maybe his thoughts have gotten a little out-of-whack, maybe he has stopped taking good care of his physical health, maybe he is keeping himself from dating because of his unwillingness to mentally let go of his wife. These in fact are all practical problems that could be solved.

And many therapists would be happy to help Joe battle his own insufficiencies by helping him find rational and practical ways to solve these problems…

However, the efficacy of a person’s problem-solving ability always rests on the accurate definition of their problems. If you are trying to solve the wrong problem, no solution will ever really do the trick!

The reason why Joe is not dating is a logical consequence of a problem, which Joe himself has not quite adequately understood. Sure there are good arguments why he should be dating: It will maximize his chances of meeting another partner, and if he meets another partner maybe he will have someone new to fill the void in his life. But if his therapist had not been so busy helping him solve this problem, Joe might have discovered something else beneath it that might be even more valuable…

Therapy Goal B: Getting to the Root of the Problem

What Joe might have discovered is that he is afraid to let go of his wife for a number of reasons that may not seem logical to someone who is not in Joe’s particular shoes. He might have been helped to realize that he is afraid that once he lets go of loving his wife, he will never be able to feel that sense of love again.

This realization is not a problem to be solved, but a problem to be curious about.

Instead of jumping in to solve Joe’s problem, Joe’s new therapist instead helps Joe reflect on why that is.

Well, before he got married, Joe spent most of his life feeling rejected by other people. As a way of coping with the rejection, he became astute at shutting down his own need for affection. He developed a lifestyle where all his emotional connections were rather shallow and where he never truly allowed himself to depend on anyone.

His wife changed all that, but now that she is soon to be gone, Joe is faced with becoming his old lonely self again. His wife leaving him is thus only really the problem in some superficial sense.

Her departure is merely the occasion that reveals a series of others problems, which Joe had not had to face until now: Maybe he was not as emotionally available in the marriage as he could have been? Maybe he is still a hurt and rejected adolescent at his core, and the divorce is re-inflicting an old wound? Maybe his strategy of shutting down his emotions as a means of survival is now exposed as the devil’s bargain?

And this is where Joe’s real therapy begins…

A Better Therapy Solution…

The problem, it turns out, is not really his wife wanting a divorce, or Joe wanting to hold on, but rather Joe needing to come to terms with unresolved issues related to rejection, dependence, fear, and loss.

Had Joe continued with his old therapist, he would never have arrived at this more intimate understanding of the real issues involved. Instead of delving deeper into his problem, Joe would then instead have been implementing solutions to a problem he had not fully understood.

Finding a solution to a problem is easy, finding the right problem to solve is hard…

To discover the real problems is the goal of therapy…

About me: I am Rune Moelbak, a psychologist in Houston, Texas. I aim to provide a more thoughtful kind of therapy that will help people get to the root of their problems…

Why Psychotherapy is not about Solving People’s Problems…

The Uncommon Wisdom of Psychotherapy…

Psychotherapy is not about solving people’s problems, at least not in the same way as a math teacher helps you solve a math equation, or an auto mechanic helps you fix a broken car. As a person, your problems cannot be separated from you, and you can therefore not simply treat the problem without in some fundamental way becoming changed yourself.  In fact, as I will explain, sometimes the very desire to solve your problems, may itself be part of the problem…

This is a difficult idea to understand in a society that values self-improvement and shows us every day how we can use the latest technological advances to improve how we look, how we feel, and how we perform. Self-help gurus, experts in the media, and the latest “solution-focused” psychotherapies, seem to offer us the knowledge and techniques to “fix” ourselves and become who we want to be.

Why our Symptoms are not Problems to be Solved…

The idea that we can solve our psychological issues by finding some technique or rational solution, is often the product of an unstated dualism. The symptom that bothers us, be it a perceived character flaw or some other deficit or deficiency, has often become split off from ourselves. It has become a part of ourselves that we do not accept. We experience it as incongruent with who we want to be. Our disliked symptom seems to serve no role and have no contribution to make. It is considered “irrational” and unwanted. And the best thing therefore is to find a way to be rid of it.

And yet this separation of our irrational and problematic parts from our cherished and rational self is a flawed starting point for change. It assumes that we are like a four-legged lizard that can simply lose its tail when it is no longer needed. We might as well be trying to spit out our own tongue or eat our own mouth, because the task we have set ourselves is just as contradictory.

Discovering the Logic of our Symptoms

The problem is that our annoying little habits and traits only appear senseless and tasteless when we have defined our problem in too narrow of a way. Only when we cut our symptom off from  a wider interest in understanding ourselves, does the symptom appear like a bad tooth that can simply be plucked without any repercussions for the rest of us.

Once we begin to understand what really keeps the symptom in place, however, we realize that the symptom is often a sign of an internal conflict with which we are struggling as a human being. The symptom, therefore, far from being a problem we can simply solve, is thus in fact a solution to a problem which we have not been able to solve. It points us toward a larger issue of which we are not aware. The symptom indicates that something is awry, but does not indicate what exactly. This however is what psychotherapy is for… 

Hence, a person who desperately wants advice about how to stop having panic attacks, discovers through psychotherapy that the panic attacks are really a result of the person’s battle against his own impulses. The person has not allowed himself to admit to feeling angry with his parents and has in fact waged an ongoing battle against himself to not feel certain feelings that produce anxiety and discomfort. His need for tight control of his emotional life and the impossible bind that he not be who he is, is nevertheless a failing strategy. His anxiety attacks indicate precisely this.  

The person’s pursuit of a solution to get rid of his anxiety attacks, as if they were simply irrational and alien intrusions into his existence, keeps the real issue at bay. Instead of heeding the message of the symptom, the person now instead enters into a battle with a part of him which he cannot understand. He may try anti-anxiety medication, relaxation techniques, and whatever other desperate solutions people can offer him. But because his attempt at a solution is an attempt at covering up the real problem, whatever he tries to do is destined to fail. He is like a person attempting to become a lizard, or attempting to divide himself in two. He wants to rid himself of the symptom, but does not realize that the symptom is connected to him, just like his nose is connected to his face.

How Psychotherapy Can Help Us

Many of our psychological symptoms and issues are the result of such impossible battles with ourselves. The more we try to fight against what we don’t like, the more the disliked parts of ourselves are forced to return with a vengeance or to appear at the most inopportune times.

When we instead stop trying to solve our problems, and start to be curious about what sustains them in the first place, we may discover to our surprise that our symptoms all of a sudden disappear.

If I am feeling angry but cannot accept anger as part of my life, this is not really a problem to be solved, but is rather a problem that begs a whole new series of questions. Why am I for example uncomfortable with anger?  Might it be that I fear that it can be destructive and make me lose the love from others on which I desperately depend? If so, how did my sense of love and worth in relation to others become so tenuous? And what repercussions does this have for my ability to assert my own needs without feeling guilty or bad? Might it force me to act out my resentment in passive aggressive ways that interfere with my ability to both endure and maintain intimate relationships?

These series of questions are all contained within one single symptom. What started out as a panic attack has now given way to an exploration of inhibited anger, problems with intimacy, and questions about tenuous self-esteem. These questions have not simply displaced me from the real issue, but have problematized my initial problem, and made it about something more than the simple removal of a symptom. As the problem has shifted, so has the nature of my symptom and the solutions that now seem relevant. Rather than being solved, the symptom has now dis-solved.

Instead of battling my symptom, which had initially been a blemish on my self image and a nuisance to get rid of, the symptom now instead shows itself as a gift in disguise. Unwrapping its message leads to ever greater riches in my understanding of who I am and why I am the way I am. Instead of running around like a lizard wanting to lose my own tail, I now begin to integrate all aspects of myself into one unified congruent existence… Instead of solving my problems, I begin to understand what they are really about in the first place… This is what psychotherapy can help you do. 

About me: Rune Moelbak, Ph.D.  is a psychologist and psychodynamic therapist in Houston, Texas. To read more about the theoretical principles that guide me in my work, visit my website, or listen to this recent podcast where I explain more about my approach to psychotherapy