What Psychotherapeutic Approach Right for You? (Cognitive, Psychodynamic, Supportive?)

I treat a variety of people so my work is continuously creative. I am privileged to help them develop and change as they find their way through a morass of conflicting life scripts.

Many ask me about cognitive behavioral therapy, or CBT, and so I thought I’d review the basics of this popular therapeutic approach and compare it with other therapeutic techniques.

In CBTyou, the client identify the situations or conditions in your life to focus on and become aware of your thoughts, emotions and beliefs. Then we work together to discover and reframe your negative or inaccurate thinking referred to as cognitive distortions. 

CBTis considered short-term therapy, limited to consist of 10-20 sessions. However, the length of treatment may change, depending on the complexity of issues. Homework, such as exercises or reading assignments, may be a part of the treatment. 

In any type of psychotherapy, it is important to remember that, as you begin to confront past and current conflicts, you may at first feel worse; you may not feel relief or see improvement until you’ve had several sessions. The goal of treatment may not cure or make an unpleasant situation go away, but will give you the power to cope with it in a constructive way and to feel better about yourself and your life.

The boundaries among the psychotherapeutic approaches are not as precise as you might think. For example, CBTtherapy may combine interpersonal therapy to focus on relationships with other people. 

Although a psychoanalytic treatment is less focused, and examines your early life history, this brand of talk therapy also includes elements of CBT.

Sigmund Freud, commonly referred to as the father of psychoanalysis, worked with individuals to examine their core beliefs and their relationship to behavior, actually incorporating into his practice, elements of what today we call CBT.

Many people say simply “I want to be happy.” But how to define happiness?

Actually the Greek philosopher Aristotle, who lived long before the birth of psychoanalysis or CBT, defined happiness in a way that dovetails with the goal of the psychotherapies. He proposed that happiness comes from a continuous effort to become the best possible version of one’s self. Like his teacher, Plato and Plato’s own teacher Socrates, he subscribed to the ancient proverb: Know thyself.

A successful psychotherapy may be more a matter of finding a good-enough psychotherapistthan seeking a specific brand of therapy. 

A good- enough therapistis positive, encourages dialogue and doesn’t impose any personal agenda on you. The therapist remains supportive, objective and uninvolved in your life outside of the therapeutic session, and recognizes and applies the best approach/technique to guide you to uncover the obstacles, thinking patterns or conflicts that impede your progress. (In my personal psychotherapy, I’ve had both good-enough and not-so-good psychotherapeutic experiences.)  

Conclusion: In a supportive, safe environment, a good-enough psychotherapist integrates psychological techniques and identifies the factors that obstruct your progress toward personal growth and happiness.

Dear Reader, I look forward to your comments.

jsimon145@gmail.com

The Mysterious Memory

As a psychiatrist, I am my most important patient, and I use my reactions, experiences, and behaviors to learn more about myself and others. A recent personal discovery shocked me. So astounding that it is worthy to share with others because it says a lot about the mysteries of the memory. After several years of glancing at the wall in my living room on which I’ve mounted portraits of my significant family members, I realized I omitted a photo of my mother, probably the most important person of all because I knew her first and longest. More than anyone else, she is responsible for who I am today, and I am grateful to her. So how could I stoop to this oversight?(Notice the paradox:  Stoop downto overlook.  Appreciating paradox is other ground worthy of exploration.)

My mother Ruth and I had lived thousands of miles away for several decades while my father lived nearby and played a more central role in my life. But Ruth, a feminist, instilled in me the rights and equality of all humans, and thinking of her, sparked another memory that had laid dormant for some sixty-odd years; a lesson from my homemaking class about how to wash sweaters without shrinking them, a lesson that if I’d remembered all these years, would have saved me a fortune in dry cleaning bills.

In Junior High we girls took the homemaking class while the boys studied shop.  Liberal-minded Ruth disparaged the division between what was taught to the boys vs. the girls. Way ahead of her time, she did not think that knowledge belonged to one sex or the other. She realized that a mind is omni-capable regardless of its proportion of X and Y chromosomes. To be honest, I wasn’t the sort of girl who would have  derived more benefit from studying shop. I didn’t seem talented in either arena. No Martha Stewart I. Nor would I have become a master woodcutter or builder.

The question is: How and why these sudden sparks of insight! Someday we may understand more about memory’s mysteries. With the help of the relatively new technique of Functional Magnetic Resonance Imaging (fMRI), neuroscientists are positioned at the frontier of observing the mechanisms of the brain in action.

We know that the more we remember, the more we can and will remember. Connecting to the hidden or buried thoughts and feelings is a luxury as well as a necessity because connectivity is what keeps us young. And mental and physical stagnation contribute to aging.

Let’s toast to the process of connecting to our connectivity!

Connectivity: Our Brain and Depression

A recent New York Times editorial by Dr. R. Friedman  sums up some groundbreaking research on the brain. Thanks to the relatively new technique of FMI (Functional Magnetic Imaging), the working parts of the brain can be visualized, yielding amazing discoveries of the complex organ in action.

Although we’d believed that the brain didn’t develop after adolescence, now scientists have learned that the brain is potentially remodeled on a daily basis and  that our activities have a great deal to do with the process.

Healthy habits support brain growth and development, and lead to connectivity within the central executive network. This vital area helps to regulate emotions, thinking and behavior. In recent studies, Gregory Miller, a psychologist at Northwestern University found that 12-14 year olds in violent neighborhoods in Chicago had better cardiac and metabolic health than their peers. With MRI studies he observed that higher levels of connectivity contributed to their resilience to cope with trauma.

The good news is that many roads lead to connectivity and contribute to good brain health-exercise, healthy diet, meditation, mindfulness training.

At the opposite extreme, addictive behavior like poor dietary habits, smoking and/or a sedentary life can decrease the brain’s potential to connect to the central executive network and can potentiate depression. 

Glancing at the really morbid side, post mortem brains of depressed people have been found to be lacking in BDNF, or brain-derived neurotrophic factor, the vital neurotransmitter responsible for brain growth. Potentially, a vicious cycle develops: Less BDNF perpetuates depression, hindering the brain’s ability to remodel itself. 

Each of us is personally responsible for maintaining our own brain health. However, a depressed person may not be able to do so. This new research supports the necessity to treat depression as soon as possible. 

This latest data is especially gratifying to us psychotherapists, because it shows the science behind the benefits of psychotherapy and pharmacotherapy (as well as the healthy habits listed above.)

Personally, this new information explains why I have found daily journaling essential to my sense of well-being.  Without understanding that I was doing so,  I have been furthering connectivity within my brain by writing, a habit that I thought was an anomaly like the high maintenance daily tune-up needed to keep a jaguar car running smoothly. 

I began jotting down my thoughts in a notebook when I was 10 years old and my last brother was born. I didn’t understand why I loved him and hated him at the same time! So I wrote and synthesized the two sides of the story—that he was adorable, but he deprived me of my mother’s attention and affection.) Jotting these words on paper undoubtedly increased the connectivity within my brain helped me get beyond the confusing dilemma. 

Many years later, I learned the benefits of exercise. In the throes of a depression when I couldn’t budge my mind out of negative thinking, I took my body to the gym and discovered that exercise lifted me from the depths of despair.

Conclusion: New brain research supports the view that treating depression –ASAP—is imperative. Resilience is related to our brain’s connectivity, which gives us the ability to change and lead a satisfying life.

Dear Reader, Please send your comments to: jsimon145@gmail.com.

Connecting to Body, Mind and Feelings (what I learned from a little pine tree)

Every morning I jot down my thoughts, free-associating as I type them into my laptop. If I skip this routine, I feel unmoored like a ship lost at sea.

I’ve learned that if I don’t spend time alone, I can’t communicate with my deeper self. Not infrequently I make connections that explain my past behavior. This morning’s scribbling revealed the ever-present influence of the unconscious and why I purchased a little, live potted Norwegian pine tree from Trader Joe’s the previous day. I was confused by my action; in years past I hadn’t wanted a pine’s stalk cut down to wither in my living room.

But this year, no one was compelling to have a tree. So why did I buy the little potted tree? The next morning, as I wrote in my journal I made the connection between my actions and my unconscious.  I was replacing a pine that I had accidentally killed by giving it in too much water; the loss was greater because it had been a gift from a special person. 

The point is that we often don’t realize the work involved in connecting to ourselves—our minds, our feelings, our bodies. For example, people who stretch their muscles, joints and tendons and become aware of their bodies are less likely to fall and become disabled. Those who face their psychological struggles are likely to be happier in the long run than those who run away and avoid their conflicts.

Henry David Thoreau wrote in Walden(1854 ), his personal journey of self and voyage of self discovery, “The mass of men (and women) lead lives of quiet desperation.” Connecting to ourselves is the way to avoid living a dissatisfied life.

A “good enough” therapist helps a person connect to his or her self. When you are confused or unsure if your therapist is helping, you can jot down your mixed thoughts and feelings to help resolve your doubt.  

Best wishes to all in the New Year. I hope that you will connect in many ways to your bodies, minds and feelings.

Please feel free to write your comments to me at jsimon145@gmail.com.

Where Is Home?

I know two Marilyns, one on the west and one on the east side of Manhattan. Each of them is extraordinary because they are artists, lovely people and have the most beautiful apartments I’ve ever seen. But their spaces are more than beautiful and artistic:  they are their homes, external manifestations of themselves, lived in, cherished and shared with family, friends and acquaintances. They are proud of their respective spaces. By contrast I don’t think I have ever failed to apologize for something about my home: the clutter, disorganization, haphazard furniture, dust...you name it. I have it all, at least some of it, some of the time.

My mother and father did not have extraordinary homes either. Nor did they care. A home was somewhere to live, to place your head down on the pillow at night.  The matter of aesthetics was a moot one. Aesthetics were a bourgeois concern, as extravagant as a daily ice cream cone to a starving person. 

I write this blog to answer for myself: What makes a home? Although I spent only twelve years, from age six to eighteen, in my large pink room in Rockland County, I still dream of the view from my windows facing east and north. In the summer I rejoiced as I gazed at the sun, a ball of yellow-orange fire, rising over the treetops while my family slumbered; I had a sense that I had an advantage over humans and nature.  I was alone in my private space, but not alone because I was nestled within the bosom of my family­_ the best of all possible worlds. I had it all: the back and forth, the in and out, like the freedom of a playful puppy loose in a yard with a pet door opening into the kitchen so she can enter and exit at will. In spite of the advantages to which I was privy, I wasn’t fully home in my heart.  I was attracted to what I hadn’t had: the aesthetic dimension. I became involved with a brilliant physician who was artistic, possessed a magnificent sense of style and lived in his exquisitely appointed apartment. He opened up the realm that intrigued me. We visited shops and restaurants simply to admire and study the décor.  But after a few years I learned that this man could explode into a violent rage. I wasn’t safe in his space. 

All I could garner from this shock is that life is multilayered, so complex that few of us reach our full potential without experiencing some trials and tribulations along the way.

In my years as a psychiatrist I have met many people, some of whom have been fortunate in having a place in their childhood that they could call safe—a home. In contrast, some have known abuse that leaves them unable to distinguish between what is safe now in the real world. If they are lucky, they find a very good psychotherapist to lend them a solid anchor (as I did). Then they have to learn to unburden themselves of symptoms, such as eating disorders, depression, anxiety, hallucinations, and/or other counterproductive behaviors. They have to learn to distinguish what is safe in the world for their vulnerable psyches and what is perilous, like a baited hook to a fish swimming free in the vast ocean. And all this is so internal, invisible to the naked eye, that these people suffer in silence in the world and scream noiselessly in the misery of their hearts and souls that few can understand. 

After many peregrinations I’ve learned that the real home is invisible and transcends space and time. The real home resides within the psyche that can sort out the real from the imagined attacks in the intra-psychic, interpersonal and international realms. 

Dear Reader, I welcome your comments. jsimon145@gmail.com

Guns, Bullets and the Medical Model

Dear Reader, As a result of the latest gun massacre in Parkland, Florida, I am re-posting this relevant blog. Thank you for your interest. 

It is a great irony that guns and bullets that kill, more rapidly than any pill heals, can be readily obtained. The distribution of medications like antibiotics, antidepressants, anti-anxiety medicines is strictly monitored, prescribed in specific amounts by professionals to individuals who require them for a limited period of time. Guns and bullets

are readily available at gun shows and on the internet "where anybody with a credit card can order semiautomatic weapons for overnight delivery." (The New York Times, December 19).

In his editorial column in The New York Times on December 20, Nicolas Kristoff provides some brutal statistics:

 1. Every two months more Americans die in gun violence than in the 9/11 attack, according to data from the Centers for Disease Control and Prevention.

 2. We lose some 2,800 children and teenagers to guns annually according to a study by the Children's Defense Fund.

3. More than twice as many preschoolers die annually from gun violence in America as law enforcement officers are killed in the line of duty.

Violence is difficult, and at times, impossible, to predict so background checks solve only part of the problem.  Adam Lanza had not been violent before he gunned down 20 children and six adults , massacring them in minutes, at Sandy Hook Elementary School in Newtown, Connecticut on December 14, 2012. 

People who commit mass murders rarely participate in psychological counseling. Targeting and stigmatizing people with a psychiatric history hardly encourages people to seek treatment.  

In last week's blog I mentioned that each of us, like President Lincoln, is to some extent "damaged goods." The issue is not "them vs. us" but to recognize our commonality.

This country has 300 million guns, almost one for every citizen in the United States. Some people believe that more guns will prevent violence. Research shows that more guns result in a greater number of both homicides and suicides. 

By contrast to the unpredictability of the human mind, guns and bullets predictably kill. It stands to reason then, that a simple, effective approach would be to control the distribution of guns and ammunition.

  

Physicians are supervised and re-certified. Hospitals are required to have Utilization Review systems and review boards. Utilization review boards could be set up to monitor the distribution and use of weapons. Guns and bullets could be prescribed like medicine, in an appropriate quantity to an individual for a specific purpose for a given time period.

I hope we can put aside our selfish, uninformed beliefs and unite in the common goal to protect our children and innocent citizens, including you and me.

Conclusion: Rules for the distribution of medicine that heals contrast to the free distribution of weapons that kill. We need strict ways to distribute and track weapons and ammunition.

Dear Reader, I welcome your comments. jsimon145@gmail.com

One Giant Fallacy: Guns and Predictions

Dear Reader, As a result of the new massacre in Parkland, Florida I am re-posting this relevant blog.

Two recent incidents publicized in the media show that instituting

background checks alone is insufficient to prevent gun violence. 

First, the tragic murder of Christopher Kyle the retired Navy SEAL sniper and author of  “American Sniper: The Autobiography of the Most Lethal Sniper in U.S. Military History.” He was gunned down, along with another colleague on February 2, as they tried to help a fellow veteran. They could not imagine that their comrade, suffering from the paranoia of PTSD, would turn his gun against them. 

The second incident involves Christopher Dorner, a former Navy reservist and a Los Angeles policeman from 2005 to 2008. Unable to get his life back on track after he was fired from the police force in 2008, Dorner went on a murderous rampage this February,  aimed at his former colleagues-police officers- and even more heinous, their families. His unpredictable attack initiated  “a plan of historic proportions,” the largest police manhunt in history, and was most treacherous because Dorner was well-acquainted with police tactics.

These examples show that:

 1. We’re overly optimistic about our ability to predict who will use a gun at the appropriate time for the right reason. The formula of Them Vs Us, the good guys versus the bad, isn’t terribly useful. More often than not, no one can predict who, whether a policeman, a military man, or a private citizen, will use a weapon to kill innocent people.

2. We overestimate the concept of self-control. As I mentioned in last week’s blog, the forensic psychiatrist Michael Stone, quoted in The New York Times on January 16 said, “Most mass murders are done by working-class men who’ve been jilted, fired, or otherwise humiliated, and who undergo a crisis of rage.”

The irony is that we issue and re-issue licenses to drive a car. We certify and re-certify physicians to treat and to dispense medications to heal.  (Please refer to my blog of December 24: Guns, Bullets and the Medical Model). Yet the laws applying to lethal weapons, which potentially endanger the lives of us all, are lax.

Conclusion:  We need strict ways to distribute weapons and ammunition for a specific purpose similar to the model for dispensing medication. 

In spite of the claim that guns offer protection, the data show that, more often than not, they are used to inflict damage on innocent people, and the gun wielder himself. 

Dear Reader: I invite your comments: jsimon145@gmail.com