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The Limits of Talk

by Mary Sykes Wylie

Bessel van der Kolk likes to introduce his workshops on Post-Traumatic Stress Disorder (PTSD) with medical film clips from World War I showing veterans diagnosed with what was then called "shell shock." In these dramatic and riveting clips, one soldier sits hunched over on his hospital cot, staring blankly ahead, responding to nothing and nobody until the single word "bomb" is said, whereupon he dives for cover underneath the small bed. Another man lies almost naked on the bare floor, his back rigidly arched, ...

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Discoveries from the Black Box

by Mary Sykes Wylie, Richard Simon

The human brain is a wet, coconut-sized, walnut-shaped organ, the color of raw liver and the consistency of an overripe peach. Comprised of billions of nerve cells, each connecting electrochemically with an average of 10 thousand others, it's the most complex biological entity known on earth. The number of possible interconnections among its neurons exceeds the estimated number of atoms in the universe. Just as remarkably, it can make such intricate and baffling self-transformations that many insist it ...

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The Big Moment

by David Waters

Psychotherapy Networker.

It was the kind of tense stalemate between an angry, critical father and an increasingly withdrawn teenage son I'd seen many times through the years. Greg was a single parent who seemed to regard every exchange with his shy, 14-year-old son, Tad, as an opportunity for a "corrective experience." But they were both bright and articulate, and therapy started off with both of them readily agreeing to spend more time together.

Having contact isn't the same as making contact, ...

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10 Best-Ever Anxiety-Management Techniques

by Margaret Wehrenberg

"I don't think I want to live if I have to go on feeling like this." I hear this remark all too often from anxiety sufferers. They say it matter-of-factly or dramatically, but they all feel the same way: if anxiety symptoms are going to rule their lives, then their lives don't seem worth living.

What is it about anxiety that's so horrific that otherwise high-functioning people are frantic to escape it? The sensations of doom or dread or panic felt by sufferers are truly overwhelming--the very same ...

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Trauma

The Limits of Talk: Bessel Van der Kolk Wants to Transform the Treatment of Trauma
By Mary Sykes Wylie
January/February 2004

The Politics of PTSD: How a Diagnosis Battled Its Way into the DSM
By Mary Sykes Wylie
January 2004

Bringing the War Home: The Challenge of Helping Iraqi War Vets
By Cecilia Capuzzi Simon
January/February 2007

Creating a Culture of Healing: Recovering from Trauma in War-Ravaged Gaza
By James Gordon
January/February 2007

Applying the Brakes: In Trauma Treatment, Safety Is Essential
By Babette Rothschild
January/February 2004

The End of Innocence: Reconsidering Our Concepts of Victimhood
By Dusty Miller
July/August 2003

 

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful in learning more about the effects of trauma. People searching for information on the following terms and concepts found these articles helpful:

Trauma
Post Traumatic Stress Disorder (PTSD)
EMDR
Cognitive Therapy
Exposure Therapy
Antidepressants
Combat PTSD
Vicarious Trauma
Compassion Fatigue
Abuse Survivors
Mind/Body Techniques
Somatic Therapies
Somatic Experiencing
Mindfulness

Sample from: The Limits of Talk, by Mary Sykes Wylie

And what was the treatment that he felt was not really helping his patients to move on? It was standard talk therapy 101--helping them explore their thoughts and feelings--supplemented with group therapy and medications. During individual sessions with clients, he often focused intensely on patients' past traumas, in the interest of getting them to process and integrate their memories. "I very quickly went to people's trauma, and many of my patients actually got worse rather than better," he says. "There was an increase in suicide attempts. Some of my colleagues even told me that they didn't trust me as a therapist."

The fundamental conundrum of how trauma affects the mind and body that still plays out in treating trauma survivors was already crystallizing in van der Kolk's mind 20 years ago. "When people get close to reexperiencing their trauma, they get so upset that they can no longer speak," he says. "It seemed to me then that we needed to find some way to access their trauma, but help them stay physiologically quiet enough to tolerate it, so they didn't freak out or shut down in treatment. It was pretty obvious that as long as people just sat and moved their tongues around, there wasn't enough real change."

From Psychotherapy Networker, January/February 2004

 

Sample from: Creating a Culture of Healing, by James Gordon

Afterward, we share our drawings. Ali, a surgeon, quick-moving and humorous, begins. In his first drawing, he's alone and looks confused. In the second, his four children stand in front of an Israeli soldier, who's pointing his gun at them. "I live near an Israeli settlement," he says, "and, every day, when I leave the house, I worry that something will happen to my children before I come home. Two years ago," he adds matter-of-factly, "my house was bombed." In the final picture, the one that shows the "problem solved," he's joyfully playing with his children. The occupation is over and the Israeli soldiers have gone home. "I'm thankful to God," he concludes.

Several others hold up their own pictures of endangered children, assuring me that they didn't have to copy from each other. "This is our biggest concern," Mahmoud says. "Everyone worries about their children, every single morning when we leave for the hospital or clinic." They share memories of homes vacated on Israeli orders and destroyed, of bombs shaking their houses, of children bleeding in hospital emergency rooms. Later I think of the recent training we led in Israel, where health professionals drew their own pictures of vulnerable children traveling on buses or sitting in malls that might be attacked.

From Psychotherapy Networker, January/February 2007


Sex

Erotic Intelligence: Reconciling Sensuality and Domesticity
By Esther Perel
May/June 2003

In the Mood: Desire Seldom Comes to Those Who Wait
By Michele Weiner-Davis
May/June 2003

Pathways to Sexual Intimacy: Revealing Our Many Selves in the Bedroom
By Richard Schwartz
May/June 2003

Satori in the Bedroom: Tantra and the Dilemma of Western Sexuality
By Katy Butler
March/April 1999

What Is This Thing Called Love? The Answers Are Being Discovered in the Laboratory
By Pat Love
March/April 1999

The Evolution of Modern Sex Therapy
By Katy Butler
March/April 1999

Beyond Viagra: Why the Promise of Cure Far Exceeds the Reality
By Barry McCarthy
May/June 2004

Passionate Marriage: Helping Couples Decode the Language of Their Sexuality
By David Schnarch
September/October 1997

 

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful in learning more about sexual issues. People searching for information on the following terms and concepts found these articles helpful:

Sexual Issues
Erectile Dysfunction
Sex Addiction
Arousal
Premature Ejaculation
Sex Therapy
Orgasmic Disorders
Sexual Disorders
Foreplay
Sexual Abuse
Sexual Violence
Pleasure
Eroticism

Sample from: Erotic Intelligence, by Esther Perel

It always amazes me how much people are willing to experiment sexually outside their relationships, yet how tame and puritanical they are at home with their partners. Many of my patients have, by their own account, domestic sex lives devoid of excitement and eroticism, yet are consumed and aroused by a richly imaginative sexual life beyond domesticity--affairs, pornography, prostitutes, cybersex, or feverish daydreams. Having denied themselves freedom and freedom of imagination in their relationships, they go outside, to reimagine themselves with dangerous strangers.

Yet the commodification of sex--the enormous sex industry--actually hinders our potentially infinite capacity for fantasy, restraining and contaminating our sexual imagination. The explicitness of sexual products undermines the power of mystery, the voyeuristic pleasures of the hidden. Where nothing is forbidden, nothing is erotic. Furthermore, pornography and cybersex are ultimately isolating, disconnected from relations with a real, live, other person.

A fundamental conundrum in marriage, it seems to me, is that we seek a steady, reliable anchor in our partner, and a transcendent experience that allows us to soar beyond the boundaries and limitations of our ordinary lives. The challenge, then, for couples and therapists, is to reconcile the need for what's safe and predictable with the wish to pursue what's exciting, mysterious, and awe-inspiring. That challenge is further complicated when the partners are on opposite sides of this divide.

From Psychotherapy Networker, May/June 2003

 

Sample from: The Evolution of Modern Sex Therapy, by Katy Butler

Modern sex therapy often begins with instruction in "sensate focus." The pressure to have an orgasm, keep a firm erection or prolong intercourse is taken away. Instead, individuals or partners are told to set aside time to caress themselves or each other in a relaxed environment, without trying to achieve any sexual goal. Once anxiety is lowered, sex therapy often proceeds successfully, especially in treating the following common problems:

Vaginismus. Vaginismus is the spastic tightening of the vaginal muscles and can make intercourse impossibly painful. It can be so severe that not even a Q-tip can be inserted in the vagina, and some women with vaginismus have never, or rarely, completed sexual intercourse in the course of years of marriage. Often the result of physically painful experiences like childbirth, painful intercourse, rape or molestation, it is a learned fear response. Therapy involves teaching the woman to relax and breathe while gently inserting the first of a graduated series of lubricated rods, starting with one as small as is necessary for comfort. In ensuing weeks, the woman uses incrementally thicker rods and then inserts her partner's finger and finally his penis into her vagina. Nothing is forced, and insertion is always under the control of the woman.

From Psychotherapy Networker, March/April 1999


Positive Psychology

20 Weeks to Happiness: Can a Course in Positive Psychology Change Your Life?
By Richard Handler
January/February 2006

Why Is This Man Smiling? A Self-Described Grouch Is Trying to Turn Happiness into a Science
By Mary Sykes Wylie
January/February 2003

Living on Purpose: The Seeker, the Tennis Coach and the Next Wave of Therapeutic Practice
By Katy Butler
September/October 2003

Positive Aging: A New Paradigm for Growing Old
By Robert Hill
May/June 2007

 

Sample from: Living On Purpose, by Katy Butler

These athletes didn't use their limited reservoir of "free will" to tell themselves to relax. Instead of cluttering their brains with that kind of management decision, they followed a behavioral sequence repeated so often that it had grooved itself into the cluster of brain cells close to the brainstem sometimes called the "reptilian brain." Their rituals were automatic, even under pressure. They were done mindlessly, just as an experienced driver steps on the clutch and smoothly shifts gears without thinking about it.

Between-point rituals turned out to have startling training effects. Loehr fitted the athletes with wireless monitors and discovered that the heart rates of the champions dropped as much as 15 to 20 beats between points. They didn't win every game. But because they took real breaks--what Loehr called "oscillation"--they played at the top of their games for years, while talented but volatile players, like John McEnroe, burned out young.

Loehr showed his videos to the tennis kids--and his growing list of private clients--and had them mimic the champions' confident walks. Their games improved. He organized 90-minute cycles of oscillation (intense exertion followed by rest and recovery) into their days, and they improved again. He tailor-made new rituals to address individual weaknesses, and the athletes improved still more.

From Psychotherapy Networker, September/October 2003

 

Sample from: Positive Aging, by Robert Hill

Now the principles of Positive Psychology are captured in a new term specific to later life—namely, "positive aging." The idea behind positive aging is that there are sources of happiness in our later years that are inherent in the processes of growing old. In other words, positive aging is not how well we're able to dodge our infirmities, but rather, our ability to focus on what makes life worthwhile in our later years in spite of the physical or mental challenges that may arise.

We all have known people who were born with the type of attitude that allowed them to grow old gracefully and get the most out of life right up to the end. For the rest of us, however, there are specific actions and habits of mind that we can learn, which, with focus and practice, can help the process of aging become a more positive experience. To grow old with a positive frame of mind, it's important to learn to take four basic actions:

From Psychotherapy Networker, May/June 2007


Mindfulness

A Quiet Revolution: Therapists Are Learning a New Way to Be with Clients
By Jerome Front
January/February 2008

The Soul of Relationship: Where Self and Other Meet
By Molly Layton
January/February 2008

A Week of Silence: Quieting the Mind and Liberating the Self
By Daniel Siegel
November/December 2006

Appointments with Yourself: Don’t Mistake Your Schedule for Your Life
By Michael Ventura
November/December 2006

The Precarious Present: Why Is It So Hard to Stay in the Moment?
By Robert Scaer
November/December 2006

Any Day Above Ground: After Recovery, What Then?
By David Treadway
January/February 2008

Hello Darkness: Discovering Our Values By Confronting Our Fears
By Steven Hayes
September/October 2007

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful in learning more about mindfulness in therapy practices. People searching for information on the following terms and concepts found these articles helpful:

Mindfulness
Buddhism
Meditation
Retreats
The Present
Acceptance and Commitment Therapy (ACT)
Mindfulness Based Stress Reduction (MBSR)
Brain
Relaxation
Mind Body
Relapse Prevention
Flow

Sample from: A Week of Silence, by Daniel Siegel

After focusing on the self, we focus on others. We wish safety, happiness, health, and ease first on a benefactor (someone who's supported us and our development in life), then on a friend, followed by someone about whom we feel neutral. Often an image of that person is useful to have in mind as these wishes are expressed. The next step is harder--wishing these blessings on a "difficult" person in our life, one with whom we may have a challenging relationship. And the next step can be even harder: we're asked to offer and ask for forgiveness. "I ask you for forgiveness for anything I've done or said that's caused you harm or painful feelings." Then, with the same words, one forgives this person.

I chose a friend with whom I've had a long-standing relationship that had ended with confusion and hostility recently. I pictured his face, saw the troubles that led to our rift, and asked his forgiveness for what had happened between us. It was hard, as he hasn't been forthcoming in trying to make a reconnection. But the exercise, including forgiving him for what had happened, helped me feel a sense of resolution.

From Psychotherapy Networker, November/December 2006

 

Sample from: Hello, Darkness, by Steven Hayes

A thought like Im bad invites us to argue about whether its true by providing evidence (usually from the past) on one side or the other. But whether its true or false is irrelevant to the fact that the thought is here, now. Simply noticing thoughts as processes, rather than as events that must be true or false, liberates clients from having to put their life on hold while cognitions are evaluated, accepted, rejected, argued with, or put in some sort of order.

The process of defusion dampens down the impact of thoughts and allows more flexibility in responding to them. For example, a panic disordered person thinking If I get anxious here Ill make a total fool of myself might short-cut the endless problem-solving, discrepancy-reducing mental rigamarole that makes the problem worse by simply thanking his mind for the thought, or by saying the thought again very slowly (a toooooootaaal foooooool of myseeeeeelllllllfff), singing the thought to the tune of a popular song, or saying it in a Donald Duck voice. The ACT defusion techniques all carry the same message: thoughts are just thoughts. Notice them and then do what works, not necessarily what they say.

The second fundamental ACT skill is Acceptance. When patients try to avoid, escape, or control painful feelings, the present becomes the enemy. Now is where and when feeling occurs, but theyre concentrating on the imagined future in which the now will be different. Coming into the present requires psychological acceptance--a voluntary and undefended leap into the multifaceted, multisensory moment. As with any leap, this means abandoning some degree of control. In a physical leap, we leave it to gravity to carry us safely back to earth. In a leap of acceptance, we give over control to the now, allowing our experiences to present themselves in their full breadth and depth.

From Psychotherapy Networker, September/October 2007


Leaders in the Field

The Top Ten: The Most Influential Therapists of the Past Quarter-Century
March/April 2007

Super Shrinks: What’s the Secret of Their Success?
By Scott Miller, Mark Hubble, and Barry Duncan
November/December 2007

The Accidental Therapist: Jay Haley Didn’t Set Out to Transform Psychotherapy
By Mary Sykes Wylie
November/December 2007

Larger than Life: Marianne Walters Was Family Therapy’s Foremost Feminist
By Mary Sykes Wylie
May/June 2006

The Power of Paying Attention: What Jon Kabat Zinn Has Against “Spirituality"
By Richard Simon and Mary Sykes Wylie
November/December 2004

The 8 Minute Cure: Can Watching Dr. Phil Change Your Life?
By Michael Ventura
July/August 2005

The Untold Story: Carol Gilligan on Recapturing the Lost Voice of Pleasure
By Mary Sykes Wylie
November/December 2002

It’s More Complicated Than That: Don’t Smooth Out Life’s Wrinkles Says Salvador Minuchin
By Richard Simon
November/December 1996

Panning for Gold: Michael White Is the Ultimate Prospector
By Mary Sykes Wylie
November/December 1994

 

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful in learning about the influence of psychotherapy leaders today on therapy practices. People searching for information on the following terms and concepts found these articles helpful:

Leaders in the Field
Supershrinks
Strategic Therapy
Structural Family Therapy
Social Change
Pop Psychology
Media Psychology
Feminism
Top Ten
Most Influential Therapists
Therapeutic Movements
Therapeutic Pioneers
Founders
Empirically Supported Treatments
Research

Sample from: Supershrinks, by Scott Miller, Mark Hubble and Barry Duncan

Should Ericsson's bold and sweeping claims prove difficult to believe, take the example of Michael Jordan, widely regarded as the greatest basketball player of all time. When asked, most would cite natural advantages in height, reach, and leap as key to his success. Notwithstanding, few know that "His Airness" was cut from his high school varsity basketball team! So much for the idea of being born great. It simply doesn't work that way.

The key to superior performance? As absurd as it sounds, the best of the best simply work harder at improving their performance than others do. Jordan, for example, didn't give up when thrown off the team. Instead, his failure drove him to the courts, where he practiced hour after hour. As he put it, "Whenever I was working out and got tired and figured I ought to stop, I'd close my eyes and see that list in the locker room without my name on it, and that usually got me going again."

Such deliberate practice, as Ericsson goes to great lengths to point out, isn't the same as the number of hours spent on the job, but rather the amount of time specifically devoted to reaching for objectives just beyond one's level of proficiency.He chides anyone who believes that experience creates expertise, saying, "Just because you've been walking for 50 years doesn't mean you're getting better at it." Interestingly, he and his group have found that elite performers across many different domains engage in the same amount of such practice, on average, every day, including weekends. In a study of 20-year-old musicians, for example, Ericsson and colleagues found that the top violinists spent 2 times as much time (10,000 hours on average) working to meet specific performance targets as the next best players and 10 times as much time as the average musician.

From Psychotherapy Networker, November/December 2007

 

Sample from: The Power of Paying Attention, by Richard Simon and Mary Sykes Wylie

How was it that Kabat-Zinn was allowed to try a decidedly fringy approach on patients in the absence of any professional credentials in this line of work? Or as he puts it, "How the hell did somebody with no training in clinical medicine or psychology, no credentials, and no license, get to work with medical patients?" He was given carte blanche partly because he was passionate and articulate, and also because his Ph.D. in molecular biology from MIT with a Nobel Laureate dissertation advisor provided an entr´ee in professional circles, even if it didn't have much bearing on his new job.

While the program was a "clinic," in name only when it began, today, it stands proudly housed in its own spacious quarters, with the full staff of directors, instructors, administrators, receptionists, and bureaucratic billing procedures of any self-respecting hospital department. Still, the basic content of the program has hardly deviated from what it was at the beginning. While patients are greeted with open-hearted kindness and authentic presence, they're also asked to commit themselves to full participation in the eight-week program--go to weekly classes, meditate for at least 45 minutes six days a week (using tapes provided), and attend a day-long, silent retreat in the sixth week.

The results patients experienced in the new clinic were almost immediate. One doctor told Kabat-Zinn, "You did more for my patient in eight weeks than I've been able to do in eight years." People with all kinds of medical and emotional conditions reported that they slept better, were more relaxed, and were less anxious. Persistent headaches went away, blood pressure dropped, and pain often decreased. What Kabat-Zinn had done for them was "astounding," they told him, "a miracle." To which, Kabat-Zinn, ever the stern empiricist, constitutionally allergic to both mysticism and hero worship, would reply, "Don't use that language. I didn't do anything for you. You did it yourself. All I did was arrange the conditions and give you enough support and encouragement and tools to do it."

From Psychotherapy Networker, November/December 2004


Ethics

The Ethical Eye: Beyond “Risk Management”
By Ofer Zur
July/August 2007

Can We Talk?: Let’s End the Conspiracy of Silence about Ethical Dilemmas
By Mary Jo Barrett
March/April 2002

To Tell the Truth: Letting Go of Our Inscrutable Facade
By Jay Efran
March/April 2002

Nightmare in Aisle 6: A Therapist Caught in the Act of Being Herself
By Linda Stone Fish
March/April 2002

The Slippery Slope: Violating the Ultimate Therapeutic Taboo
By Susan Rowan
March/April 2002

The Crush: Challenging Our Culture of Avoidance
By Mary Jo Barrett
March/April 2002

The Necklace: When Does a Rule Become a Straitjacket
By Jenny Newsome
March/April 2002

Love, Dr. Lagerfeld: Sometimes It’s Okay to Trust Your Instincts
By Michael Hoyt
March/April 2002

A Triple Boundary Crossing: From Client to Friend to Client
By Arnold Lazarus
March/April 2002

Everybody’s Business: There Are Few Secrets in a Small Town
By Jan Michael Sherman
March/April 2002

 

 

Content Search Overview: Therapists, social workers, counselors and others found these articles helpful in learning more about the importance of ethics in therapy practices. People searching for information on the following terms and concepts found these articles helpful:

Ethics
Dual Relationships
Boundaries
Gifts
Risk Management
Self-Disclosure
Sexual Boundaries
Boundary Crossing
Boundary violation
Confidentiality
HIPPA
Records
Taboos

Sample from: The Ethical Eye, by Ofer Zur

The most frequently uttered words coming from these sources seem to be "don't" and "never." Consider the commandments regularly issued against what these experts consider dangerously risky behaviors. "Don't touch your clients—a handshake is the outer limit!" "Minimize self-disclosure; keep your anonymity intact!" "Never venture outside the office with a client!" "Don't accept gifts from a client!" "Never socialize or share a meal with a client." As Richard Leslie, an attorney specializing in psychotherapy issues and a consultant to the American Association of Marriage and Family Therapy, put it in one all-purpose rule, "If you have to ask, don't do it!"

The problem with these blanket condemnations is that many of the forbidden acts may be among the most powerful therapeutic methods at our disposal. We know that touch is one of the most elementary human ways to relate, and can have a powerful reassuring and healing effect. Self-disclosure can help fearful and defensive clients connect with us, and learn from us through modeling—a proven cognitive-behavioral intervention in itself. Sometimes going to the client, rather than making the client come to us, is the only reasonable way of doing therapy: take, for example, the empirically successful home-based family therapies with juvenile offenders, or therapy with a homebound sick or elderly client. A gift may be an important way for a client to express gratitude; refusing it could be deeply offensive and shaming. Sharing a meal with an anorexic client is often part of an effective, system-based treatment plan. "Dual relationships" with clients are often unavoidable and therapeutically helpful for a therapist who works in a small town or rural setting—your children may go to the same school as your clients' children; you may belong to the same church or synagogue. Conscientious, ethical therapists know all this, but even as we necessarily engage in these "forbidden" activities in the interest of being good therapists, we may feel a shudder of apprehension that we're somehow dangerously flouting rules written in stone.

From Psychotherapy Networker, July/August 2007

 

Sample from: The Slippery Slope, by Susan Rowan

Since that day seven years ago, I have been fortunate enough to be allowed to return to practice. I passed a forensic evaluation and my licensing board has reinstated me, under strict conditions that include having a mentor (a specialist in transference and countertransference) to oversee my clinical work. I've undergone prolonged retraining, including an individual ethics tutorial. I've studied the professional literature on ethics violations and have been educated in the need for boundaries. The lawsuit was settled by my insurance carrier and I stopped drinking. As a condition of my license reinstatement, I am required to undergo psychotherapy until my therapist and I feel I don't need to any longer--at least another two or three years.

I realize that some therapists reading this may feel sympathetic toward me--that I tangled naively with the sort of boundary-less client that we're frequently warned against. But the responsibility lies with me. It was my responsibility, not hers, to know my profession's norms and to preserve clinical boundaries. It was my responsibility to understand that power between a client and a therapist is never equal and that a so-called friendship is never appropriate after clinical work. It doesn't matter how provocative, vulnerable or seductive a client is. It is my responsibility not to create pathological dependencies.

From Psychotherapy Networker, March/April 2002

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