By Rich Simon These days, many noble and once well-remunerated occupations—like journalism and magazine publishing—seem in danger of declining into economic irrelevancy. And, not to unduly shock anybody reading this, the financial prospects of therapists aren’t looking too hot now, either. Not only are we told there are way too many of us—600,000 mental health professionals nationwide—for the population to sustain, but managed care has done its best to shrivel whatever pittance we used to be able to count on for our services. Read more …
Do you want to enhance your clinical effectiveness? Do you feel that the body and the mind are treated as separate entities when they should be treated as a whole? Join Rubin Naiman as he helps to widen your perspective as a therapist and helps you to bridge the mind-body rift.
After the session, please let us know what you think. If you ever have any technical questions or issues, please feel free to email firstname.lastname@example.org.
By Rich Simon Therapists have always loved stories about dramatic in-session breakthroughs, those rare times when clients unexpectedly experience what seem like epiphanies—sudden insights about themselves and their lives, after which nothing will ever be the same for them. This kind of transformative moment can make the slow, painful slog of therapy feel worthwhile, and it’s a welcome counterbalance to the frustrations of a difficult, underpaid, underappreciated vocation. As a teary-eyed, beaming client waves a grateful good-bye, “That,” we can say, “is why we do therapy!”… Or so the fantasy goes. Read more …
Explore with renowned clinician Dan Siegel how applying the latest advances in the neuroscience of child development to clinical practice can have practical implications for parents and families. You’ll discover how therapists can help parents raise calmer, happier children by teaching kids to think and listen before reacting, shifting their emotional states through physical activities, and paying attention to their left brain story-telling.
You’ll gain a broader perspective on the social context of parent-child relationships today with Ron Taffel. He’ll explain how clinicians can help parents reassert their authority by creating effective “I mean it” moments with their kids and teens and other practical strategies for parents.
What are the benefits and drawbacks of working individually with a child in therapy as opposed to working with the family at large? When is it effective to involve parents and other family members in treatment? Explore with Martha Straus the best ways to work with postmodern families in therapy.
Explore the distinct challenges to attachment and intimacy that the stepfamily structure often creates. Patricia Papernow, who’s worked as a trainer, consultant, and therapist with stepfamily relationships, will cover practical strategies for helping clients form healthy stepfamily relationships.
Bullying has fallen more and more into the media spotlight lately. Is it that kids are becoming more aggressive? Or are we just paying more attention to this phenomenon? Is it the new forums available for these kinds of behavior—21st-century technologies that can make it easier to kids to bully? How can therapists, parents, and schools help the child who’s being bullied? Learn with Stan Davis, the co-leader of the Youth Voice Research Project, about how to focus on resilience in the child who’s being bullied and to help strengthen their support communities, in addition to working to stop the bullying behaviors.
Teach parents a new way to praise and encourage their children while getting them to comply and overcome difficulties by shifting the focus from “problems” to helping kids gain meaningful new skills. In this approach, parents will take on the role of guides and cheerleaders and children will gain confidence in themselves. Ben Furman, psychiatrist and trainer of solution-focused psychotherapy, will explore this method and take you through case studies.
Explore the effects that overprotective parenting can have on children with Michael Ungar, director of the Resilience Research Center and author of 11 books for therapists and children. Discover how parents can best offer children opportunities to experience risk and responsibility while ensuring their safety and give them boundaries without suffocating them, increasing their anxiety, or reinforcing their need for rebellion.
Consider the enormous psychological and cultural impact of today’s digital technologies on children, adolescents, parents, and society in this enlightening address with renowned MIT psychologist Sherry Turkle. You’ll discover that our smartphones, laptops, tablets, social media sites, and other electronic gadgets have a deeper impact on us as individuals, families, and society at large than we might have previously realized.
After the session, please let us know what you think. If you ever have any technical questions or issues, please feel free to email email@example.com.
Currently, there are between 100 and 150 smartphone apps designed to supplement—and occasionally even replace—face-to-face psychotherapy. In fact, the United Kingdom’s National Health Service maintains a library of approved smartphone apps for a variety of physical and mental health concerns. In this country, the United States Department of Defense has assisted in creating several apps designed specifically to help service members track anxiety and depressive symptoms related to military deployment. Given this trend in technology and the high-level support it’s receiving, it’s increasingly important for therapists to understand what mental health-related apps are available in the world and how they might enhance, or in some cases undermine, therapy.
The Optimism app, for example, can help clients become more active participants in their treatment, particularly if some form of self-monitoring is involved. Created by an Australian company, Optimism allows clients to track information related to emotional well-being, such as mood, symptom severity, medication compliance, and hours of sleep. The app generates charts and reports to monitor progress over time, and there’s even a desktop interface that allows clinicians to collect and view their clients’ data. The app started out as a desktop software package six years ago and now averages about 10,000 downloads a month as a smartphone app, according to its developer, James Bishop. Over 80 percent of surveyed Optimism users report using it in conjunction with visits to a mental health professional for a specific mental health issue, usually a mood disorder. For clinicians doing therapy that involves mood charting, supplementary apps like this one can boost compliance by providing a convenient alternative to paper charts.
Numerous apps also offer a form of life coaching and other services traditionally provided through face-to-face psychotherapy. Unstuck, for instance, designed by SYPartners, has had more than half a million downloads since its launch in December 2011. Geared toward people struggling to make difficult life decisions, the app helps users navigate factors that may be interfering with the decision-making process and gives specific advice for developing new perspectives. For example, someone who’s taking on too many tasks alone can indicate that they’re feeling like a “lone leader” and get advice on how to start working more collaboratively.
A related app, MoodKit, was developed by two clinical psychologists to help people use traditional cognitive-behavioral therapy techniques in their daily lives. Among other features, it encourages mood-elevating activities, helps users change self-defeating thought patterns, charts daily moods, and records journal entries to increase a sense of well-being. It can certainly be used to augment professional treatment, but users don’t need to be in therapy to take advantage of what it offers.
These apps and others like them are easy to use and may be promising pathways to increased treatment compliance for that reason alone. However, they’re a long way from being a silver bullet for curing people’s mental woes. As psychiatrist Andrew Gerber of Columbia University notes, “We are built as human beings to figure out our place in the world, to construct a narrative in the context of a relationship that gives meaning to our lives. . . . I would be wary of treatments that don’t allow for that.”
But even as psychiatrists like Gerber contemplate the creation of apps that could undercut the therapeutic relationship, researchers around the world are testing their effectiveness in treating clinical problems. Cognitive bias modification (CBM), for example, involves the use of a game-like app that trains users to respond to distressing stimuli in new ways, which may have applications for people struggling with anxieties and phobias. For example, socially anxious individuals might play a game in which they’re trained to pay more attention to an image of a neutral face than a hostile one. Although the idea is promising, psychology professor Richard McNally of Harvard, whose research team conducted a 2012 study of CBM, notes that people who used the CBM smartphone app became less anxious, but so did the control group whose members played a nontherapeutic game. In other words, the placebo effect might be responsible for at least some of the positive outcome.
So while many jobs these days are being made obsolete by advancing technology, that doesn’t appear to be the case in the therapy field as of now. Rather than fearing these apps as competitors, savvy therapists will want to explore their potential as clinical assistants. After all, as intelligent and intuitive as Apple claims its iPhone personal assistant Siri to be, she’s certainly not ready for licensure.
Therapy Apps: Benedict Carey. “The Therapist May See You Anytime, Anywhere.” New York Times, 24 December 2012. http://www.nytimes.com/2012/02/14/health/feeling-anxious-soon-there-will-be-an-app-for-that.html?pagewanted=all&_r=1&;
Peter Reuell. “A Therapist at Your Fingertips.” Harvard Gazette, 13 March 2012. http://news.harvard.edu/gazette/story/2012/03/a-therapist-at-your-fingertips/.
Q: I’ve taken yoga classes for several years and know there are many physical, mental, and emotional benefits associated with the practice. How can I use yoga techniques to enhance my work as a therapist?
A:You can offer your clients many yoga-based practices to help them focus, relax, and access their feelings more readily during the session, as well as self-regulate at home. As you may know, the physical postures, known as asanas, are only one aspect of traditional yoga practice. A variety of no-mat yoga practices and rituals can help quiet mental chatter, reduce bodily tension, and promote a heightened awareness of oneself and one’s surroundings. All these techniques are perfectly suited to the consultation room.
The work of therapy can’t begin in earnest if the client’s mind is racing or fogged by depression at the beginning of the session, or if tension is so great that bodily awareness is lost. Offering a simple yoga practice as a portal into the session can enable your client to experience a shift in attentiveness and mood. Having moved into a state of heightened awareness, she or he may then be able to bring newfound clarity of mind to the issues looming throughout the session.
Carol, a woman in her mid-forties with a history of trauma and bulimia, was referred to me for yoga therapy by her psychotherapist. She entered our first session in a highly agitated state. Her shoulders were tight and drawn up toward her ears, and her breathing was rapid and shallow. She was fairly new to yoga and nervous about our work together. After two rounds of a tense-and-release exercise and a brief check-in, I guided Carol in these simple, yoga-based practices: mudra, the use of a hand gesture; pranayama, a simple yoga breath; bhavana, locating an image of sanctuary or peace; mantra, a soothing universal tone; and kriya, a cleansing breath. This series of practices, which took under two minutes, respected Carol’s revved-up state while helping her self-regulate.
Tense and release. To begin, I said to Carol in a calm voice, “Take a moment to tighten as many muscles as you can. Draw the shoulders up to the ears, squinch up your face, make fists with your hands, and sustain your breath. Compress all the getting-here-on-time anxieties and all the judgments you have into a little ball, and place it at the back of your neck. Squeeze the ball, and then let it roll down your back as you let the breath go. Beautiful! Let’s do that again. Inhale and tighten as many muscles as you can. Squeeze whatever is keeping your heart and mind from being completely open. Squeeze, squeeze, squeeze. Now, let it all go . . . beautiful!
Carol was visibly more relaxed after this exercise. Although her breath remained shallow, her face was softer and her eyes more focused.
The use of image. At this point, Carol agreed to try a simple practice we could do in our chairs to bring her current state of mind into balance. I asked her to think of a soothing image. “It could be a place,” I prompted, “real or imagined, where you’re relaxed and at ease. Or maybe,” I said, “a face comes to mind that makes you feel peaceful. It could be a human friend, a precious four-legged friend, or even a deity.”
Carol closed her eyes. After a few moments, I asked her to raise her finger if she’d found an image. When she’d located an image and had opened her eyes, I asked if she’d feel comfortable sharing her image with me. She said she saw her favorite beach in Hawaii. (If your clients can’t find an image, you can ask them to simply think the word peace.)
Notice that as I guided Carol in forming an image, I didn’t use the word safe, as this might have triggered Carol’s mind to think of the opposite, putting her back in a position of fear and anxiety. I also didn’t suggest a specific image, but guided her to create her own. That way, she felt ownership of the image, and her sense of self-efficacy and empowerment was bolstered.
Arm movement, breath, and mudra. Because her breath was shallow and in her upper chest, I didn’t ask Carol to breathe deeply at this stage, since that might have been too difficult. Instead, I chose a breath practice to work with the short breaths she was already taking. I call this practice Stair Step, but it’s actually an ancient technique known in Sanskrit as Anuloma Krama. I demonstrated how to open her arms wide to the sides, raise them up over her head, and then interlace her fingers with her index fingers extended toward the ceiling. This hand position is a mudra.
Mudras engage many nerve endings that activate various regions of the brain. In addition, by asking her to raise her arms over her head, I helped her increase body sensation and body awareness, which is important because many trauma survivors feel unsafe in their bodies. They often say they feel as though they live from the neck up. At the end of the exercise, you’ll see how, through my cuing, I made use of her heightened body awareness to allow her to reoccupy her body safely without ever having to use the word safe.
As we began the practice, I invited Carol to close her eyes or, if that didn’t feel comfortable, to lower her gaze to the floor. I kept my eyes open, so I could see how she was breathing. As a clinician, you want to keep your eyes open while leading a practice, unless your client requests otherwise, so you can monitor the effect of the practice.
As she was lifting her arms, I instructed her to inhale little sips of breath through the nostrils, as though she were climbing a mountain with her breath. When she arrived at the top of the mountain, I cued her to pause and imagine the beautiful scene on the beach in Hawaii she’d chosen as her image—sky, waves, sand, everything. After just a heartbeat or two, I guided her to lower her arms to the side, knowing that from this final position, she’d let her breath out slowly on her own. “Beautiful,” I said.
Adding the mantra. We practiced the Stair Step exercise twice, and then I told Carol that we’d add the mantra so-hum, a soothing sound that I explained means “I am that” in Sanskrit. From my intake form, I already knew that Carol’s religious beliefs wouldn’t be in conflict with a simple, nondeity mantra in Sanskrit. Had this been otherwise, we might have used shalom, amen, or soob-hahn-all-ah to meet her religious beliefs as a Jew, a Christian, or a Muslim, respectively.
We practiced the Stair Step exercise three more times with the mantra. Using the sound helped her slow her breathing even more. Research has shown that mantras are effective because an extended exhalation stimulates the parasympathetic nervous system, relaxing the body. In addition, a soothing sound like so-hum or om deactivates the limbic brain, which is often hyperaroused in individuals with a history of trauma.
Body sensing. As we finished the practice, I invited Carol to sit with her eyes closed and observe the sensations in her arms, palms, and fingertips. “Sense deeply into your palms,” I said. “The mind is a time traveler, but the body is always present. Sensing that feeling in the palms is like having a window into the present moment.”
Notice that I didn’t ask her to feel the sensation in her body in a global way. A client with a history of trauma similar to Carol’s may carry a belief that it isn’t safe to live in her body, or that she’ll be overwhelmed with emotion if she lets herself feel her body. But when we’re specific in our cues to feel sensations in the palms or fingertips, for example—places where there are a lot of nerve endings—we give the client the gift of reoccupying the body in a manner that feels safe.
When we finished these simple exercises, I could see that Carol’s belly was expanding as she inhaled, meaning she was naturally breathing more deeply. Her exhalations came slowly, and her eye contact was steady as well. She said she felt relaxed and a little excited about how easy it had seemed to shift her mood. I told her that the image of the beach in Hawaii was on the altar of her heart, and that she could go back to it any time she felt stressed. She could add the Stair Step breath and the brief pause, for no more than four counts, at the top of the mountain. Since she liked the so-hum mantra, I invited her to use that whenever she felt agitated.
At this point, we rose to move to the yoga mat. However, if Carol were your client, you could begin the work of talk therapy with greater clarity and a deeper sense of connection between the two of you.
Amy Weintraub is the founder of the LifeForce Yoga Healing Institute, which offers trainings in the clinical application of yoga. She’s the author of Yoga Skills for Therapists and Yoga for Depression. Contact: firstname.lastname@example.org.
Tell us what you think about this article by email at email@example.com.
Intimate betrayal strikes at the core of our capacity to trust and love, violating the fundamental expectation that gives us the courage to connect deeply—the belief that the person we love won’t intentionally hurt us. Whether the betrayal is through infidelity, emotional abuse, verbal aggression, or domestic violence, the psychological wound that cuts deepest is the perception that, ultimately, the person we love doesn’t care about our well-being. When humans feel betrayed, we tend to withdraw from contact or furiously lash out in distress, just as do other mammals suffering intense pain.
Cases of intimate betrayal require therapists to reach a balance between validating their clients’ pain and empowering them to improve their lives. If you don’t validate their experience enough, betrayed clients will resist your best therapeutic efforts, feeling you don’t understand their pain. However, if you validate their emotional suffering too much, they may get stuck in their intense and immediate pain. They may even feel that moving on in their lives means losing their identities, since many of them can’t imagine themselves as anything except depressed, anxious victims.
Finding this particular balance was my challenge with Debbie, who’d been married for more than 13 years to a resentful, highly critical man, who’d recently taken most of their retirement savings and left her for a younger woman. Seven months after her divorce was final, Debbie came to see me following an incident in which she’d burst into angry tears after a harried grocery checker had sighed at her for swiping her debit card backwards. Her instantaneous expression of remorse and embarrassment had only made the situation more awkward for her, the cashier, and the shoppers in line behind her.
This dramatic overreaction was one of many such incidents that had plagued Debbie since her divorce. Her previous therapist had tried to help her by exploring her emotions around her husband’s multiple betrayals and linking her anger, resentment, shame, and feelings of abandonment to childhood events. But her flare-ups over everyday occurrences had only increased. Finally, the therapist suggested she use medications, which she refused to do.
Taking a different tack, I assured Debbie that her feelings and reactions were normal—a natural response when a heart is scraped raw by a devastating betrayal. Rather than delving into her childhood, I proposed that we work on increasing her sense of self-worth while teaching her to embrace her deepest values. Through the process of becoming the person she wished to be, I said, she’d learn how to disarm her hair-trigger defense system.
Establishing a Healing Identity
The first therapeutic challenge with Debbie was to help her overcome her victim identity. Like so many who’ve suffered intimate betrayal, she’d come to identify with the bad treatment she’d suffered and all the defects and weaknesses she saw in herself as a result of it. To establish an alternate, healing identity—one that tapped into her resilience, deep values, and desire to improve her life—we began with an inventory of her strengths, which she decided were intelligence, curiosity, resourcefulness, adaptability, and integrity. Then we explored her deeper values, which she said were honesty, responsibility, spirituality, fairness, compassion, love, and appreciation of nature. When we sought out evidence of her resilience, she remembered a time several years before, when she’d recovered from a serious illness while dealing with the loss of her closest friend from breast cancer.
As this healing identity came into focus, Debbie could see clearly that she’d become bitter, anxious, and irritable during her marriage, not the kind of person she wanted to be. It isn’t unusual for people to cope by mirroring the unwanted behaviors of those who’ve betrayed them. To combat this tendency and remind clients of who they want to be, I ask them to write a letter to themselves, stating how they’ll behave differently from their betrayers. Debbie wrote, “He lied all the time; I’ll be truthful in all my relationships. He cheated on me; I’ll be loyal and sensitive to the well-being of those I love. He abused me; I’ll be compassionate to those I love. He was manipulative; I’ll be kind and supportive to those I love. He criticized me for reading too much; I’ll enjoy learning.”
Soon after writing her letter, Debbie decided to pursue a forgotten dream of launching an online macramé outlet, and she set a goal of volunteering at an animal-rescue operation once a month, which she’d enjoyed doing before her husband had ridiculed the activity as a “waste of time.”
Reconditioning the Mind
Emotional healing happens when the brain associates painful images of injury or damage with restorative images of personal symbolic significance. Restorative images motivate behavior that encourages growth and enhances a sense of safety and well-being. For most people, this process occurs naturally over time, as is evident in the normal grieving process following the death of a loved one. In the beginning, memories of the deceased amplify the sense of loss and inhibit emotional investment in others; over time, however, the focus shifts from what’s been lost to what’s been gained from knowing the loved one. This shift allows positive memories, or restorative images, of the deceased to dominate the mind.
To move on from her negative memory loops, Debbie made a list of all the multiple betrayals in her marriage, and then she chose restorative images—such as holding both her children when they were babies, her favorite necklace made by a close friend, and helping her arthritic neighbor weed his garden—to counteract each negative item on her list. To begin the reconditioning process, she put aside 15 minutes every day to go over her practice of pairing restorative images with each painful memory on the list. For most people, this activity becomes easier after a few days, but Debbie was still having difficulty after several weeks. So she tripled her list of restorative images and increased her practice sessions to seven times a day, repeating the associations for as long as it took to feel calm—usually around 10 to 12 minutes. Within six weeks, as she succeeded in training her mind to invoke her restorative images automatically, the intrusive images of betrayal waned in frequency and intensity. For the first time in her life, she felt as though she could control her thoughts and feelings.
Guilt and Shame vs. Compassion
In the aftermath of intimate betrayal, people often experience deep guilt and shame, but the key to healing is for clients to develop self-compassion and an understanding that their worth isn’t a reflection of how they’ve been treated. Instead, their self-value is ultimately connected to their deeper values and feeling of compassion for others.
To help Debbie find an alternative to the negative emotional states that dominated her life, I asked her to list the things causing her to feel guilt or shame and then to explore possible ways of expressing self-compassion and compassion for others. The following example of the process is one of several she came up with.
It took several sessions, with plenty of homework, for Debbie to finalize her lists, but soon she was incorporating what she wrote into her actions on a daily basis. The process of extending compassion to herself and others helped her clarify and embrace her deepest values.
The Ability to Love Again
In the final phase of Debbie’s treatment, the focus changed from developing a healing identity to making new connections, particularly with men. With clients at this stage, I often focus on the distinction between wise trust and its opposites: blind trust and suspiciousness. Wise trust recognizes that we’re all frail creatures capable of betrayal in weaker moments. Blind trust denies this darker characteristic of human nature; suspiciousness exaggerates its presence. Wise trust in action involves a measured assessment and recognition that, despite the alarms triggered by old hurts, the actual probability of betrayal may be quite low if a person has demonstrated trustworthiness over time and under stress.
When Debbie was ready to start dating, we spent time carefully going over the signs of trustworthiness—or a lack of it—in potential partners. We discussed how to determine the likelihood of betrayal by ascertaining how someone responds to feeling vulnerable. When someone responds to a feeling of vulnerability by becoming angry, resentful, or depressed, he or she is likelier to betray you by shutting down, punishing, controlling, or seeking some kind of temporary ego boost through infidelity, impulsive indulgence, or deception. By contrast, someone who responds to feeling vulnerable by trying to improve the situation, connect, or instinctively protect is far less likely to betray you. Eventually, as Debbie began going on dates regularly, I gave her a sheet of paper to fill out to help her assess the probability of future betrayal, asking her to circle all the words that applied. One example from this paper is: “When feeling vulnerable (e.g., anxious, devalued, rejected, powerless, inadequate, unlovable), he tries to improve the situation, connects with me, shuts down emotionally, gets angry, deceives, abuses others, abuses me.”
When Disappointment Feels Like Betrayal
After several months, Debbie began dating a man with whom she felt a strong connection. One day, however, when they were grocery shopping together, he paid too much attention to a young woman in tight shorts in the produce aisle. The fact that he’d failed to “control his eyes” while knowing her sensitivities after her ex-husband’s infidelities seemed like a full-fledged betrayal to Debbie. Since that episode, she’d found herself increasingly irritated and critical with this man when they disagreed about things like politics, books, movies, and other preferences.
I explained to her that after intimate betrayal, it’s easy to misinterpret the anxiety signals that occur with feelings of common disappointment and think that you’re being betrayed once again. To distinguish the difference between disappointment and betrayal for Debbie, I put it this way: “Disappointment is about the way the house looks at a given moment, but betrayal is a gaping crack in the foundation. We can’t assume that displaced furniture signals a crack in the foundation, just as we can’t improve the foundation by rearranging the furniture. Some disappointments can be corrected through negotiation or compromise. Others must be accepted and tolerated if the relationship is otherwise healthy and viable. However, betrayal is nonnegotiable and intolerable, and it should never be accepted without significant relationship repair.”
I went on to offer Debbie a series of specific questions she could ask herself whenever her anxiety was triggered by disappointments in a relationship.
Was the behavior a violation of trust? Debbie’s answer regarding the incident in the grocery store was “Not really, though it seemed so at the time.”
What else might it have been? Debbie replied, “I read that men are more susceptible to visual stimulation, and that sometimes they aren’t immediately aware of where their eyes go. In fact, that’s exactly how my boyfriend described it.”
In the future, what might you say to your boyfriend about how you’d like him to handle similar situations? Debbie said, “I know it’s not that big a deal for you to glance at other women and that sometimes you might not know that you do it, but I’d really appreciate it if you’d be more mindful about it when you’re with me.”
I suspect that Debbie responded well to the approach presented in this case because she was tired of feeling like a victim—a condition that was inadvertently strengthened by her previous therapist, who’d overvalidated her painful experience and tried to relate it to childhood events. In our initial work, although we discussed why her highly emotional reactions were a completely normal response to intimate betrayal, we began to focus on how she could have a greater sense of identity and self-worth by connecting with her deeper values. I began to encourage a sense of empowerment, more so when my efforts to get her to focus on her deeper values and the life she wanted to have in the future had yielded some results. At that stage of therapy, I could point out to her that her straighter posture, more resonant voice, and increased confidence indicated that she was experiencing increased well-being.
Most clients eventually learn the difference between an internal sense of authenticity (who they are at the deepest level) and the self-righteous satisfaction of feeling wronged by the disappointments and abuses they’ve endured. When they experience that tipping point, many are finally ready to do the hard, repetitious work of building new habits of emotional regulation and commit themselves to their deeper values. At that point, they can let go of their sense of victimhood and embrace the rewards—and risks—of living and loving fully as they move forward in their lives.
By William Doherty
There are a dozen admirable features of Steven Stosny’s work with this client, but I’ll focus on just one here. A key challenge to conventional psychotherapy with clients who’ve been betrayed by a loved one is the risk that we’ll inadvertently encourage them to remain stuck in a victim identity. When we spend session after session on the betrayal experience and related events going back to childhood, we may think we’re helping them work through and transcend their painful experiences, but the reverse may occur: they may come to see themselves as lifelong victims of bad or flawed people, ultimately becoming tragic figures in their own life dramas.
Stosny deftly avoids this risk by taking another path. After the necessary first step of showing deep empathy for Debbie’s feelings of betrayal, he moves quickly to work the resilience side of her experience, her “healing identity.” Although this may seem like conventional psychotherapy (don’t we all work on our clients’ strengths?), he also helps Debbie confront how badly she’s treating other people around her. My therapist colleagues Noel Larson and James Maddock, who’ve worked extensively with trauma, have observed that victim and perpetrator are often paired identities, with the victim identity giving permission to the inner perpetrator to lash out or take advantage of others. Stosny talks about it as mirroring the unwanted behavior of the one who’s hurt us.
In working with Debbie, Stosny demonstrates how we heal ourselves by understanding how we treat other people when we’re in pain, and how self-compassion must be paired with compassionate, fair treatment of others. Therefore, he highlights the importance of helping clients access their core values for how they want to live in the world. Stosny is that rare therapist who talks explicitly about values (dare I say moral values?) and invites clients to live consistently with their deepest values. Since the days of Freud, therapists have been ambivalent about values-talk in therapy, seeing it either as intellectualization not worth exploring, or as something imposed by the superego or society, to be deconstructed.
However, we now know more about how closely interpersonal values and a healthy sense of self are intertwined. Forming healthy personal boundaries—a primary goal for anyone who’s been abused and betrayed—means learning to respect the boundaries of others. In the hands of therapists like Steven Stosny, psychotherapy heals by bringing out the healer in clients.
Steven Stosny, Ph.D., is the director of Compassion Power. He’s the author of Love without Hurt and the coauthor of How to Improve Your Marriage without Talking about It. His forthcoming book is Living and Loving after Betrayal: How to Heal from Emotional Abuse, Deceit, Infidelity, & Chronic Resentment. Contact: firstname.lastname@example.org.
William Doherty, Ph.D. is director of the Minnesota Couples on the Brink Project at the University of Minnesota and cofounder, with his daughter Elizabeth Doherty Thomas, of the new Doherty Relationship Institute. Contact: email@example.com.
Tell us what you think about this article by email at firstname.lastname@example.org.
Can a connection with God offer the kind of support and affirmation that a relationship with a therapist can? New research by Stanford University anthropologist Tanya Luhrmann indicates that it can, at least for some American evangelical Christians.
Many therapists are wary of the therapeutic value of prayer or the role of religion in clients’ lives. But people have been turning to religion for comfort, healing, and understanding for far longer than they’ve been making appointments with therapists. Perhaps it’s because, as Luhrmann points out in her new book, When God Talks Back: Understanding the American Evangelical Relationship with God, people with a certain psychological makeup can create a “real” experience with God. Rather than feel God in an esoteric way, they audibly hear God addressing them personally, sometimes from across the breakfast table or in the produce aisle of their grocery store. Reports of this type might raise alarm bells for some therapists, but for some churches, this type of connection isn’t cause for concern—it’s encouraged.
In this interview, Luhrmann explains how she came to spend time in the evangelical church to study the ways members communicate with God, and how this communication can be therapeutic, particularly when people tap into their imagination and hear God talk back.
RH: What led you to study evangelicals?
LUHRMANN: I actually started with researching magicians and how magical tricks can become quite real for some of the people watching them. I was interested in how ordinary people could come to experience the world as if magic actually worked, even when it seemed to violate the rules of everyday reality. I found there were certain heuristics and narratives that, with a little suggestion, allowed some people to enter a frame of mind that would enable them to experience the “reality” of magic.
RH: Not so different from religious experience.
LUHRMANN: Right. This led to my getting interested in the mental state of “absorption”—the capacity to shift your attention from the external, everyday, instrumental dimension of life to become immersed in your own mental imagery. That shift seems to be central to the experience of religion.
Religion requires us to take what’s usually experienced internally and both imagine it as having an external reality and see a quality of goodness as real and palpable out in the world. In the evangelical churches where I spent my time researching my latest book, it was important to be able to experience God as both very loving and absolutely real. At the same time, it was recognized that some people were going to be better at it than others, and that it was something you had to learn and practice.
RH: Do you mean better at engaging in public prayer or better at feeling an internal connection with God?
LUHRMANN:Among the evangelicals I spent time with, many people would talk about hearing directly from God, but others found that difficult or impossible. Many reported talking with God and going for a walk with God as an everyday experience. It was easy for them: they weren’t embarrassed about it, and didn’t find that it was difficult to carve out time for it. And they insisted that it was a two-way interaction. But the church clearly identified them as different from people who have a really tough time hearing God.
RH: I’ve heard the term prayer warriors used for folks who are seriously committed to prayer.
LUHRMANN: Yes, exactly. I was really interested in finding out more about what was happening for them psychologically. I found that they scored high on the absorption scale, which predicted which members of a church were more likely to report that they had a back-and-forth experience with God, that God addressed them like a person, and that they could feel God’s love directly. It would also predict whether people said they heard God talk audibly or whether they experienced God with their other senses.
RH: How did you measure this?
LUHRMANN: I ran an experiment in which I asked people to listen to a piece of scripture on an iPod for half an hour a day for a month. Then, while the control group was just asked to listen to lectures from a teaching company on the gospels, the experimental group was led through the scripture again and encouraged to use their imagination.
For example, with “The Lord Is My Shepherd” psalm, they were asked to look directly at the shepherd, to look in his eyes, and to see how he held himself. They were more likely to report sharper mental images, a more vivid internal experience, a fuller sense of God’s love and presence. They also reported more hallucination-like experiences—not actual hallucinations, but vivid religious experiences outside of everyday reality. For instance, they’d report, “I thought that I saw the edge of an angel’s wing” or “God spoke to me.” It seemed that by following the instructions we gave them, they learned a different way of perceiving God.
RH: Is there any way to distinguish what some people see as delusion from a faith in the intangible?
LUHRMANN: I’ve done research on psychosis, and I know a lot about the internal experience of people who meet the criteria for schizophrenia. The phenomenological accounts of that experience are quite different from those of the people I spent time with in these churches. For the evangelicals, the experience of nonordinary reality are rare and brief and filled with a sense of “goodness.” Somebody might hear God saying, “I’ll always be with you” from the back seat of a car, and they find it comforting rather than deeply disturbing.
RH: Someone shared with you that God told them to vote for George H. W. Bush in 1988.
LUHRMANN:Yes, exactly. That’s quite different from the frightening experience of someone with schizophrenia. I think many people in the evangelical churches are invited to allow some of their thoughts to become more external, but those are the good and loving thoughts.
RH: Why would they do that?
LUHRMANN: Well, I don’t think the church would describe what they do in that way. I think the church would describe that as prayer. But I think that process is really therapeutic.
RH: Self-talk is a central concept in many therapeutic modalities. Is prayer with a loving God something like talking to an affirming therapist all day long?
LUHRMANN: Yes. I think that there’s actually evidence for that. I ran one experiment in which we gave everyone a series of measures,including the statement “I feel God’s love for me directly.” The more highly they affirmed that statement, the less lonely they were and the fewer symptoms they reported on a brief psychiatric scale. Clearly, this can be quite a powerful experience for people.
RH: So as a nonevangelical outsider, how were you received by the people you studied?
LUHRMANN: Often I felt like I was trying to get academic information while they were trying to get my soul, which at times was an exhausting experience. But most of the time, people were supportive and generous and refrained from ending every conversation with an exploration of where I was in my walk with Jesus.
I did have one long conversation with the president of a Southern Baptist seminary who loved my book, but he couldn’t stand the kind of Christianity I was describing. He believed that what’s gone wrong in American Christianity is that God has become so loving that people aren’t paying attention to judgment.
RH: Not enough fire and brimstone!
LUHRMANN: Exactly. The folks I studied don’t do brimstone. They were overall pretty accepting and appreciative, especially the people who don’t hear God speak. In fact, they found my work really interesting because they were wondering if they’re doing something wrong and even questioned whether God loved them. They took some comfort from the fact that I was a respectable scientist who was saying there are these temperamental differences that make a difference in people’s experience of religion.
RH: Rather than “ye of little faith,” you’re discussing personality characteristics, telling them it’s not their fault.
LUHRMANN: Yes, and they appreciated that there was no stake in it for me to say that.
RH: Is there any hope that religious and nonreligious people can work together in harmony?
LUHRMANN: Many of my academic colleagues who look at evangelical Christianity are just horrified. At the most fundamental level, they don’t get why anyone would participate in it. As an anthropologist, I was eager to see if I could put politics aside and contribute to a sort of bridging process. I found that it’s not that people are just cut from a different human cloth, but that like other kinds of behavior, religious behaviors are learned. This learning is part of what makes religious faith satisfying, exciting, and joyful. I found that you can be a reasonable human being and still want to have those kinds of experiences.
Ryan Howes, Ph.D., is a psychologist, writer, musician, and clinical professor at Fuller Graduate School of Psychology in Pasadena, California. He blogs “In Therapy” for Psychology Today. Contact: email@example.com; website: www.ryanhowes.net.
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