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Tag: Point of View
Is Technology Changing Our Minds?
What therapists need to know in the Digital Age
By Ryan Howes
Right now, we’re all subjects of what’s arguably the most widespread, fastest-paced, unplanned experiment on human psychology ever conducted in history. The research question is: what happens to the human brain when, within a few short decades, it’s introduced—in fact, saturated in—a radically new, instantaneous communications technology that links up billions of people and expands access to untold quantities of information over the entire globe? Does this revolution in technology genuinely enhance human connection or just the opposite? Does it make us smarter in some ways, dumber in others?
Gary Small, a UCLA psychiatrist, neuroscientist, expert on memory and aging, and author, with his wife Gigi Vorgan, of iBrain: Surviving the Technological Alteration of the Modern Mind, is on the cutting edge of research about how our digital world is transforming the human brain. In this interview, he discusses how technology is changing our minds and suggests when therapists should respond to clients whose relationship with technology has become unbalanced.
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RH: How did you get started looking at how technology influences the brain?
SMALL: My field is geriatric psychiatry, and I’ve done a lot of research over many years on brain function, brain structure, brain aging, and mood and memory. As a tech geek myself, I was drawn to the question of how all these new technologies are affecting the brain. At some point, the question that most interested me changed from “How can we use technology to measure the brain as it ages” to “Let’s find out what this other technology is doing to the brain at every age.”
RH: Speaking of all ages, you were recently quoted in a New York Times article about the impact of easy-to-use tablet computers on toddlers. What’s your take: good or bad?
SMALL: Basically, we don’t know, but there’s a growing concern because a lot of parents are increasingly using tablets and other digital technology as pacifiers. Is that going to inhibit children’s development of language skills? Some studies suggest that too much screen time could contribute to AD/HD symptoms and lower performance in school, but there’s also a lot of individual variation: some children are more sensitive than others to large amounts of screen time.
RH: Speaking of the impact of technology, how about adults? Is it true that my cell phone is destroying my capacity to remember phone numbers?
SMALL: It’s not destroying it, but basically what you’re describing is a nonissue. The reality is that you don’t need your brain to remember phone numbers in today’s world. For that and many other things, you can use your digital devices to augment your biological memory—for remembering names and faces, and for focusing your attention when you’re having a conversation. In fact, your brain power is better spent learning the apps to use so you can take advantage of the computer as an extension of your biological brain.
RH: So don’t go overboard in seeing computers as having a damaging effect on our cognitive capacities?
SMALL: Exactly. [Phone rings in background.] Please excuse me for a moment [On hold. Four minutes of Muzak.] Hi. I’m sorry about that. I’m afraid I’ve got a fundraiser right now that needs a little bit of my attention. I don’t usually take calls like this, but this underlines part of the whole problem with technology.
What I was just doing in taking that call is called continuous partial attention—scanning the environment for something that’s more imminent than what’s going on. It’s actually a stressful thing that’s not good for our brains or for our relationships. In fact, right now I feel a little guilty that I wasn’t paying full attention to you.
RH: No harm done! Actually, I’m so used to being interrupted by technology that I hardly even notice it.
SMALL: This is one of the issues that people frequently experience in face-to-face conversations these days. They’re talking with someone who won’t look at them because the other person is texting at the same time. So they think, “Eh? Does this person really care about me?” This is having more and more of an impact on the level of social connection people feel.
RH: How’s the influence of technology different from any other factors on social connection?
SMALL: We don’t exactly know, but the principle is this: your brain is sensitive to mental stimuli from moment to moment. If you spend a lot of time with a repeated mental stimulus, neural circuits that control that stimulation will strengthen at the cost of weakening other neural circuits. Basically, most of us are logging too much technology time, and we’re paying a price. We’re not engaging this powerful brain in activities like looking people in the eye, noticing nonverbal cues and emotional expressions, empathizing with other people. That’s a big concern in today’s technological world.
RH: So it’s not technology itself that’s the issue: it’s the fact that technology takes us away from so many other important social activities?
SMALL: Right. And there’s the very real issue of technology and addiction. Some people are addicted
to video games or to shopping online or gambling online, and that
can be destructive to their lives. Studies suggest it can worsen AD/HD, and it may even contribute to the development of autism spectrum disorders.
RH: When should therapists be concerned about a client’s relationship with technology?
SMALL: My alarm goes off if clients keep interrupting a therapy session because they’re answering texts or making calls or checking websites. Any time I see a patient with an inability to unplug for a while—someone who can’t have a conversation because he’s too busy messing with technology—I consider it an issue worth discussing.
RH: What impact might technology have on the future of therapy?
SMALL: Of course, many therapists already use technology in their
practice. Video conferencing and the use of virtual-reality therapy for people with post-traumatic stress and phobias or obsessive-compulsive disorders are increasingly common. There are applications you can download to help with mood and anxiety disorders. Clients can even wear sensors that will alert their therapist when they’ve reached a certain threshold point of anxiety. I think we can take advantage of technology to enhance therapy and increase its effectiveness.
RH: So you’re optimistic about our future with technology?
SMALL: I have faith in humans, and I think we’re going to make the right decisions. We need to bear in mind that technology is neither all good nor all bad. The challenge is to integrate it into our lives, rather than let it become something that enslaves and controls us.
But with young kids, I do have a special caution. The parents of small children have a responsibility to make sure they don’t overuse it and that they spend plenty of time offline. For adults, same thing: don’t spend hours and hours just answering your email. As with so many other issues in life, it’s a question of balance and putting things in perspective.
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: rhowes@mindspring.com; website: www.ryanhowes.net.
Finding the Hero Within with Ken Hardy
Exploring the link between trauma and oppression
By Ryan Howes
One of the hallmarks of the family therapy movement of the ’60s, ’70s, and ’80s was the exploration of the power of social issues like race, class, and ethnic background in clients’ lives. Leading figures in this movement, like Salvador Minuchin, Braulio Montalvo, Marianne Walters, and Monica McGoldrick, were outspoken about the importance of paying attention to the impact of social issues in the therapy room. But these days, we don’t hear much about the connection between psychotherapy and the larger social issues of the day. It seems that, for most therapists today, multiculturalism is a required, four-hour CE workshop, not a cause worthy of attention. One exception is Kenneth Hardy, a professor of family therapy at Drexel University in Philadelphia, who’s dedicated himself to working with troubled inner-city adolescents and keeping alive psychotherapy’s social conscience.
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RH: You once said: “My training prepared me to be a pretty good white therapist.” Could you elaborate on that?
HARDY: I did my graduate training in the early 1980s at the Medical Research Institute in Palo Alto, and spent time at the Family Therapy Institute in Washington, D.C., with Jay Haley. I learned a great deal at both places, but there was little that spoke to me as a person of color. Whatever discussion there was about race or culture tended to pathologize people of color without seeing their inherent strengths. When I left my graduate program and got a job at a psychiatric outpatient clinic in Brooklyn working with a population that was largely people of color, I saw the first day that there was a massive disconnect between what my training had taught me and what they needed from me. While I’d been well trained, I felt like I was a white therapist in black skin.
RH: Has training changed since that time?
HARDY: Well, I think there’s been improvement. You’ll certainly find more faculty of color in training programs—not a substantial number, but one or two people. You’ll find some course content focused on themes of race, class, and ethnicity. But when I talk with students of color, the kinds of experiences they describe today are chillingly similar to the ones I experienced some 30 years ago. They still don’t feel entirely safe bringing up issues of race or ethnicity. Is it better than when I was a student? Absolutely, it’s better.
RH: You described the shift in your work with inner-city teens as moving from, “What’s wrong with you?” to “What happened to you?” Could you elaborate on this?
HARDY: Lots of the young people I see have been perpetrators and done some pretty horrific things in the world. But as a therapist, I’ve found it most useful to start by getting curious about what happened in their lives that contributed to their violent behavior or other aspects of who they are. I see them not just as perpetrators, but perpetrators who were themselves victims before they became perpetrators. So I typically ask early on, “Who were you before you became who you are today?” I want them to think about the events in their lives that reshaped them and led them to be where they are today.
The lives of these kids are filled with trauma, and trauma can reshape every aspect of our lives. As a therapist, I begin by looking at what happened along the way to clients that’s incited this shift in them. I’ve found that doing that is a much more helpful place to begin than trying to decide what’s wrong with them.
RH: What does this approach look like?
HARDY: The kids I see are coming in for things like robbery, violent crime, or chronic truancy. I’ve found again and again that trauma provides a powerful backdrop to those presenting problems. It’s really important not to start the relationship by focusing on their criminal activity. So I’m asking them to talk about their experiences of being poor, black kids in a poor neighborhood of Philadelphia, for example.
RH: You mention that a big part of your work with these young folks is affirmation. What do you mean?
HARDY: I once overheard someone talking about how a periodontist had to impact his gum and create some sort of synthetic gum. Something like that happens in psychotherapy. Often we have to build up the underdeveloped parts of people and find strengths where we can—to lay a foundation for growth. Affirmation starts to rebuild or restore what’s been destroyed, to create a foundation from which therapy can actually take place.
That’s not always so easy, especially if someone’s life narrative as a result of trauma is that “I ain’t nothing.” That can be difficult to rewrite. If I dare to see something redeemable in such people, they may think I’m trying to manipulate them. How could I honestly see something valuable in them?
RH: You like to talk about seeking out our clients’ “untapped heroism.” What does that mean?
HARDY: It comes from my deep conviction that no matter how egregious our behavior, we still have in us some redeemable qualities—something that sets off a flicker of light in the midst of everything that’s awful. So I’m always looking for that quality of what I call heroism in these young people—that part within them that’s managed to survive against tremendous odds. Heroism is this undying will to keep on keeping on, despite all kinds of adversity.
Whether you find that quality in your clients depends on what you look for. A therapist who looks for pathology sees it. A therapist who looks for strength finds it. You have to change what you look for in order to change what you see.
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: rhowes@mindspring.com; website: www.ryanhowes.net. Tell us what you think about this article by e-mail at letters@psychnetworker.org.
Frederic Luskin on the Power of Forgiveness
By Ryan Howes
A new calendar inspires many to turn over a new leaf. For some of us, this may mean learning to turn the other cheek. In recent years, the biological benefits of forgiveness have been widely publicized: lower blood pressure and cholesterol, better sleep, and an improved immune system. Psychologically, people who forgive show lower levels of depression, anxiety, and anger, enjoy better relationships, and report higher levels of optimism and happiness. Sounds great, so why is forgiveness so damn difficult?
Frederic Luskin has some interesting thoughts on that subject. As director of the Stanford Forgiveness Project, he’s studied forgiveness for the past 20 years. He authored Forgive for Good: A Proven Prescription for Health and Happiness and has shared his wisdom with survivors in Northern Ireland, as well as those at Ground Zero in Manhattan.
Since he’s an expert on the psychology of forgiveness and on therapeutic pathways to achieving it, we thought the beginning of the year might be an especially good time to hear from him.
——
RH: How did you become interested in forgiveness?
Luskin: In addition to the pain of being badly hurt by a close friend without having any idea how to deal with it, I needed to find a dissertation topic when I was graduating from Stanford. This was before there was a lot of research about forgiveness. I thought what I learned about getting over my own wounding might have a broader application, and it just seemed like a good opportunity to bring more psychological understanding to something that’s traditionally been such a spiritual concept.
RH: I’m reminded of the Alexander Pope quote: “To err is human; to forgive, divine.” Do we equate forgiveness with spirituality or God more than we do other virtues?
Luskin: I think so, because it’s so difficult. The human tendency is to deliver payback for any hurt that’s been experienced.
RH: The “divine” part of that statement suggests that it requires supernatural strength to forgive.
Luskin: I don’t believe that. I think it takes something more than the essential selfishness that most of us operate out of, but I don’t think it’s divine to understand that you don’t want somebody else to suffer just because you’ve suffered.
RH: As you’ve seen, it’s terribly difficult for a lot of people.
Luskin: That’s part of the reason why the research that we did is so important. Making a connection between enhancing one’s health and forgiveness gives people additional motivation to do something that they might not do otherwise. People may not worry about whether they’re going to heaven, but at least forgiveness reduces their blood pressure and their chance of having a heart attack.
RH: Your work calls into question several beliefs about forgiveness. I’ll toss out a few true-or-false statements here: “Forgiveness means forgetting.”
Luskin: That’s false. It’s actually remembering differently. While lack of forgiveness is remembering something with an edge or a grudge or a sense of injustice, forgiveness means remembering it more benignly, with compassion. It involves some purpose of moving ahead, rather than just being stuck in the past.
RH: “Forgiveness requires repentance from the other.”
Luskin: The fact is that you can forgive someone who’s dead. So it can’t require that.
RH: Isn’t it easier to forgive when the other person is repentant?
Luskin: Certainly, if somebody is really apologetic and takes responsibility—“My bad. I really hurt you. No excuses.” Then forgiveness is easier. It’s not just bad because you got hurt, but I did something wrong.
When someone says, “I’m sorry because you’re hurt,” well, that can make the person who’s been injured feel at fault because they were hurt.
That’s an offensive kind of apology. It’s different when you say: “Boy, I did wrong, independently of whether or not you got hurt. I also see how that wrong has impacted you, and I’m sorry for that.”
So there are two steps—“I did wrong, and that wrong hurt you.” Then the next step is, “Since it’s my responsibility, what can I do to make it better for you?” That’s a true apology, and that makes a real difference.
RH: Is that because it validates the feelings of the victim?
Luskin: Always.
RH: It says, yes, it really was your fault, I don’t have to blame myself or take some of that responsibility. You’re taking it.
Luskin: Well, you still have responsibility for living your life and moving on, but at least that person has said that they’re a significant contributor to the distress and the tears.
RH: Another belief: “Forgiveness is a one-time thing.”
Luskin: No. It’s a process we do over and over. Sometimes you’re reminded of painful situations when you least expect it. Sometimes the person comes back into your life, or you’re just remembering what they did and you have to go through it again.
RH: One final statement: “Forgiveness means everything returns to the way things were.”
Luskin: Sometimes it returns to the way it was, but sometimes you can’t go back. After all, how can you go back if someone close to you has been murdered? Nevertheless, if somebody makes a mistake and they say they’re sorry and ask forgiveness, you can go back to the same type of relationship that you had.
RH: I heard a talk at which you said: “Forgiveness is the experiencing of being at peace right now, no matter what happened five minutes or five years ago.” How is peace related to forgiveness?
Luskin: What is forgiveness except the experience of peace around your own life? It’s acknowledging that you’re OK. Forgiveness is all about people’s perception of their life. If I feel bad, that’s my experience. Just because bad things happen doesn’t mean that I have to behave badly. Understanding that can make a huge difference for many people.
RH: Why do you think we have such a tendency to perpetuate the bad?
Luskin: Part of that is the way our neurology is wired to look for things that are wrong in order to keep us safe. Part of it is the way many cultures foster revenge, retribution, payback, and total self-absorption.
RH: I’ve noticed that victimhood can make people feel like they’re in a position of power, one that they’re reluctant to give up.
Luskin: But feeling resentful and victimized is a highly limited form of power. The price you pay is feeling perpetually uncomfortable and off center. We get angry when life isn’t working; we don’t get angry when life is working.
If you see people who are angry or who are nursing a long-standing grudge, it’s probably because their life isn’t working, and they don’t know what else to do. The whole task of forgiveness comes down to redirecting energy from a preoccupation with helpless resentment to finding a better way to live one’s life.
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: rhowes@mindspring.com; website: www.ryanhowes.net.
Tell us what you think about this article by e-mail at letters@psychnetworker.org, or at www.psychotherapynetworker.org. Log in and you’ll find the comment section on every page of the online magazine.
Moral Issues are at the Heart of Elections
By Ryan Howes
Jonathan Haidt on Why We Vote the Way We Do
By the time you’re reading this, the 2012 election will have been decided, and we’ll all have had our fill of the partisan rancor that’s become commonplace in politics. Perhaps you yourself have had the experience of getting lost in an argument in which you became exasperated that people on the other side couldn’t see what was so obvious, despite your best efforts to reason with them.
When caught in the stalemate of a political debate, the advice of Jonathan Haidt, author of The Righteous Mind: Why Good People Are Divided by Politics and Religion and a social psychologist in the New York University Stern School of Business, is to save our breath–or at least recognize that what we think we’re arguing about isn’t really what we’re arguing about. Haidt believes that most political debates, at least the way they’re usually conducted, are useless because the underlying issues aren’t what they appear to be on the surface. Politics, he says, is ultimately about our stance on fundamental moral beliefs and group loyalties–things that aren’t usually influenced by facts, figures, or rational policy debate. In the interview that follows, he offers a perspective on why we vote the way that we do that differs from what you’re likely to read about in our mainstream election-season coverage.
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RH: Your book is based on the idea that most of us don’t understand the true roots of political differences. What are we missing?
Haidt: People often assume that politics is primarily about self-interest. They wonder why someone would vote for a candidate who’s going to raise their taxes or cut their benefits. But politics, especially at the presidential level, is more like religion than a shopping excursion. Despite all the individualism and materialism within our culture, our group affiliations matter deeply to most of us. Politics begins to make more sense when you understand it as a tribal phenomenon.
RH: So, in politics, group membership trumps individual need?
Haidt: Yes. The more we care about our ethnic group, our city, our state, our occupational group, the likelier we are to vote for politicians who we believe will advance those interests, even when they diverge from our individual interests. For example, it’s striking how many liberal parents with children weren’t more opposed to forced school bussing in the 1970s. Politics is largely about moral missions for the nation, and the president is expected to be the high priest of the American civic religion. It can be illuminating to see the left and right in this country as practicing different civic religions, and looking to very different high priests.
RH: From a moral standpoint, what’s the difference in the outlook of the left and the right?
Haidt: To begin with, left and right have different understandings of fairness. The left tends to focus on equality, with an emphasis on equality of outcome. In contrast, the right cares exclusively about proportionality of outcome: if outcomes are equalized when deservingness isn’t the same, they consider that an abomination. This is why welfare is such a contentious issue. When social conservatives look at people who might have contributed to their own sorry state, they’re deeply offended by the thought of bailing them out, but on the left, compassion for those who are suffering is more widespread. There’s a basic difference in moral attitude about how each side thinks about “fairness.”
RH: But fairness is often raised by both sides in debating social-justice issues, like gay marriage.
Haidt: The left tends to focus on victim groups–on people whom they see as being treated badly and denied opportunity. We’ve had several civil-rights revolutions in this country since the ’60s, first for African Americans, then for women, and then the disabled. Gay people are pretty much the last group against whom it’s legal to discriminate. That’s become one of the central issues for the left in recent years.
RH: It’s no secret that most therapists are politically progressive and aware of the limitations of the right’s perspective.
What are the limitations of the left’s perspective?
Haidt: The basic principle of moral psychology is to begin by understanding someone’s concept of sacredness. Once you do, you’ll find an intense energy, as well as some blindness. If you know what a group holds sacred, you’ll see what most animates it, but you’ll also see places where it loses its perspective and can make mistakes in the name of politics.
An example would be the Obama administration’s position on forcing organizations to pay for contraception. Had there been organizations that were actively banning contraception, they would have been an understandable foe. Instead, the question became, “Should Catholic hospitals and schools, despite their moral position, be forced to pay for contraception?” When the Obama team went ahead and pushed that issue, it was totally unprepared for the outrage it triggered.
RH: Does it come down to the left and right just having fundamentally different ideas of how things should be?
Haidt: Well, both sides care about fairness, and both sides care about liberty–but on the right, their version of fairness is much more focused on catching cheaters and slackers. The idea of a person getting something for nothing really makes their blood boil. That’s why we had Republican Congressman Joe Wilson’s “You lie!” moment during Obama’s healthcare speech in 2009. It was over the question of whether illegal immigrants can get free healthcare–something that deeply offends the right’s sense of what’s morally correct. On the left, people approach that issue from the perspective of compassion: some vulnerable, hardworking illegal immigrant is here in America and gets hit by a car, what should happen to him? Are we going to let him die? It’s a fundamental difference of viewpoint, but rational debate leads nowhere because you can’t change people’s minds on moral and political issues with arguments and evidence.
RH: Why not?
Haidt: Political views aren’t like views about factual matters. If you believe that it’s faster to drive to the airport than take mass transit, and I give you evidence that mass transit is faster, there’s a good chance that I’ll change your mind, because your goal is actually to get to the airport more quickly. With political and moral questions, our goal isn’t “the truth.” That’s why it’s always vital to bear in mind the importance of group membership when trying to understand political differences. Political beliefs act as badges of membership, badges that say who we are and give us a sense of meaning and purpose. They’re badges that we display to show our moral character. So simply refuting someone’s views about global warming or needle-exchange programs or abortion or anything else will have little effect, because people aren’t going to betray their team because you show them evidence that they’re wrong.
RH: So why do we invest so much energy in debating politics?
Haidt: The goal is to be a good team member. We argue not so much to persuade as to show off our team membership. Blog debates on the Internet are really instructive about this phenomenon because it’s so clear there’s no chance of persuasion. People just get more and more extreme in stating their case and showing off how cleverly they can state their arguments. They’re really not interested in what the other side is saying.
RH: If we’re so fundamentally different, how do we peacefully coexist without getting more and more polarized?
Haidt: We first need to realize we actually do peacefully coexist. Things are very heated and getting worse by the decade, and yet political violence is extremely low in the United States, so we should thank heavens for that. As a social psychologist, I generally believe that the situation is extremely powerful, and that the context tends to swamp individual personality traits. So the most important single variable in your politics is the part of the country where you grew up. If you were born in rural Utah versus Boston, that’s probably more important than your score on the personality trait of openness to experience. Nevertheless, the big surprise revealed in research over the last 15 years has been that environment isn’t everything. There’s a growing consensus that temperament matters, and that political leaning isn’t somehow different from all the other personality traits.
RH: What’s the contribution of temperament?
Haidt: Our tendency to be on the left or the right is as heritable as anything else–around 0.5, depending on the measure. For example, our genes predispose us to seek change, diversity, and variety, or order, stability, and predictability. People with different brains will find different kinds of arguments and different social settings attractive. To understand political attitudes fully, you have to understand a range of factors, including genetics, neuroscience, childhood development, adolescent development, and cultural psychology.
RH: What do therapists need to know to understand the kinds of conflicts that revolve around political divisions?
Haidt: I’m not sure it’s especially helpful for therapists to empathize with people’s political beliefs per se, but I think they should be sensitive to the moral differences that are underlying cases in which ideology is dividing someone from a loved one on the other side of the political spectrum. I think we need to be respectful of both sides and recognize that both are really wise about the different kinds of threats that exist in the world. What the study of moral psychology can do is help everyone understand the other side and treat them with more understanding, even honor. The alternative is the kind of demonization that happens when our partisan reactivity activates the endless cycle of argument and rebuttal that we see too often these days.
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: rhowes@mindspring.com; website: www.ryanhowes.net. Tell us what you think about this article by e-mail at letters@psychnetworker.org, or at www.psychotherapynetworker.org. Log in and you’ll find the comment section on every page of the online Magazine.
Telling It Like It Is: Donald Meichenbaum
Donald Meichenbaum doesn’t mince words
By Ryan Howes
Back in the 1970s, Donald Meichenbaum was part of a group of innovators that included Albert Ellis and Aaron Beck. Together they challenged the prevailing behaviorist paradigm, lobbying to have the psychology field recognize the pervasive influence of thoughts and beliefs on observable behavior. Four decades later, the sometimes acerbic Meichenbaum remains an outspoken critic of what he considers unproven therapeutic practices and fads, upholding standards of empirical proof for clinical methods within the field. Now 70 and retired from his professorship at the University of Waterloo in Canada, he’s presently research director of the Melissa Institute for Violence Prevention in Miami, and has a particular interest in ensuring that the combat vets returning from the wars in Afghanistan and Iraq receive the best treatment available. As active as ever and a popular figure on the workshop circuit, he recently talked about conclusions he’s drawn from decades of experience in the field.
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RH: My students have an ongoing debate about the nature of therapy, and how much the therapist-client interaction should resemble a real relationship.
MEICHENBAUM: I get hung up with the word “real.” I mean, what’s an “unreal” relationship? Clearly, when we’re talking about therapeutic alliance, we’re talking about a relationship. The therapeutic alliance depends on the degree to which the therapist and the client agree on a set of goals and the means to get to those goals. That alliance necessarily has to do with the affective bond that develops, and the alignment between the client’s view of what’s wrong and how to get help and what the therapist has to offer. If those are in line, then you’re going to get a therapeutic bond, and everything follows from that.
RH: So the relationship needs to be real enough in clients’ lives that they’ll take the process seriously?
MEICHENBAUM: Yeah, and I’m essentially at my therapeutic best when the clients are themselves offering the advice I’d otherwise offer. In other words, I need clients to convince me that what they need is cognitive-behavioral therapy (CBT). So I use a lot of Socratic questioning to draw out people’s own wisdom. I’m a bit like Peter Falk playing Columbo: I try to get people to provide the answers they’re looking for themselves, rather than trying to become their surrogate frontal lobe.
RH: A former client just contacted me after coming home from Afghanistan. He’s had a tough time, and he’d been specifically advised to seek out EMDR treatment for post-traumatic stress disorder. What would you recommend?
MEICHENBAUM: I’ve done battle with the EMDR people so many times that I don’t want to get back into that debate. Rather than thinking that there’s one approach to PTSD that’s across-the-board better than any other, I think it’s more important to look at what’s common among all these procedures, and help people understand that there are a range of methods—besides exposure-based interventions—that can be helpful.
The choice of which method to recommend should be determined by the client’s symptomology. If your client’s main problem is hypervigilance, avoidance behavior, and mistaken beliefs, then some variation of in vivo exposure, where he can tell the narrative and then change the mistaken beliefs, would be acceptable. But if, in fact, his primary concern is guilt—his feelings about killing a buddy in friendly fire or killing others—then the treatment of choice would be a procedure focused on guilt or moral injuries. The field has advanced to a point where we can now tailor interventions to fit more closely the specific nature of the client’s distress, not just the broad category of PTSD.
Researchers Anke Ehlers and David Clark have identified that the major problem that leads to chronic PTSD has to do with biographical memories. Many people need help to incorporate the trauma memory into the larger narrative of their lives. They need help getting a larger perspective.
The other thing that’s now emerging in the literature is that helping people with PTSD isn’t just about getting rid of bad thoughts, but retrieving positive thoughts of what they did to survive. There’s an increasing recognition of the need to incorporate into treatment resilience-engendering, strength-based interventions, such as fostering positive emotions, psychological flexibility, optimism, gratitude, and spirituality. I’ve been involved in developing iPod technology for returning service members (see www.warfighterdiaries.org). These videos can be downloaded onto an iPod and people can listen to these coping stories whenever they want. This project dovetails with the Constructive Narrative approach that I now advocate.
RH: So there’s no one true cure?
MEICHENBAUM: There’s no single model that fits all. I really see myself as an honest broker, so anyone who says I have the cure, like Steven Hayes’s idea that his Acceptance and Commitment Therapy is “The Third Wave”—ACT may work with many people, but it’s not a panacea.
RH: You’ve done research specifically on what constitutes therapeutic expertise or mastery. You’ve written that people need about seven years to become an expert at anything. Is that similar to the 10,000 hours to achieve expert status that Malcolm Gladwell writes about in The Outliers?
MEICHENBAUM: That’s exactly right, we’re using the same data—10,000 hours, or, if you’re a chess player, 50,000. I say it takes seven years for a therapist to become an expert, because that’s how long it takes to see enough patients really shape up. You learn by deliberative practice, learning from your mistakes.
RH: So what can less experienced therapists do to provide good client care while they’re gaining sufficient experience to move to the next level?
MEICHENBAUM: I think it’s a journey. Some people start off a bit ahead of others because they already have core skills, like knowing how to listen, how to reflect, those kinds of things. I think that the main thing is not to be sucked up by the hype that’s associated with certain therapy models—you need to be a critical consumer. It’s also important to find a good mentor and be part of a peer group in which you look closely at each other’s work.
I think that a crucial pathway to expertise in psychotherapy is to have the guts to audiotape or videotape your sessions, and watch them with someone else; we all need that kind of feedback. The other thing is that you should develop a habit of soliciting feedback from your patients. At the end of every session, you should ask them, “Is there anything I said or did, or anything I failed to say or do, that you found particularly helpful or unhelpful?” We all need to regularly do those kinds of dipstick assessments and solicit that kind of feedback. If you’re an athlete and you miss the shot, you get immediate feedback. If you hit the golf ball in the rough, you get immediate feedback. Psychotherapists don’t get that kind of feedback automatically; they have to ask for it.
RH: As one of the founders of CBT, how far do you think it’s come?
MEICHENBAUM: Years ago, the behavioral traditionalists attempted to get all cognitive types kicked out of the American Association of Behavioral Therapy. They tried to make sure that no articles with the word “cognition” appeared in journals like JABA [Journal of Applied Behavior Analysis]. A letter was even circulated specifically identifying people who were bastardizing behavior therapy. Today AABT has changed its name to the American Association of Cognitive Behavior Therapists. One has got to be impressed with that kind of growth.
In addition, there’s an increasing appreciation of the particular factors that make cognitive-behavior therapy effective, like the therapeutic alliance and the whole business of nurturing hope and attending to feelings. So I think CBT has continued to develop and embrace a broader perspective, recognizing that feelings impact thoughts, as well as thoughts impacting feelings.
Finally, I think that there’s a great deal more humility about the limitations of CBT. Recent studies in the area of depression highlight that behavioral activation and helping people get exercise is equally, or more, effective than cognitive therapy. In the area of substance abuse, CBT is no better than other kinds of interventions, like 12-step groups. In fact, in substance-abuse studies using CBT, there’s no evidence that the cognitions have changed, or that the mechanisms of change are in any way linked to the specific CBT procedures. So I think anyone who’s sensitive to the data has to be given pause by how little we still know about what particular mechanisms lead to change.
RH: It’s humbling!
MEICHENBAUM: Sure. I think if you’re honest in this profession, that’s usually the right stance.
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: rhowes@mind spring.com; www.ryanhowes.net.
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Is Resistance Dead...
Read more...
Or have the rumors been exaggerated?By Clifton Mitchell
With all the recent developments in research, theory, and practice, we have more treatment options to choose from than ever before. Why then do so many practitioners still find client “resistance” a regular companion in their consulting rooms?
Insights and Tools
In Consultation
Peer Supervision Groups that Work
By Eleanor Counselman
Three steps that make a difference
Q: I’d like to organize a peer supervision group, but I’ve heard their failure rate is high. What do you recommend? A: Peer supervision groups provide a welcome respite from the isolation of private practice and an informal, nonevaluative setting after years of formal supervision, particularly for young therapists. They offer valuable guidance on difficult cases and tough ethical dilemmas to therapists at any level of experience. And they’re free! However, as you note, many of them fail. In my experience, careful attention to the initial contract and the ongoing group process can make a huge difference in helping them sustain their membership and thrive. Though they’re often called peer supervision groups, it would be more accurate to call them peer consultation groups. Members don’t have direct supervisory responsibility for one another’s cases: they simply offer suggestions, which members can accept or reject. They typically have four to six members who have approximately the same level of professional experience or share a specific area of interest. Members meet on a regular, usually biweekly, basis. Group consultation, with or without a leader, offers advantages over individual consultation. It includes the possibility of multiple perspectives on the same problem and the reduction of clinicians’ shame about confusions and mistakes as they share similar stories about their struggles with difficult cases. Another benefit is peer interaction, which develops one’s professional sense of self. The hall-of-mirrors effect—seeing yourself as others see you—which is so potent in therapy groups, is a major component of the supervision group experience. Nevertheless, despite the many benefits, it’s challenging to start and maintain a consultation group, particularly if it’s a leaderless one. They can fail to thrive or suffer from “task drift,” moving them away from discussing clinical material and into a form of therapy. It can be difficult to integrate new members and maintain clarity about the group’s own process. Presenting cases in supervision in any format poses obvious risks to one’s self-esteem, and group dynamics add additional risks: issues of power, competition, exposure, and shame can lead members to drop out. It’s especially challenging to manage group dynamics in leaderless groups, as it’s usually the leader’s role to remain aware of what’s happening within the group, and without a leader in charge, shame or fear of being judged may silence members. The most successful leaderless groups seem to be those in which the group members find a balance between a focus on cognitive and emotional issues—talking about cases and about the feelings that arise when seeing clients—while consciously managing the functions that a designated leader would serve. These include protecting the group contract, setting and maintaining appropriate norms, and handling gatekeeping matters, such as bringing in new members. A crucial component of maintaining an atmosphere of group safety is regular, dependable member attendance. Without this, a group will never feel like a place to take risks. Members need to be willing to bring up concerns about irregular attendance because, just as in a therapy group, member lateness and absences can indicate issues that need exploring. Chronic irregular attendance can be demoralizing and cause a group to fail. When it comes to group safety and cohesion, Woody Allen was right: 90 percent of supervision group success is about showing up. A significant issue in any supervision group is shame and the reluctance to expose oneself. To make supervision groups feel safer, therapist David Altfeld developed a model of group consultation in which all group members simply share their emotional reactions and associations to a situation being discussed, instead of one person presenting a specific case issue and everyone else giving advice as resident “experts.” This procedure levels the playing field by not allowing members to compete for the best case analysis. It leaves room for highlighting emotional issues, countertransference reactions, and parallel process. Making everyone vulnerable in this manner avoids opportunities for excessive criticism (or its counterpart, excessive niceness) and encourages emotional sharing. Another group consultation model, developed by Irish therapist Bobby Moore, focuses only on minimal case information, such as a patient’s age, length of time in therapy, and perhaps a little demographic information. Then the presenter talks about his or her thoughts, fantasies, feelings, and associations about the patient and the therapy. Group members then share their associations. Following that, the initial presenter is invited to share any further associations. Only at this point does the presenter give the facts of the case and the clinical dilemma. Finally, the group thinks together about what’s been discussed and what it indicates about the case. For those interested in the power of the collective unconscious, this is a fascinating process to experience. To succeed, a consultation group must feel safe and useful to its members. Here are a few simple principles to follow: Clarify the group structure. The group needs to agree on the frequency and length of meetings, which is best accomplished with a predictable schedule. The group needs to agree on its task and focus: is this group for any clinical issue or just for couples, or trauma, or group therapy? How much time will the group spend on “schmoozing,” and will there be one or more than one case presented each time? What will be the presentation format? While most groups use verbal presentation, some groups are now using videoclips—which makes the discussion much livelier. Agree on membership issues. How many members will the group have, and how will new members be integrated? Once a group has formed, I believe that decisions about adding more members should be a group decision. While it may be tempting to accept a request from someone who wants to join the group, a total of six members seems to be the maximum number for each member to have enough opportunities for presentations. Attend to the group process and dynamics. While groups should build in a “schmooze” or “check-in” time, there needs to be an agreed-upon limit to the socializing, so that the group doesn’t become a therapy group or a coffee klatch. Without a leader, the members themselves must monitor the group’s procedures and raise any important issues. Some groups do this ad hoc; others schedule a regular review meeting to evaluate how things are going. Leaderless peer supervision groups can help clinicians at any stage further clinical learning and combat professional isolation. They’re likeliest to succeed when the group members have a clear working agreement, maintain regular attendance, and create an environment in which both emotional and cognitive learning occurs. Eleanor Counselman, Ed.D., is a past president of the Northeastern Society for Group Psychotherapy and an assistant professor of psychiatry at Harvard Medical School. She’s published numerous articles on psychotherapy and has a private practice in Belmont, Massachusetts.Case Study
Women Who Cheat
By Tammy Nelson
Understanding the message of the affair
Even though our ideas about sex and sexuality have greatly advanced over the last half-century, our culture still holds a double standard about infidelity. While no one is entirely surprised by the behavior of a Bill Clinton, an Elliot Spitzer, or a Tiger Woods—men will be men, after all—we still tend to pathologize women or shame them (or both) for having affairs. In my view, far from being evidence of pathology or marital bankruptcy, a woman’s affair can be a way of expressing a desire for an entirely different self, either separate from the marriage altogether or still in it. An affair can be what I call “a can opener” for women unable to articulate for themselves why they’re unhappy in their marriages, much less empower themselves to leave or begin an honest conversation with their husbands about what they feel is wrong. In my practice, I’ve heard many women say, “I didn’t even know what I wanted until the affair was over and I realized that I really wanted to end my marriage,” or “I had no idea that I used the affair as a way to wake up our relationship.” Many infidelity treatment approaches today are based on the idea that the unfaithful spouse is a perpetrator, someone who wronged the other person. While the pain caused by infidelity can’t and shouldn’t be denied, it generally isn’t understood well enough that many women cheat because they struggle with their self-identity in their lives and lack of empowerment in their marriages. To some extent, the affair makes up for a felt lack of an adult self. Sometimes, understanding an affair as an unconscious bid for self-empowerment, relief from bad sex, or a response to a lack of choices or personal freedom is an important first step toward a fuller, more mature selfhood. Searching for the Bartered Self Sarah came to therapy with her husband, Rob, for couples therapy after he caught her cheating. Married for 10 years, he felt hurt, angry, and hopeless about the marriage. He sat across from Sarah on the couch, with his head in his hands. “I have no idea how we’re going to get past this. Sarah says she wants to work this out, but I don’t know if we can put this marriage together again after what she’s done.” Rob had read emails between Sarah and her boyfriend that explained in detail how much they were enjoying virtual sex—watching each other masturbating over a webcam—which had both shocked and devastated him. He’d thought their sex life was good, but admitted that having kids had gotten in the way of their relationship. He thought they still loved each other, and Sarah agreed. They were both unclear why the affair had happened, but said they wanted to recover their marriage, if possible. At the end of their first joint session, Sarah asked whether she could see me individually. Rob consented, so I asked if they’d be OK with an open secrets policy: what’s said in the individual session stays in the session. They agreed that whatever Sarah said could be kept private, though she could share with Rob what she wished to from our individual sessions. In our first individual session, Sarah asked if therapy could be a place where she could talk honestly about the affair. This led to a discussion of the difference between privacy and secrecy, both in her marriage and in her sessions with me. Keeping secrets in her marriage had given Sarah a sense of space—a secret place where she could grow her sexuality, dream her dreams, and keep a part of her that no one else had control over. Our first conversation revolved around how the space she’d created could be shifted from secret to private, and how she could keep a differentiated, individuated boundary around herself in her relationship. This could give her a healthy degree of separation from her husband without having to lie or be deceptive to stake out her space. I then explained to Sarah that, in my view, infidelity recovery has three phases: crisis, insight, and vision. The crisis stage occurs right after disclosure or discovery, when couples are in acute distress and their lives are in chaos. At this point, the focus of therapy isn’t on whether or not they should stay together or if there’s a future for them, but on establishing safety, addressing painful feelings, and normalizing trauma symptoms. In phase two, the insight phase, we talk about what vulnerabilities might have led to the extramarital affair. Becoming observers of the affair, we begin to tell the story of what happened. Repeating endless details of the sexual indiscretion doesn’t help, but taking a deeper look at what the unfaithful partner longed for and couldn’t find in the marriage—and so looked for outside of it—as well as finding empathy for the other, who was in the dark, can elicit a shift in how both partners see the affair and what it meant in their relationship. Phase three is the vision phase, which includes seeking a deeper understanding of the meaning of the affair and moves forward the experience and resulting lessons into a new concept of marriage and, perhaps, a new future. In this phase, partners can decide to move on separately or stay together. This is where the erotic connection will be renewed (or created) and desire can be revived. In this phase, the meaning of monogamy changes from a moralistic, blanket prohibition on outside sex to a search for deeper intimacy inside the marriage. A vision of the relationship going forward includes negotiating a new commitment. Establishing Safety During early sessions in the crisis phase of treatment, Sarah’s view of the world was shifting, and she didn’t know what she wanted. She wavered about whether she wanted to stay with Rob, wondering whether she should move on and seek genuine emotional independence alone or stay and try to be both fully herself and fully married to Rob. She wasn’t sure she could trust me to understand her and didn’t trust her husband, either, even though she herself had acted in a way that wasn’t trustworthy. Gradually, Sarah revealed that she’d felt that she had no space of her own in the marriage, literally or figuratively. Her husband had a home office, but she had no comparable space for herself. Her dependence on Rob was nearly total: he balanced the checkbook, paid the bills, earned the money, and told her when she could make ATM withdrawals. He even counted the cash in her wallet and decided how much she should spend at the hair salon. She’d never been encouraged or allowed to feel empowered and independent. As a result, she’d started rebelling against her husband like an adolescent against a too-strict father, sneaking out at night or during the day when he was at work and having clandestine sexual encounters. Sarah’s affair consisted primarily of quick liaisons in the back of her car. Her boyfriend met sexual needs not being fulfilled at home. Although the sex was quick, furtive, and secret, he gave her orgasms and oral sex and was willing to experiment in ways she found exciting. But while buoyed by the thrill and energy of this new relationship and her long-buried ability to feel pleasure—even wondering if she might be falling in love—she also felt guilty. Frightened by the growing intimacy with her lover when they were together, she began meeting him online, masturbating with him through a webcam. After Rob discovered the affair, he’d demanded Sarah’s email and voice mail passwords, which she gave him. Although this made her feel exposed, vulnerable, and humiliated, she thought her husband deserved the transparency—as the “innocent” party—and that she should be punished. All these thoughts conformed with many of society’s constructs about women who have affairs, but they reinforced her long-brewing resentment that her marriage wasn’t an equal partnership: she was the “bad child”; her husband, the aggrieved parent. At this point, I reframed the affair for Sarah in a way quite different from her own perspective (and that of many therapists). I asked whether it was possible that the infidelity was less a transgression than a move toward self-respect and self-empowerment. Could she have been seeking autonomy and individuation, as well as a more mature state of sexual development? Was she trying to find her voice, maintain a stronger sense of herself, create a personal boundary that no one could cross, and remain in her marriage? Yes, she’d betrayed her husband; this was beyond doubt, I added. And this method for finding herself was clearly not working if she wanted the marriage to survive. But perhaps she’d paradoxically tried to sabotage the marriage as a desperate attempt to develop more emotional maturity and become a more independent and grown-up wife. As we spoke, Sarah realized that, while her intentions in having the affair hadn’t been conscious, she did want to grow into a fuller woman and mature sexual adult. She admitted she thought she could bring that woman back into the marriage and into the relationship. This made one point crystal clear: she could no longer be satisfied with the marriage as it was. Gaining Awareness Having gotten a clearer portrait of Sarah’s marriage, we moved on to the insight phase of treatment. What did the affair mean about her? What did it mean about Rob? And what did it mean about their marriage? As we explored these questions, Sarah discovered quickly that the affair had far more to do with her marriage than with her husband, whom she said she loved and with whom she wanted to stay—but only if it could become a more equal partnership. When I asked what the affair told her about Rob, she said, “I felt that he wanted me to fill a certain kind of role; it wasn’t just about replaying my mother’s position. Rob liked being in charge, liked bossing me around and being a kind of father. I know why, too. He recently lost his job, and the only place he felt any power or control was at home. He was mad that they’d fired him and took it out on me. In a way, he’s always done that: when people reject him, he gets angry and controlling. But with us, the more he tried to control me, the more I wanted independence from him.” We worked in sessions to identify some key areas where she could feel more autonomy and still be in relationship with Rob. She started small, choosing their television shows, making decisions on where to go to dinner, instead of saying, “I don’t care where we go. Where do you want to go?” When Rob asked her to have sex, she told him she wasn’t ready yet, but would let him know when she was. Although Rob felt he had little or no control in these situations, he did begin to appreciate signs of the new, more adult Sarah, someone equal to him, with whom he could have a conversation and negotiate choices. He realized it was a relief that he didn’t have to do it all himself, and he actually felt less lonely in the marriage. When I asked Sarah what the affair meant about her marriage, she said, “In the affair, I felt stronger, more mature, sexier, calmer, more charming, and more alive.” We talked about whether she could integrate her sexier, more mature self into the marriage or whether the relationship was fundamentally flawed. To her, being in her marriage meant giving up a sense of personal power, while having an affair gave her a sense of independence, choice, and more control. She didn’t know how to have a grown-up relationship with her husband that encompassed safety and desire. Reenvisioning a Marriage Treatment in the third phase included helping Sarah get in touch with her fantasies and reconnect with pleasure—one of her greatest challenges in therapy. She felt guilty when she thought about her own pleasure, and had compartmentalized her needs into the affair, as something separate, wrong, and forbidden. Her fantasies and desires were something she felt shame about sharing with her husband. Bringing that sexual part of her into the marriage was the beginning of erotic recovery for her and for her marriage, but she still had to learn to connect with her desires and to communicate them to Rob. I asked her to write down some of her sexual fantasies and share what she thought the desire or longing underneath them was. For instance, if the fantasy was to have someone grab her hair and kiss her, was this spurred by a longing to be held, to be out of control, to know that she was wanted and desired, or all of the above? The goal was to normalize her sexual needs: her affair had been a breach of monogamy, not a sexual pathology. “If you could have anything you wanted, what would you ideally expect from your sex life with your husband?” Sarah answered shyly, “That he’d pursue me and we’d try new things in bed.” When I asked her if she knew what the longing underneath might be, she said, “My real longing underneath is to be totally special to him.” Sarah went on to work on a vision of a more intimate and adult sexuality. This included asking Rob to behave in ways that made her feel special and trying to make him feel special as well. By this point, she was committed to creating a mutual vision of a new monogamy with her husband, and I suggested they return for couples therapy and focus together on their erotic recovery. Several months later, Rob and Sarah are still working on an agreement for a new, monogamous marriage together. Sarah is committed to sharing her real thoughts and feelings with Rob. In this way, her adult self and her adult needs become a priority that can be talked about and negotiated in the relationship. She feels they’re now given as much importance as Rob’s needs. Rob’s commitment to Sarah is that he tries harder to share his feelings and work on creating a more emotionally intimate relationship. They both try to be conscious of the distant and disconnected roles learned in their childhoods, and focus instead on the emotional intimacy they really want from the relationship. Their new monogamy includes a focus on their erotic recovery. The affair created an erotic injury to their relationship, and Rob and Sarah continue to work on this as a goal of healing. They’ve made a commitment to sharing their fantasies and talking about what’s working in their love life. When they feel distant or dissatisfied, they want to learn to talk about it and turn toward each other instead of shutting down or turning to someone else outside the marriage. Sarah now understands that her journey to self-empowerment and freedom can happen at the same time that she’s a wife and partner. Her adult choices include staying in a mature, monogamous relationship, while creating space for working on her own self-identity. Her worth in the relationship continues to be a focus of our couples therapy. Her cheating makes sense to her now in the context of her life issues, but she has a new empathy for Rob and how it affected him. As therapists, it’s important to discern what our goal is for the women we treat in infidelity therapy. Are we helping them end an affair or end their marriage? Is it our job to remind them of their vows or simply to help them heal? By viewing women’s infidelity as a possible search for a new way of being, we can help them reenvision a fully committed relationship with greater empowerment and equality. CASE COMMENTARY By David Treadway While I admire the sensitive work Tammy Nelson did in rejuvenating Sarah and Rob’s marriage, both emotionally and erotically, I believe that zooming in too quickly to examine the root causes of an infidelity without addressing the emotional impact of the betrayal on both parties usually leads to incomplete healing. Although I say to couples that each partner is 50 percent responsible for what’s not working in a marriage, I always add that choosing to have a secret affair is 100 percent the responsibility of the unfaithful spouse. Most of the time, couples need a way of healing the fundamental breach of trust before being able to fully repair the relationship. In working with couples following a secret affair, I use a four-step model based on the treatment approach of clinical psychologist Janis Abrahms Spring: Step 1: The betrayed partners have as much time as needed to share their hurt, anger, and sense of devastation while unfaithful partners listen as nondefensively as possible without explaining or rationalizing their behavior. The therapist helps the partner who had the outside relationship to be compassionate and caring about the impact of the affair. Needless to say, this may take more than a single session. Step 2: The unfaithful partners are then taught to write a letter in which they take full responsibility for having done harm, indicating what they’ll do to ensure it won’t happen again and what concrete steps they’ll take to make amends. In addition to agreeing never again to see the other party in the affair, other ways to make amends might include giving up drinking for a year or getting rid of the boat where the affair took place. Step 3: The letter of amends is read in session, and the concrete actions that constitute an attempt at atonement are agreed upon by both partners. Step 4: Only at this point is the challenge of learning how to forgive discussed, and only if betrayed partners are ready to begin to work on it. If so, they’re coached on how to write a forgiveness letter that involves accepting the attempts at atonement and expressing a willingness to let go of a sense of injury. This all takes place with the understanding that forgiveness can’t be legislated; it has to grow over time. It’s my experience that patiently and thoroughly working through this difficult process without shaming and blaming is what allows a couple to move on to achieving a level of intimacy and trust that they typically never had before. I remember a man named Paul who’d gone on to transform his relationship with his wife after her affair and referred to their new sense of connection as his “second marriage.” In one of our last sessions, he put his arm around his wife, smiled at me conspiratorially, and said, “You know what I like best? Here I have this extraordinary woman and a brand new ‘second marriage,’ and the lawyers didn’t get a dime!” AUTHOR'S RESPONSE I agree with David Treadway’s observation that working with couples after an infidelity takes lots of finesse and that, of course, the feelings of the person who’s been deceived and betrayed need to taken into account and addressed. Like Treadway, I think Janis Spring’s “secrets policy” can be invaluable, offering helpful clinical guidelines for individual work when necessary. Since this case study was told from Sarah’s point of view, it doesn’t delve into Rob’s feelings, nor do we get to see much of the couples work. Instead, the focus is on the special issues of identity and empowerment for women who have affairs. If I’d told the fuller story of the therapy with this couple, I’d have devoted more attention to the third phase of treatment—the attempt to help them develop a new vision of their marriage, which I call the “new monogamy.” However, the most important message I hope readers take away from this case is that even after the wrenching pain of an affair, therapists still have an opportunity to help troubled couples create a new relationship with better communication, fuller intimacy, and realistic hope for a better future together. Tammy Nelson, Ph.D., M.S., a board-certified sexologist, licensed professional counselor, certified sex therapist, and Imago therapist, is the founder and executive director of the Center for Healing. She’s the author of The New Monogamy; Getting the Sex You Want; and What’s Eating You? David Treadway, Ph.D., is director of the Treadway Training Institute. He’s the author of Home Before Dark: First Year with Cancer and Intimacy, Change, and Other Therapeutic Mysteries: Stories of Clinicians and Clients.Point of View
Is Technology Changing Our Minds?
What therapists need to know in the Digital Age
By Ryan Howes Right now, we’re all subjects of what’s arguably the most widespread, fastest-paced, unplanned experiment on human psychology ever conducted in history. The research question is: what happens to the human brain when, within a few short decades, it’s introduced—in fact, saturated in—a radically new, instantaneous communications technology that links up billions of people and expands access to untold quantities of information over the entire globe? Does this revolution in technology genuinely enhance human connection or just the opposite? Does it make us smarter in some ways, dumber in others? Gary Small, a UCLA psychiatrist, neuroscientist, expert on memory and aging, and author, with his wife Gigi Vorgan, of iBrain: Surviving the Technological Alteration of the Modern Mind, is on the cutting edge of research about how our digital world is transforming the human brain. In this interview, he discusses how technology is changing our minds and suggests when therapists should respond to clients whose relationship with technology has become unbalanced. ----- RH: How did you get started looking at how technology influences the brain? SMALL: My field is geriatric psychiatry, and I’ve done a lot of research over many years on brain function, brain structure, brain aging, and mood and memory. As a tech geek myself, I was drawn to the question of how all these new technologies are affecting the brain. At some point, the question that most interested me changed from “How can we use technology to measure the brain as it ages” to “Let’s find out what this other technology is doing to the brain at every age.” RH: Speaking of all ages, you were recently quoted in a New York Times article about the impact of easy-to-use tablet computers on toddlers. What’s your take: good or bad? SMALL: Basically, we don’t know, but there’s a growing concern because a lot of parents are increasingly using tablets and other digital technology as pacifiers. Is that going to inhibit children’s development of language skills? Some studies suggest that too much screen time could contribute to AD/HD symptoms and lower performance in school, but there’s also a lot of individual variation: some children are more sensitive than others to large amounts of screen time. RH: Speaking of the impact of technology, how about adults? Is it true that my cell phone is destroying my capacity to remember phone numbers? SMALL: It’s not destroying it, but basically what you’re describing is a nonissue. The reality is that you don’t need your brain to remember phone numbers in today’s world. For that and many other things, you can use your digital devices to augment your biological memory—for remembering names and faces, and for focusing your attention when you’re having a conversation. In fact, your brain power is better spent learning the apps to use so you can take advantage of the computer as an extension of your biological brain. RH: So don’t go overboard in seeing computers as having a damaging effect on our cognitive capacities? SMALL: Exactly. [Phone rings in background.] Please excuse me for a moment [On hold. Four minutes of Muzak.] Hi. I’m sorry about that. I’m afraid I’ve got a fundraiser right now that needs a little bit of my attention. I don’t usually take calls like this, but this underlines part of the whole problem with technology. What I was just doing in taking that call is called continuous partial attention—scanning the environment for something that’s more imminent than what’s going on. It’s actually a stressful thing that’s not good for our brains or for our relationships. In fact, right now I feel a little guilty that I wasn’t paying full attention to you. RH: No harm done! Actually, I’m so used to being interrupted by technology that I hardly even notice it. SMALL: This is one of the issues that people frequently experience in face-to-face conversations these days. They’re talking with someone who won’t look at them because the other person is texting at the same time. So they think, “Eh? Does this person really care about me?” This is having more and more of an impact on the level of social connection people feel. RH: How’s the influence of technology different from any other factors on social connection? SMALL: We don’t exactly know, but the principle is this: your brain is sensitive to mental stimuli from moment to moment. If you spend a lot of time with a repeated mental stimulus, neural circuits that control that stimulation will strengthen at the cost of weakening other neural circuits. Basically, most of us are logging too much technology time, and we’re paying a price. We’re not engaging this powerful brain in activities like looking people in the eye, noticing nonverbal cues and emotional expressions, empathizing with other people. That’s a big concern in today’s technological world. RH: So it’s not technology itself that’s the issue: it’s the fact that technology takes us away from so many other important social activities? SMALL: Right. And there’s the very real issue of technology and addiction. Some people are addicted to video games or to shopping online or gambling online, and that can be destructive to their lives. Studies suggest it can worsen AD/HD, and it may even contribute to the development of autism spectrum disorders. RH: When should therapists be concerned about a client’s relationship with technology? SMALL: My alarm goes off if clients keep interrupting a therapy session because they’re answering texts or making calls or checking websites. Any time I see a patient with an inability to unplug for a while—someone who can’t have a conversation because he’s too busy messing with technology—I consider it an issue worth discussing. RH: What impact might technology have on the future of therapy? SMALL: Of course, many therapists already use technology in their practice. Video conferencing and the use of virtual-reality therapy for people with post-traumatic stress and phobias or obsessive-compulsive disorders are increasingly common. There are applications you can download to help with mood and anxiety disorders. Clients can even wear sensors that will alert their therapist when they’ve reached a certain threshold point of anxiety. I think we can take advantage of technology to enhance therapy and increase its effectiveness. RH: So you’re optimistic about our future with technology? SMALL: I have faith in humans, and I think we’re going to make the right decisions. We need to bear in mind that technology is neither all good nor all bad. The challenge is to integrate it into our lives, rather than let it become something that enslaves and controls us. But with young kids, I do have a special caution. The parents of small children have a responsibility to make sure they don’t overuse it and that they spend plenty of time offline. For adults, same thing: don’t spend hours and hours just answering your email. As with so many other issues in life, it’s a question of balance and putting things in perspective. 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: rhowes@mindspring.com; website: www.ryanhowes.net.Bookmarks
A Review of Jared Diamond's New Book
Is Now Really Better? Lessons from Traditional Societies
By Diane Cole The World until Yesterday: What Can We Learn from Traditional Societies? By Jared Diamond Viking. 499 pp. ISBN: 9780670024810 “NOW IS BETTER.” The bold logo, emblazoned on a stylish tote bag, caught my eye recently at a favorite museum shop. The tote cleverly served as both self-help logo and advertisement for the contemporary art exhibition I’d just viewed. The high-concept show had centered on the psychology of human happiness, and this was one of its chief precepts. But as appealing as the slogan was at first sight, upon further reflection, it seemed insufferably smug. I’d just read the multidisciplinary scientist and bestselling author Jared Diamond’s provocative new book, The World until Yesterday: What Can We Learn from Traditional Societies? and one of his first lessons is that we don’t all live in the same “now”—or even necessarily share the same psychological assumptions or expectations. Indeed, he writes, “Psychologists base most of their generalizations about human nature on studies of our own narrow and atypical slice of human diversity.” As a result, he continues, “Most of our understanding of human psychology is based on subjects who may be described by the acronym WEIRD: from Western, educated, industrialized, rich, and democratic societies.” By contrast, his decades of living for extended periods among traditional peoples in isolated regions of the Pacific Islands has taught Diamond just how weird Western societies can seem when seen through the lens of small-scale societies. To begin with, he writes, “Many of my New Guinea friends count differently (by visual mapping rather than by abstract numbers), select their wives or husbands differently, treat their parents and their children differently, view danger differently, and have a different concept of friendship.” To Diamond, who’s a serious scholar (a professor of geography at UCLA) and a master of making scholarly ideas accessible (as in his Pulitzer Prize–winning book, Guns, Germs, and Steel) these differences provide an opportunity to rethink how our particular WEIRD “now” evolved—and the benefits and losses incurred in that journey. Yet Diamond’s purpose in taking us with him as he explores the organizational structures, cultural practices, and ways of living that have been forgotten or just plain jettisoned by Western modernity is neither to wistfully romanticize traditional cultures as “simpler” nor to discredit Western progress as soulless consumerism. He’s not about to advocate that we give up modern hygiene and medical resources, and has no desire to revive indigenous practices that strike us as nothing less than heinous—like infanticide, strangling widows, or abandoning the old to die when they’ve outlived their usefulness. His goal is to sift through old ideas for reconsideration, with clear eyes and an open mind. With one foot planted in the “now” of Western culture and the other spanning the traditional cultures he’s studied, he makes a compelling case for the ways in which reincorporating at least some of these old ways can pay off—in wisdom and perhaps even economically—in our modern-day world. He begins with the ways in which small-scale societies of New Guinea maintain law and order and regulate disputes, both among members of one tribal group and between different groups. Precisely because these societies are so small, both parties in a dispute—whether related to land, theft, or accidental death—are likely to know each other, and may even be members of the same extended family. Unlike in litigation in large cities, where the two parties will most likely be strangers, in these villages, the disputants will continue to encounter each other and farm, hunt, or trade together in the normal course of daily life. That’s why, in these societies, pointing blame, deciding who’s right or wrong, and meting out punishment through the kind of lengthy, adversarial trial system we practice in the West would be counterproductive. It would likely divide village members against one another, disrupt the smooth functioning of the community necessary for its survival, and even risk a cycle of revenge killings. Instead, for New Guineans, finding “justice” hinges on restoring the previous relationship to what it had been before, with both sides being able to save face, reconcile, and clear the air so they can get on with their individual and communal lives. To avoid lingering grievances, this all should happen as quickly as possible, through mediation (often with the help of mutually respected leaders) and rituals of compensation—such as gifts of food and goods, or a shared feast. How is this applicable for the West? Putting reconciliation and mediation first surely could serve families in civil law cases having to do with divorce, family inheritance feuds, and other domestic issues, Diamond suggests. “Far from helping to resolve feelings, court proceedings often make feelings worse than they were before.” As he points out, “All of us know disputants whose relationship became poisoned for the rest of their lives by their court experience.” It’s a sentiment with which many psychotherapists and lawyers would heartily agree, and which some states have already signed on to, in terms of requiring mediation prior to divorce. This is an area that cries out for more study by both the legal and the psychotherapeutic communities. Moving on to family life, Diamond notes that children in hunter-gatherer societies seem more emotionally secure, independent, and curious than kids reared here—not just to him, but to other Westerners who’ve spent time in traditional cultures. He has no studies to back up this impression, but he nonetheless wonders if this greater self-confidence is due, at least in part, to such traditional practices as “the long nursing period, sleeping near parents for several years, far more social models available to children through allo-parenting [provided by adults in addition to the biological parents], far more social stimulation through constant physical contact and proximity of caretakers, instant caretaker responses to a child’s crying, and the minimal amount of physical punishment.” Despite the lack of scientific proof, he avers that the long-term success of these methods in these societies makes them worth a try. In this, he seems a bit behind the Western “now,” where some of these practices have been gaining traction for decades. At the same time, unfortunately, too many of the current realities in Western life—parents’ overly long working hours, the lack of funding for community support systems, and overuse of digital games that double as babysitters—make the goal of more interactive parent–child time seem admirable rather than realistic. One possibility: take a lesson from the positive ways in which some traditional societies value their elders and organize programs that regularly bring seniors into more direct contact with young people to be potential mentors. It would be a new twist on allo-parenting that could be beneficial to many generations simultaneously. Diamond is particularly persuasive in his case for a mindset he calls “constructive paranoia.” The idea is that it’s self-protective to become vigilant to the signs of the many low-risk but frequent hazards we face repeatedly. For traditional societies, this encompasses the possibility of lion attacks, dead trees falling over, or an enemy ambush in the forest; for us, traffic accidents, heart attack warnings, and icy sidewalks. While traditional societies learned the importance of continuous awareness to potential danger from life-and-death experiences, too often we in the West take our continued well-being for granted—at our own peril. We assume that we won’t fall asleep at the wheel, no matter how little we’ve slept the night before, or that the taxi will stop at the red light, rather than speed through and catch us, texting unawares, as we cross the street. Diamond speculates that, in addition to training themselves to be alert as a survival instinct, traditional societies further help guard against negative occurrences by continually and constantly talking to one another about every last detail of their daily lives, including minute observations about any change in behavior, weather pattern, strangers approaching, newly fallen trees, or animal tracks. Rather than being boring, such conversations serve up information that helps instill and refine the instinct for caution as they go about their lives. In our case, adopting such a mindset—and listening for nuggets of advice in someone’s seemingly endless tale of medical ills—might help us bypass an avoidable pitfall. Diamond continues with a (literally) stomach-churning chapter about the public health crisis wrought in traditional societies by the Western diet. When he visited New Guinea in the early 1960s, Diamond reports, “The non-communicable diseases that kill most First World citizens today—diabetes, hypertension, stroke, heart attacks, atherosclerosis, cardiovascular diseases in general, and cancers—were rare or unknown among traditional New Guineans living in rural areas.” But the introduction of Western lifestyles into many of these areas has brought, within decades, high rates of these diseases. The culprits, as he sums them up, are “salt, sugar, fat and sloth.” We all need to teach—and learn from—each other to eat less, consume more healthfully, and exercise. How to do that is the subject for another book entirely. But in the meantime, the lessons Diamond distills in this book provide plenty of food for thought. Contributing editor Diane Cole is author of the memoir After Great Pain: A New Life Emerges, and writes for The Wall Street Journal and other publications. Contact: djcole86@gmail.com.
© 2013 Psychotherapy Networker
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