Tag: Point of View

Wearing Your Heart on Your Face

The Polyvagal Circuit in the Consulting Room

By Ryan Howes

As we all learned in school, we have two options in the face of perceived danger: fight or flight. But that was before neuroscientist Stephen Porges, author of The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation, undertook his research into the relationship between human physiology and social engagement.

Porges’s work—which noted researcher Paul Ekman called “a truly revolutionary perspective on human nature”—dramatically broadens our understanding of the sympathetic and parasympathetic systems, and explains how our bodies and brains interact with one another to regulate our physiological states. However, what may be more pertinent to therapists is the extent to which our autonomic nervous systems influence long-term issues with intimacy and trust. In the interview that follows, Porges offers some research-based insights into how therapists can more effectively convey safety to clients and clarifies the evolutionary roots of anxiety, depression, and trauma.

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RH: Can you explain your Polyvagal Theory in simple terms?

Porges: It’s hard to make it simple, but let’s try by starting with what we’ve all learned about the autonomic nervous system. It’s a pair of antagonistic systems: the sympathetic supports mobilization, and the parasympathetic supports immobilization, usually associated with relaxation, growth, and restoration. In the past, we tended to believe that stress responses were, in general, vested within the sympathetic nervous system’s capacity to support fight-or-flight behaviors. But there’s another defense system, unrelated to the sympathetic nervous system and dependent on the parasympathetic nervous system. The mechanisms and adaptive function of this defense system are impossible to understand from the paired antagonism model. The parasympathetic defense response is mediated through a vagal circuit producing a behavioral shutdown such as fainting or, from a clinical perspective, dissociation. This defense system doesn’t fit within the fight-or-flight model. Nor does it fit within the view that the vagus, the major nerve in the parasympathetic nervous system, mediates calmness and induces resilience and health.

RH: Your work suggests that our autonomic systems are better thought of as hierarchical, rather than competing.

Porges: Right. The vertebrate autonomic nervous system has changed through stages of evolution, and the human autonomic nervous system shares several of these autonomic circuits with more ancient vertebrates. Functionally, our autonomic nervous system is composed of three phylogenetically organized subsystems. We utilize our newest systems first, and when they don’t work, we recruit older ones. In terms of evolution, the newest autonomic circuit is a uniquely mammalian vagal circuit, which inhibits the heart rate by placing a tonic inhibition on the heart’s pacemaker. This circuit also inhibits sympathetic activity. The brainstem areas controlling this neural pathway coordinate the nerves controlling the muscles in the face and head. So people are literally showing their heart on their face. That’s because humans are social beings who have to convey to one another that we’re safe to come close to, to hug, and in some cases, to have sex with. To convey this message of safety, we utilize the newest vagal circuit to down-regulate our sympathetic defenses and present cues of safety when it’s appropriate. While the face is a crucial vehicle for this, the voice also plays an important role in conveying a physiological state of calm. If the voice has a higher-pitched frequency, it’s saying, “Don’t come near me.”

The thing to bear in mind is that the vagal circuit is both expressive and receptive. That’s why you feel calmer when I use a soothing, prosodic voice. When the vagal circuit is working, our middle-ear muscles change our capacity to hear predators or low-frequency sounds. Middle-ear muscles, similar to the muscles of the face, are regulated by the brainstem area that controls the mammalian vagal circuit. Typically, when there’s something in the environment that threatens us, we turn off the vagal circuit, because it inhibits our ability to mobilize: it gets in the way of moving to fight or to flee.

RH: That’s because it’s the vagal system that makes us freeze, right?

Porges: Yes, but there are two vagal systems. The root of the Polyvagal Theory is the recognition that in the absence of the ability to fight or flee, the body’s only effective defense is to immobilize and shut down. This can be observed as fainting or nausea, both features of an ancient vagal circuit that reptiles use for defense. However, unlike the uniquely mammalian vagal pathway, these vagal pathways are unmyelinated, and are only effective as a defense system when the newer circuits, including the sympathetic nervous system, are no longer available for interaction and defense. Our reptilian ancestor was similar to a turtle, and the primary defense for a turtle is to immobilize, inhibit breathing, and lower metabolic demands. Although immobilization may be effective for reptiles, it can be life-threatening for mammals, and for humans it can lead to states of dissociation. The Polyvagal Theory provides a way of seeing how the organization of our nervous system can shape our understanding of clinical disorders and issues, enabling us to see symptoms like dissociation not as bad behaviors, but as adaptive reactions to cues in the environment that trigger our physiological responses to perceived dangers.

Think about it this way. When you want to calm a person down, you smile and talk to them in a soothing way. The nervous system detects these cues and down-regulates or inhibits the sympathetic nervous system. But when the sympathetic nervous system is activated as a defense system, it turns off all those social-engagement behaviors. Clinicians are aware of that. But what they often don’t understand is the role of the vagal system in shutting down as a defensive strategy in response to a life threat. When someone is immobilized, held down, or abused, the vagal system is triggered, and they may disassociate or pass out—or perhaps drop dead or defecate. It’s an adaptive response.

I often talk about immobilization with fear and contrast it to immobilization without fear. The mouse in the jaws of a cat is immobilized with fear. The mouse isn’t voluntarily playing dead; it’s fainted. But someone in the embrace of a lover, parent, child, or friend is immobilized without fear.

RH: We might call that stillness, or peace.
Porges: Right, you’re still, but you’re being present. For reptiles and more primitive vertebrates, the primary defense system was to disappear—to immobilize, stop breathing, and look like you’re dead. For mammals, immobilization is a risky business. We have to be selective about whom we can feel still, calm, and comfortable with.
Many clients have difficulty feeling comfortable in the arms of another. They can’t immobilize without fear. If you go through their clinical histories, you’ll find that many were severely abused and had experiences of being forcedly held down. These experiences of forced immobilization trigger fear responses and shutting down. Those who survive these experiences don’t want to be immobilized and find it difficult to be held and calmed, even by people who are trying to be helpful. This response is often expressed as anxiety and a need to keep moving, which is a functional defense to a fear of immobilization. Often individuals with a history of immobilization with fear will adaptively become anxious and go into panic states to avoid this immobilization state. This is a problem many therapists see in their practices.

RH: What are the practical implications of Polyvagal Theory for clinical work?

Porges: It heightens our appreciation of the role of creating safety in therapy. For example, our bodies, physiologically, are extraordinarily sensitive to low-frequency sounds. We, like other mammals, interpret these low-frequency sounds as predatory. If your clinical office is bombarded with sounds from ventilation systems, elevators, or traffic sounds, your client’s physiology is going to be in this more hypervigilant defense mode. Likewise, if you sit some people in the middle of the room away from a wall, they may become hypervigilant and concerned with what’s going on behind them. If we’re not safe, we’re going to assume that neutral faces are angry faces. We’re going to assume the worst because that’s what our nervous system tells us to do. As vertebrates evolved into mammals, they had to interact with other mammals for survival. They needed to detect the social cues and identify when it was safe to be with another mammal. Thus, vocalizations in social contexts are less about syntax and language and more about the intonation conveying emotional state. Again, this is critical in therapy because the intonation of voice conveys more information about the physiology of the client than the syntax.

RH: In other words, how you’re saying something means more than what you’re saying.

Porges: Absolutely. When you were an undergraduate, what were the lectures that put you to sleep? Was it the college professor who was off in space, who basically read from notes and had no prosodic features and no engagement? Social communication has little to do with syntax and a lot to do with intonation, gestures, and a cluster of behaviors we would call biological movement. The face is moving along with the voice and hand gestures. The behavioral features trigger areas of our brain outside the realm of consciousness and change our physiology, enabling us to feel closer and safer with another. Good therapy and good social relations, good parenting, good teaching, it’s all about the same thing—how do you turn off defensiveness? When you turn defense systems off, you have accessibility to different cortical areas for more profound understanding, learning, and skill development.

Ryan Howes, PhD, is a psychologist, writer, musician, and clinical professor at Fuller Graduate School of Psychology in Pasadena, California. He blogs for “In Therapy” at Psychology Today. Contact: rhowes@mindspring.com; website: www.ryanhowes.net.

Tell us what you think about this article by email at letters@psychnetworker.org.

Religion as a Therapeutic Experience

By Ryan Howes

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.

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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: rhowes@mindspring.com; website: www.ryanhowes.net.

Tell us what you think about this article by email at letters@psychnetworker.org.

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.

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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.

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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.