Clinician's Digest - Page 2

The physiological reactions that follow crying, such as respiratory arrhythmia, indicate that the body is attempting to regulate stress. But that doesn't mean that crying decreases stress—the decrease may be attributable to some other reason. Most social psychologists believe that, since crying typically attracts social support, it's the hugs, concern, and tender responses from others, not the crying per se, that make a tearful person feel better. Crying also can defuse others' aggressiveness.

Most of us learn as babies that crying gets us hugs, food, and attention. But it's important to recognize that some people haven't experienced that reaction; crying can fail to attract positive responses or even provoke negative ones. Parents who are narcissistic, depressed, or severely stressed may react to crying babies with inattention, hostility, or physical violence. In addition, some people who received nurturing when they cried as babies may experience negative responses to their crying at other developmental stages. As a result, crying can elicit shame or anxiety in some people just as it does feelings of connectedness, comfort, and support in others.

Rottenberg and Bylsma's study suggests that instead of assuming tears mean that therapy has hit a sweet spot, clinicians should explore their clients' past associations with crying and how they feel about their tears now. What's most likely to provide a healing experience when clients cry in therapy isn't the crying, but the therapist's response. When clients cry, therapists may feel sympathy or the urge to comfort, but if they don't communicate that to clients, even subtly, and explore the feelings associated with crying, shedding tears may be a disconfirming or miserable experience for clients.

Making Peace with Auditory Hallucinations

Recent trends in therapy, especially those emphasizing mindfulness, encourage clients to turn their attention toward, and accept, emotions or "parts" of themselves that may initially seem frightening. Although that approach isn't new—Gestalt therapy advocated this years ago—the prevailing view has been that encouraging psychotic people to acknowledge different aspects of themselves as real encourages splitting and further psychosis. Now a study by a team of British psychologists led by Jasmine Chin of the University of Surrey, reported in the March 2009 Psychology and Psychotherapy: Theory, Research and Practice, suggests that instead of targeting schizophrenics' auditory hallucinations as symptoms to be eliminated, therapists should consider helping them develop a relationship with their voices.

It's a counterintuitive and controversial idea. Not only might this approach potentially support the psychotic symptom, but even Chin's study finds that most people who hear voices don't want to develop a further relationship with them. But want it or not, the study points out, people with auditory hallucinations already have a relationship with their voices, usually a difficult one, and they expend much time and energy trying to control them.

The study asked 10 psychotic people suffering considerable distress with their voices how they understood the relationship. Most personified their voices, assigning gender or names. (This urge was so strong that the few who didn't personify them fought the urge to do so). They usually experienced themselves as engaged in a struggle for power and control. "The voices magnify whatever it is I'm concerned about, or they'll comment on something I'm concerned about, which . . . often makes me more stressed than I was," one patient reported. But some voices served a potentially healthy function, reminding people they'd made good decisions in the past, or encouraging them to practice their social skills with the voices so they could go out into the world.

Along with these tangential supports for the notion of helping people with schizophrenia come into better relationships with their voices, Chin points out another reason. A study in the November 2004 Psychological Medicine, led by British psychologist Max Birchwood, found that people's relationships with their inner voices mirrored their social relationships with the external world, often reflecting their sense of being powerless and controlled by others. Chin speculates that when therapists, along with everyone else in schizophrenics' world, try to drive a wedge between them and their inner voices, it may actually reinforce this internalization of social stigma.

Richard Schwartz, the originator of Internal Family Systems Therapy, who's worked with nonpsychotic clients who hear voices, thinks there may be something to Chin's idea. "Once they realize that I'm neither afraid of nor pathologizing their voices," he says, "most clients are better able to relate to them from a less fearful and more curious, confident, and even compassionate place."

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