Ann Arbor therapist offers counseling, helping clients achieve satisfying life.
Effective Psychotherapy

Counseling for Individuals and Couples

Category: Cognitive Behavioral Therapy

Side Effects of Psychotherapy

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I am a therapist and I believe in the power of therapy to alleviate suffering and contribute to people’s quality of life. I have seen it happen many times. In this post I would like to discuss some of the potential risks and  side effects that are not widely discussed.

  1. Dependence: Some clients start to depend on their therapist for every decision they need to make. A related issue is when the client effectively channels the therapist in his everyday interactions with friends and family. When the client overly identifies with the therapist it can lead to awkward social interactions and impedes the quest of the clients in finding their own voice. It is up to the therapist to point out excessive dependence, to explore its meaning and to prevent it.
  1. Reliance on the connection with the therapist as a sole resource to meet emotional needs, instead of expanding a support network. Therapy should help a person improve their social skills, expand their social network and not serve as a substitute.
  2. Not knowing when to terminate therapy: I have heard countless stories about patients wanting to stop therapy, and well-intended therapists have convinced them to stay. My policy is clear. I greatly respect the clients’ wishes to terminate therapy. There are times at which I initiate the discussion on stopping therapy. Similar to the role of a parent, there often comes a point that the client needs to be gently pushed out to stand on their own two feet.
  3. Expense. – This is probably the most recognized issue. .The money that you pay towards therapy, may prevent you from pursuing other activities that could improve your quality of life, and contribute to your growth as a person.
  4. Time – the time and energy you invest in therapy, could have been spent with loved ones, on meaningful activities that could contribute to your quality of life. No, I do not recommend avoiding psychotherapy, if you could benefit from it. I work as psychotherapist because I believe therapy can change people’s life. I had the privilege to witness people’s growth.  There is a large body of empirical evidence that supports the benefits of therapy,  above and beyond what medication alone can offer.

However:

It is OK to gauge whether there is a fit between you and your provider.

It is OK to check from time to time with your provider about the approach, directions, goals and the need for continuation.

It is OK to weigh the benefits of psychotherapy against the cost – what does it prevent you from doing because of the investment in both time and money.

It is OK to see your provider on less than a weekly basis, or as needed – provided it works for both of you.

My policy on terminating therapy is that if a client decides to quit therapy, I do not try to dissuade them unless there is a clear indication of danger.

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7 Effective Coping Mechanisms for Adults who suffer from ADD

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In my experience ADD in adulthood is often misdiagnosed, especially if the person happens to be intelligent, a female, or both. Many times the person is diagnosed as suffering from depression. The diagnosis of depression may be correct, but it is the result of the problem, not the root cause. ADD in  adults often leads to recurring failure and under-achievement and this may lead to depression.

Recommended book on coping with ADD as  adults:
Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program Client Workbook (Treatments That Work)

This book brings helpful coping mechanisms for people that suffer from ADD. Almost anyone could benefit from using these skills.

The main skills discussed in the book are:

1. Get a calendar, whether a paper one, or a computerized. My inclination is to direct people to a computerized system, unless they are not computer Savvy. Most people with ADD have awful handwriting, and their writing tends to be very messy.

2. Get a to do list, organized by priorities, and with a deadline. People with ADD tend to go for low priority tasks because they are easier, or more attractive. Putting a formal list in place with priorities, helps people organize their day in a more appropriate way.

3. Learn how to break each task into small steps, so that they are not overwhelming.

4. Mange your environment, to minimize sources of distractions.

5. Find out  how long you can work on a single  task without being distracted. Use a watch for that purpose, studying your own performance as you go about your daily tasks. Once you have an idea of the optimal period in which you remain focused, break any task you need to do to smaller ones that can be accomplished in that time frame.

6. Deal with the depression that is associated with ADD, otherwise you will find it difficult to make the necessary changes in your life.

7. Learn better study skills.

While medication prescribed for ADD can be helpful, it is insufficient. Additional work is often required for the person suffering from ADD to reach his or her full potential.

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Cognitive Distortions of Depression

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Depression contributes, and is maintained by common distorted thought patterns. It is a vicious circle, which keep us depressed.

This checklist is taken from the Wikipedia, “Feeling Good” book  and other sources, with some changes and additions. As you go through this list try to  identify these patterns that you tend to use. It may be an  eye opener: You will realize that what sounded like “the reality”,  is indeed very subjective. This is the first step to start controlling those thought patterns, and influence your mood. You may want to keep track of these thought patterns in a journal. There is some overlap between the different thought distortions.

  1. Black and white thinking – No shades of grey. Thinking of things in absolute terms, like “always”, “every”, “never”.     If it is not perfect, it is a failure.
  2. Overgeneralization – Taking isolated cases and using them to make wide generalizations. Generalization from one detail , or aspect of a situation, to the whole situation.
  3. Mental filter – Focusing almost exclusively on  negative or upsetting aspects of an event while ignoring other positive aspects.
  4. Disqualifying the positive – Continually deemphasizing  positive experiences.
  5. Jumping to conclusions – Drawing negative conclusions  from little  evidence. Two specific subtypes:
    • Mind reading – Assuming you can read the feelings and thoughts of others. You know for sure what other people think of you, and of course is it negative.
    • Future reading –  Catastrophizing.  You expect the worst possible outcome, however unlikely. You ruminate about “What if”.
  6. Magnification and minimization – Distorting aspects of a memory or situation through magnifying or minimizing them such that they no longer correspond to objective reality.  If you are depressed, often the positive characteristics of other people are exaggerated and negative characteristics are understated. The reverse  happens when you think about yourself.
  7. Emotional reasoning – Accept your emotions as a valid evidence.  “I feel therfore it is true”. If you feel stupid , than you are  stupid.
  8. Should statements – You know the way things “should” be.  You have rigid rules which  always apply, no matter what the circumstances are. Using “should” statement  leaves you and others feeling preasured, guilty, and on the long run  jeopardizes any motivation for change. It does not allow you to be flexible and adapt to  changing circumstances.
  9. Labeling –  Rather than describing  a  specific behavior, you assign a negative  label to yourself.  it is not the action that was a mistake, you are the mistake. Frequntly, you judge others as harshly as you judge yourself.
  10. Personalization – Attribution of personal responsibility and guilt to yourself   for events over which you have no control.
  11. False expectations: Assuming that other people should be able to read your mind, without any need of your part to express your emotions and needs.  Assuming that your happiness depends on somebody else.

© Wikipedia
A depressed person

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Post Traumatic Stress Syndrome – Veterans

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Recommended movie: Waltz with Bashir

“Waltz with Bashir” is an  examination of post traumatic stress disorder in veterans. This Israeli animated film is a documentary on the Lebanon war, that took place in the early 1980’s.  The movie documents  the  journey of the director back  into the horrors of that war.  The director is driven to delve into his past  in an effort to fill in a period in his life that he has blanked out, but fills him with unease

The movie consist in interviews of people that were there, in Lebanon. The “animated” people in the movie are real people, identified by their real name.

As the director searches out friends from that period in his life he comes across the many forms that PTSD can take. Some have recurring nightmares they cannot shake off; or flashbacks that disturb their daily activities. One of the veterans could go through the day only by smoking marijuana incessantly. He left Israel , distancing himself from this environment, probably to avoid any trigger that could remind him of the war.

Most veterans felt guilt. Guilt for what they have done, or have not done, or failed to prevent. Sometimes even guilt for surviving, while others died.

The movie shows that  PTSD may be caused not only by  traumatic events that were personally experienced but horrors that were witnessed and events that fundamentally violate the ethics on which we were raised.

Sometimes PTSD takes the form of being alienated of daily life. One of the protagonists came for vacation from the war. He walks down the familiar street, but everything he sees seemed  strange, different. He cannot engage in the regular mundane life, with all its trivialities.  When I worked with veterans in Israel, many times this was the most disturbing symptom. As if they are not fully alive any more.

Many of the protagonists would be considered  “functional”. They manage to work and to have family. They probably do not fulfill the full criteria of PTSD as defined in the DSM. Nevertheless, they suffer. Their quality of life is diminished. Sometimes they are not able to apply their full potential, even if they seem from the outside as functioning people.

Now, that American soldiers are coming back from Iraq, this movie is more important than ever. It helps the victims of PTSD and their families understand  what they are going through. Hopefully, this movie will help them see that they are not “crazy” and will reduce their loneliness.

Warning: In spite of the movie’s  striking  beauty, it is not an easy movie to watch.

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Post Traumatic Stress Disorder (PTSD)

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Excellent workbook that gives basic information on and the theoretical foundation of post traumatic stress disorder (PTSD). The workbook also contains an outline of exposure therapy for post traumatic stress disorder.

Exposure therapy is considered the most effective evidenced based therapy for PTSD. It helps people deal with trauma  in the past, and  enables them to move forward. It consists of confronting the painful memories and the triggers that arouse them. Repetition, which lies at the heart of exposure therapy, eventually causes the painful memories to lose their intrusive intensity.

EMDR, which is in vogue today, is a form of exposure therapy.

Reclaiming Your Life from a Traumatic Experience: A Prolonged Exposure Treatment Program Workbook (Treatments That Work)

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Social Anxiety

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Managing Social Anxiety By Debra Hope

Social anxiety can reduce you quality of life, not let you achieve your full potential, and ultimately lead to depression. What results is a vicious cycle – the more anxious you are, the more barriers you will encounter in your life, the more depressed you become, which ultimately contribute to your anxiety. I recommend this self-help book. It is part of a series published by Oxford University Press. All the books adhere to cognitive-behavioral approach. They come in pairs – one for the client, one for the therapists. All those I have seen so far, were excellent. If you read this book, and work along its guideline, you may not even need to see me. And if you do, it will shorten the treatment and make my work easier.

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Dialectical Behavior Therapy

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DBT (Dialectical Behavior Therapy) was initially developed by Dr. Marsha Linehan for people who suffered from personality disorders, particularly borderline personality disorder.  DBT is not about insight, or delving into your past. It is a collection of very practical skills to help you better manage your emotions, your interpersonal relationships, and hence your life. The basis of all these skills is the practice of mindfulness, taken from Buddhism. Mindfulness means the state of mind that allow you to be completely immersed in the present situation, rather than in the past or in fantasy. None of these skills are innovative; but sometimes, while contending with life’s difficulties we need to be reminded of skills that may seem obvious or almost trivial.

Many types of therapy claim that our mental health is best served by getting in touch and experiencing our emotions to the fullest. While this approach is often effective and serves many people well, DBT takes an alternative approach. DBT tries to teach us to regulate our emotions in order to better cope with everyday life. I find this approach very helpful for people that struggle with clinical depression, anxiety, panic attacks, or even people who struggle with anger management issues,  and struggle to go through the day. Only after the depression and anxiety get somewhat under control, a person would have enough energy and inner resources to delve in  and benefit from insight oriented therapy.

In my opinion, these skills are useful for everyone of us. The following link will provide you with handouts. The best way to learn these skills would be in a therapeutic group or in individual therapy.

Dialectical Behavior Therapy .

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