WASHINGTON – Romance does not have to fizzle out in long-term relationships and progress into a companionship/friendship-type love, a new study has found. Romantic love can last a lifetime and lead to happier, healthier relationships.

“Many believe that romantic love is the same as passionate love,” said lead researcher Bianca P. Acevedo, PhD, then at Stony Brook University (currently at University of California, Santa Barbara). “It isn’t. Romantic love has the intensity, engagement and sexual chemistry that passionate love has, minus the obsessive component. Passionate or obsessive love includes feelings of uncertainty and anxiety. This kind of love helps drive the shorter relationships but not the longer ones.”

These findings appear in the March issue of Review of General Psychology, published by the American Psychological Association.

Acevedo and co-researcher Arthur Aron, PhD, reviewed 25 studies with 6,070 individuals in short- and long-term relationships to find out whether romantic love is associated with more satisfaction. To determine this, they classified the relationships in each of the studies as romantic, passionate (romantic with obsession) or friendship-like love and categorized them as long- or short-term.

The researchers looked at 17 short-term relationship studies, which included 18- to 23-year-old college students who were single, dating or married, with the average relationship lasting less than four years. They also looked at 10 long-term relationship studies comprising middle-aged couples who were typically married 10 years or more. Two of the studies included both long- and short-term relationships in which it was possible to distinguish the two samples.

The review found that those who reported greater romantic love were more satisfied in both the short- and long-term relationships. Companion-like love was only moderately associated with satisfaction in both short- and long-term relationships. And those who reported greater passionate love in their relationships were more satisfied in the short term compared to the long term.

Couples who reported more satisfaction in their relationships also reported being happier and having higher self-esteem.

Feeling that a partner is “there for you” makes for a good relationship, Acevedo said, and facilitates feelings of romantic love. On the other hand, “feelings of insecurity are generally associated with lower satisfaction, and in some cases may spark conflict in the relationship. This can manifest into obsessive love,” she said.

This discovery may change people’s expectations of what they want in long-term relationships. According to the authors, companionship love, which is what many couples see as the natural progression of a successful relationship, may be an unnecessary compromise. “Couples should strive for love with all the trimmings,” Acevedo said. “And couples who’ve been together a long time and wish to get back their romantic edge should know it is an attainable goal that, like most good things in life, requires energy and devotion.”

Article: “Does a Long-Term Relationship Kill Romantic Love?” Bianca P. Acevedo, PhD, and Arthur Aron, PhD, Stony Brook University; Review of General Psychology, Vol. 13, No. 1.

Studies have shown that chronic pain might not only be caused by physical injury but also by stress and emotional issues. In particular, people who have experienced trauma and suffer from Post Traumatic Stress Disorder (PTSD) are often at a higher risk to develop chronic pain.

Chronic pain is defined as prolonged physical pain that lasts for longer than the natural healing process should allow. This pain might stem from injuries, inflammation, or neuralgias and neuropathies (disorders of the nerves), but some people suffer in the absence of any of these conditions. Chronic pain can debilitate one’s ability to move with ease, may hinder their normal functioning, and the search for relief can lead to pain medication addictions, which compound the problem. Chronic pain is also often accompanied by feelings of hopelessness, depression and anxiety.

Many people are already familiar with the fact that emotional stress can lead to stomachaches, irritable bowel syndrome and headaches, but might not know that it can also cause other physical complaints and even chronic pain. One logical reason for this: studies have found that the more anxious and stressed people are, the more tense and constricted their muscles are, over time causing the muscles to become fatigued and inefficient. More subtly, one might develop psychosomatic symptoms or stress-related symptoms because of unresolved emotional issues. These are not new discoveries; researchers have studied the mind/body interrelationship for several decades because of the importance of this link.

Experts have noticed that experiencing a traumatic event can have an impact on the development of pain. In fact, approximately 15-30% of patients with chronic pain also have PTSD. Peter Levine, an expert on trauma, explains that trauma happens “when our ability to respond to a perceived threat is in some way overwhelming.” Most researchers disagree on a precise definition of trauma, but do agree that a typical trauma response might include physiological and psychological symptoms such as numbing, hyperarousal, hypervigilance, nightmares, flashbacks, helplessness, and avoidance behavior.

During a traumatic event, the nervous system goes into survival mode (the sympathetic nervous system) and sometimes has difficulty reverting back into its normal, relaxed mode again (the parasympathetic nervous system). If the nervous system stays in survival mode, stress hormones such as cortisol are constantly released, causing an increase in blood pressure and blood sugar, which can in turn reduce the immune system’s ability to heal. Physical symptoms start to manifest when the body is in constant distress.

If someone has experienced a trauma prior to their current injury or trauma, old memories can potentially be triggered, exacerbating the effects of the newer trauma. Dr. Bessel van der Kolk, a well-known trauma researcher, explains; “Research has shown that, under ordinary conditions, many traumatized people, including rape victims, battered women and abused children, have a fairly good psychosocial adjustment. However, they do not respond to stress the way other people do. Under pressure, they may feel (or act) as if they were traumatized all over again.”

Often, physical pain functions to warn a person that there is still emotional work to be done, and it can also be a sign of unresolved trauma in the nervous system. Even if one has grieved and processed the emotional impact of a trauma, the nervous system might still unwittingly be in survival mode.

Maggie Phillips, author of Reversing Chronic Pain, writes: “Whether or not trauma was connected to the event or condition that originated their pain, having a chronic pain condition is traumatizing in and of itself.”

Since trauma has been found to have a strong correlation to chronic pain, a combination of psychotherapy and physical therapy would be the most logical pain management option for stress and chronic pain relief. Maggie Phillips states that imagery is a more effective intervention than verbal therapy, because trauma tends to impair the language and the mind’s organizational capacities. Psychotherapy that uses imagery, addresses the nervous system, and facilitates cognitive behavioral therapy is recommended.

To tackle the physical aspect of chronic pain, Dr. Mindy Marantz, director of the Healthwell clinic in San Francisco, suggests focusing on alignment in the body, as well as posture that supports organized alignment. Additionally, she advises to address potential inflammation, and provides strategies to help calm the nervous system such as Craniosacral therapy or Feldenkrais Movement Re-education. “These both will help ’stoke’ the lymphatic system, which in turn helps diminish the effects of fluids that pool as a result of injury. Lymphatic massage as well as compression wraps and education help bring this often overlooked pathway to recovery to patients’ attention.”

Beginning a daily program of walking can help to mobilize the muscles and is the best way to stimulate the lymph system to do its job and oxygenate injured muscles. The International Association for the Study of Pain concluded that acupuncture is also effective in long term chronic pain reductions related to musculoskeletal pain.

PTSD and chronic pain are often connected, and both must be addressed in order to help a person be fully functional again. Although one might not be aware of the lingering effect of the trauma, or believe that the traumatic event has been put behind them, the body could be clinging to unresolved issues. Relevant psychotherapy can help to resolve the physical problems.

Written by: Susanne Babbel, PhD, MFT

Posted by: Admin | October 21, 2009

Rage, Shame and the Death of Love

Concealed deep within the human psyche lies an enduring world, a kingdom which exists and yet is separate from our awareness.  Within this shrouded domain reside the remnants of intensely painful experiences that were propelled out of sight for safe keeping.  These imprints that were thrown into the unconscious eventually form into a structure that without warning becomes conscious, as if these early experiences were happening in the present moment.  From this hidden place comes rage, born out of painful humiliations.  This shame shifts our sense of reality and casts a shadow over our experiences with others.

What could be the origin of our tendency to repress pain?   The answer may lie in two different areas.  First, when an infant experiences acute pain caused from powerful breaks in the emotional connection from parent to child, the intensity is so severe it cannot be emotionally or intellectually processed.   Instead these powerful emotions are torn away from consciousness or “split off” from awareness.  This splitting occurs because the infant has not formed enough of a self-structure to deal adequately with such feeling states.  This unprocessed or disorganized material can be referred to as chaotic or overwhelming. Out of the necessity to make order out of chaos, an internal system forms to manage these elements so that they remain secure and safe from exposure.  We refer to this system as the shame/envy/rage/guilt cycle.  The second explanation as to why this unconscious system exists may have something to do with a primitive stage of evolutionary development when life was organized around hunting.  To survive physical and emotional suffering it may have become necessary to suppress the memory of pain so the hunt could continue.  Though we may no longer need this psychological reflex, it remains a force which can cause distortions in our thinking and feeling.  This territory of the unconscious endures as a primeval and intensely emotional place, locked away from our conscious minds.

Shame can best be described as an emotional wound to the self for which one blames oneself as if one’s person is the reason.  Something like “the reason that I get yelled at is because I am bad.”  When personal shame is stimulated by an event that is similar to the original shaming experience, the pain energy converts to rage as it becomes conscious.  The shame system operates on its own because we are not in contact with the pain and therefore it appears spontaneously.   This pain is organized around sets of values, beliefs, defenses and wishes which translate messages to this private world holding it in or when it cannot be controlled, suddenly releasing it.  These vigorous wounds are capable of generating massive shifts of unprocessed pain that can flood the body with fierce rage.  As the person matures the force of this energetic rage is often so intense that it blasts out of the unconscious into the world of others.

Shame-wounding from parents and significant others most often begins during infancy and continues throughout life.  Because this inner world of shame operates in obscurity it can be characterized as a jungle, wild and primitive.   The shift from a shameful stimulation to a rage response is a means of avoiding agony and voiding it at the same time.  This constantly expanding jungle of the unconscious produces an enormous amount of negative energy.  Rage energy is particularly intense because it is combined with a deep-rooted fear of retaliation and abandonment.  The expression of rage mixed with terror is indicative of major emotional breaks occurring at a time when the infant was utterly dependent on the parents for survival.  A neglected infant or child cannot risk expressing rage because it may lead to even further loss or abuse.  If the suffering from abuse continues for extended periods during childhood the pain will intensify and further develop the shame/rage system.

While growing in secrecy, the child’s shame increases in proportion to the intensity of abuse experienced from the world around him.  As the child matures, the rage that has been generated from previous abuse cannot be restrained, and inevitably explodes either toward himself or others.

The four main categories of child abuse are:

1.  Sexual abuse, such as rape, incest, and/or sexual relations between children and adults;

2.  Emotional abuse, such as intense criticism or humiliation and the effects of shaming experiences from parents or others;

3.  Neglect, such as abandonment or long periods of emotional or physical absence;

4.  Physical violence such as beating, or inflicting physical injury throughout childhood.

Shame and rage are effects of these causes, or emotional responses to these experiences.

The basis for what is referred to in our society as “evil behavior” originates from the shame and rage that developed from experiences of childhood abuse.  Case histories of serial killers invariably reveal innumerable instances of intense child abuse from close relatives.  The cause and effect of intense abuse causing deep shame resulting in the formation of profound rage is illustrated in the film “Henry: Portrait of a Serial Killer” where the killer describes the horrors of a childhood filled with rage, sexuality and violence.  The viewer traces Henry’s violence and rage to his early years through evocative scenes.   In one such scene Henry’s mother arrives home with two men for a drunken orgy, while her children and wheel-chair-bound husband look on from the other room.  After numerous such experiences the father shoots himself in the head in an act of impotent rage toward his adulterous wife.  This experience resounds in the head of Henry.  The abuse here is evident in the observing of his mother openly engaging in sex and watching the effect on his father.  His love for his father fueled his rage toward his mother and tied it to his sexuality.  The identification with the impotence of his father and his urge to retaliate toward his mother was acted out again and again in episodes with women, who he ritually murdered.  Thus, Henry’s extreme expression of rage is linked not only with his childhood pain, but also to a disturbed relationship with sexuality.

Rage then is the messenger of shame, the communicator of this inner world to others.  Upon closer examination, one of the intentions of rage is to create a kind of empathy in order to manifest in the “other” how we feel.   Rage becomes a primal or primitive attempt to reconstruct a broken emotional bond.   Rage operates as a mechanism to empty out “bad self” or shameful feelings from within the psyche.  Rage, while conceived from an effort to connect, to correct an injustice or insult, causes great emotional consequences, namely that it is alienating, destructive, and inflicts pain on others.  If this negative energy is directed inward, it is experienced as masochistic self-criticism and self-loathing.  If it is directed outward, it is manifested as sadistic onslaughts that resemble primitive revenge.   Rage is ultimately a formula for failure often taking on ritualistic or compulsive patterns of behavior that the person is unable to control.  The problems that it may aim to correct may never be resolved.

To fully understand the concept of shame and its complexity, some specific definitions will be offered throughout the text.

Shame

The word “shame” originates from the Teutonic root word “skem” which means “to cover oneself.”  Shame is an intense reaction to the pain of humiliation and necessitates deception to keep it concealed.  For shame to be exposed could mean more humiliation and that would feel intolerable.  For example, if a child grows up in a home where he feels unloved, neglected and worthless, he would feel ashamed of his own shame and would need to hide this knowledge from others and even himself.  The pain he feels about his worth would create massive fear and anxiety about being abandoned by his parents.  In order to keep the hope of being worthy of his parents love he may try to be perfect as an attempt at redemption.  In this way he would need to form a public perfect self and live a private hell that would operate quite contrary to one another.  Many of us live in varying degrees of this kind of secrecy, both within and toward the world.  An example of this behavior would be characterized in a child who was raised by parents who were alcoholic and depressed.  The abusive alcoholic parent may be critical or physically abusive and the other parent being depressed would not protect the child from the abuse.  The child would then feel helpless, weak, worthless and inadequate.   He would also be incredibly rageful but have no one to direct it toward but himself.  This circumstance would create massive shame and intense defenses to ward off the dangerous rage that he felt toward his parents.

Shame wounds that occur as a result of child abuse whether from neglect, violence, sexual abuse, humiliation, betrayal or abandonment are often subsumed into a child’s self image.  These experiences produce “bad self” feelings and are felt as self-loathing, inadequacy, powerlessness, weakness, and worthlessness.   Shame is so often experienced as a sinking feeling, a wish to disappear or hide.   Shame is metaphorically the fear of being caught with one’s pants down.  We protect ourselves from feeling shame through defense mechanisms that oppose the original shame feeling.  These defenses can be observed in behavior such as self-righteousness, grandiosity, perfectionism, devaluing of others or as a defense against shame by acting need-less, selfless, or disingenuous.  We may also observe some people whose behavior seems directly opposed to the true nature of their shame or insecurities.  This seeming confidence is observed in: exhibitionists, grandstanders, posers, and those who need to constantly be the center of attention.

To better understand what causes shame, Maurice J. Barry Jr., most eloquently describes what kinds of experience creates these emotional wounds.

In the genesis of the shame reaction, the parent’s attitude toward the child is one of angry rejection of the child himself.  The parent fears and rejects the child’s dependency and masks the fear with anger.  Punishment is used in the form of humiliation and the parent takes the transgression as evidence of the innate badness on the part of the child.  The “badness” on dispassionate examination turns out to be a common human impulse (such as needs). But the parent attacks the child’s right to such an impulse and thus degrades the child’s self concept.   This includes threats of abandonment and is followed by an angry separation of the parent and child.  The child, through repetitive similar onslaughts, is forced into the humiliating attitude of being worth less than the parent is worth.  He fears abandonment, fears his own resentment, and suffers a decrease in confidence in his own capacities.  All this is most painful, but since the child is held at a distance and finally left alone by the still angry parent, the child must resolve the tensions by himself and with himself in painful solitude.

Sylvan Tompkins, a neurologist proposes a physiological explanation for shame.  He describes a neural pathway in the brain for shame. He believes that shame is a universal condition shared by all human beings.  He further asserts that these shame neural pathways are also linked to joy and pleasure.   Tomkins’ theory concludes that people are most acutely sensitive or “shame prone” when they are joyous and vulnerable.  There is comfort in knowing that we are not alone.

Shame causes positive side effects as well. One of the beneficial elements appears to be a byproduct of the fear of being cast out of our family, group or culture.  We endeavor to avoid the shame of exclusion by conforming to our cultural values and behaving in a manner that engenders culturally sanctioned approval.  The urge to belong, not shamed, to want our family to be proud of our achievements is a positive component of shame.  This desire to avoid shame encourages people to make efforts toward being accepted into the larger culture even to strive toward greatness.   Herein lies an element of human nature; avoiding pain is often an incentive in directing our lives toward more positive goals that are difficult and sometimes fearful.

Development

The eminent psychological theorist Heinz Kohut has observed that every child has two chances at emotional health.  If they do not form a bond with the mother, they have another chance for an emotional connection with the father.  The infant develops his basic temperament and identity through interactions and emotional connections with parents and significant caretakers.  Building a healthy identity is a complex task and requires a considerable focus on the self.  In developing healthy self-esteem, children strive to be at the center of family life and thus need to be egocentric or self-centered.  The effect of childhood egocentrism in adult behavior often results in goal-directed ambition, healthy self-esteem, interests, hobbies, appropriate career choices, and feelings of self worth.

Children need to concentrate on themselves so that the typical developmental stages of identity-formation will be completed.  Thus, negative emotional experiences during childhood disrupt the natural developmental process and create a deficit.  This gap in the normal process produces more shame because the person believes that they are to blame for the deficiency in their identity and abilities.   For example, if a child feels secure with his environment he feels free to venture out and explore.  This activity produces both knowledge and curiosity, which will make the child a better student, more likely to prepare for career and life choices.   Children who are mediators between warring family members who are experiencing profound emotional pain or a myriad of other issues (like alcohol, drugs or illness) cannot afford to spend time on themselves.  Children who miss out on developmental task completion are often aimless by the time they reach adulthood.  They are confused because they do not know what they have missed out on and blame themselves because they cannot understand why they are living out their life in a dead end job.   Many of us know people who seem perpetually stuck in their self-centered childhood.   What we are witnessing are people who were never able to complete the normal processes during childhood.  These prerogatives would include learning the developmental imperatives that are required to move onto the next stage.  Erik Erikson, the renowned developmental psychologist described eight stages of human development.  The first stage being Basic trust vs. Basic mistrust and the outcome being drive and hope.  If this stage is never reached and resolved, a person’s ability to trust, their sense of possibilities and drive would be disturbed.  Other stages of development involve willpower, direction and purpose, method and competence, devotion and fidelity, affiliation and love.

Identification with one’s parents is the precursor to identity formation.  All children identify with their parents because imitation is the primary mechanism the infant utilizes to learn language, proper behavior, and how to survive in the world.  Children who feel that their parents are interested in them cultivate the ability to develop their talents without the terror of failing.  One might imagine for a moment what a child feels like, looking up at parents who appear to be “gods,” who actively pay attention by loving, listening, and helping.   Imagine the opposite of that situation and what effect that might have on a developing psyche.  When we consider the factors which are fundamental to emotional health, it is obvious that this kind of quality attention helps to bolster the self-esteem of infants and children.  If neglected, children become depressed.  Statistics have demonstrated that abused children most often become child abusers.  If they experience violence and sexual abuse as children, they become physically and sexually violent adults.  Parents who experienced intense shaming in their childhood cannot be expected to behave in a healthy manner toward their children.  The awesome power of identification is demonstrated by people who suffer terrible child-abuse, and eventually transfer the same abuse they received onto their own children.

Parents who are non-responsive, neglectful, raging, and are particularly controlling, especially concerning feeding and affection, produce helpless rage in their infant.  When parents punish their infant/child for crying, being hungry, needy and clinging or express unrealistic expectations of what the infant “should” be they will cause the child/infant to believe that her needs are bad.   The parents may want the infant to be a “good baby” i.e. clean, obedient or sharing with her other siblings at a time when it is not developmentally possible.   Parents who see their infant as an intrusion or resent its presence, create a feeling of shame.  This feeling will eventually form into part of the child’s identity.  Infants cannot distinguish outside from inside. So when they feel shamed they internalize the pain as a part of the self.  The rage resulting from this kind of rejection is now attached to a set of dependency needs or experiences that were shamed and are propelled into the unconscious forming into a shame/envy/rage/guilt system that will operate in secrecy.  This system then functions as an influence over thinking and feeling.

Recent psychological theoretical thinking places the origins of shame within the first two years of life, before the self or identity has entirely formed.   An infant by definition is absolutely dependent on his parents for food, shelter, love and is consequently quite vulnerable to injury at this sensitive period of time.   Ideally, parents interpret the infant’s cries to decide what needs are being expressed, and then respond appropriately to satisfy the infant with food, affection, or comforting.  Under optimal circumstances, loving parents form an empathic bond as they hold, gaze, cuddle and interact with their infant.  The infant senses the parent’s attention and thus feels secure.  The emotional bond which develops during this time is considered by Margaret Mahler and Mary Ainsworth to be an empathic attachment or symbiosis.  The ability of parents to respond to the infant’s needs for affection and food enables the infant to feel secure to explore her world.  When an infant does not sense that her parents are empathically connected she will feel less safe and will consequently have a difficult time separating and exploring. If the infant’s source of protection is insecure, she will feel unprotected and by necessity cling to the parent for safety. This kind of instability limits the infant’s ability to concentrate on forming an identity.  Infants and children who experience the lack of a parental interest feel unimportant.  When children are criticized, they feel “bad” about themselves. Parents who ignore their children make them feel worthless.  When parents do not respond to the cries of their infant, they create in them a feeling of being powerless.  The most common indicators of shame wounds in adult behavior are: self-criticism, phoniness, shyness, perfectionism, and approval seeking.

An important component in healthy development is for parents to teach their children how the world works, as well as how to interact with others in it.   If a child matures into adult life without coping skills, good modeling of positive adult problem-solving behavior, empathy or well-developed values, he will eventually come to feel that there is something wrong with him. All children imitate their parents as the central method in learning to survive.  Unfortunately, this identification also includes bad behavior as well as good.

Identification with the shaming or raging parent creates a raging adult who repeats the same process often without much control or choice.  The aftermath of a raging incident is intense guilt and is followed by efforts at contrition or in extreme cases suicide.  The power of this condition is so vehement that entire methods of thought and action are invented as a means of expelling the intense pressure that shame and rage produce.  One could postulate that hate groups are an excellent example of the creation of a consistent method for the release of rage.

Rage vs. Anger

Anger can be described as a secondary response to the primary experiences of pain, fear, sadness, frustration and guilt. Anger, as opposed to raging, is a conscious reaction to primary feelings in response to something tangible. Anger will tend to dissipate after an apology, contrition or recognizing the source of the anger. Anger can be difficult to locate because we may not be connected to where it is coming from, but it is about something in the real world.

Rage is most often produced from a perception of “rejected love.” When an adult experiences rejection, the shame of the infant emerges as rage stemming from the memory of forsaken love or the shamed desire to make an attachment. The ultimate result from the frustrated desire to connect and this now despised urge to love evokes destructive feelings that attack the very thing that is desired, often precipitating an inevitable death of love. Rage is aroused by an event that mirrors a primary emotional injury. This stimulation that is similar to the original event evokes intense emotional memories. When these memories merge with shame experiences, the reaction can be violent.

Rage may have several intentions, to magically change the other, to create in the other person a shame feeling that is inside as a form of empathy, to communicate through rage in order to penetrate the other in a powerful way, or to seek revenge, as in: “an eye for an eye and a tooth for a tooth.”

The probable origins of bulimia, anorexia, and agoraphobia can then be linked to the shaming of basic impulses. With the bulimic the rage toward the self is swallowed in an orgy of hunger and expelled violently in vomiting the bad shame laden food linked with shamed basic hunger. With the anorexic it is the body that is filled with shame, then wastes away with the elimination of shame. With agoraphobia the shame is with the world that will humiliate, reject and injure, which can be understood as a projection of the rage out to the world and back toward the self.

When shameful feelings are linked to the need for affection, fear, denial and inhibition may appear. An example of shame related to getting needs met could be seen in a person who believes they are unselfishly giving of themselves with the secret intention that the other will return their giving with affection. When the receiver does not respond with appreciation and affection the giver flies into a rage. The perpetrator believes he is unselfish and does not see where the shame is operating. They truly believe that their intentions are altruistic. The reason for this is related to the idea that the shame/rage exits as if on an “island” within the psyche, apart from the self yet still connected. If shame is stimulated through rejection or humiliation, whether in fantasy or reality, powerful rage explodes from this island toward what is seen as the perpetrator. The cause and effect of this pain being apart from conscious awareness revolve around the notion that the outside world becomes a part of the interior original “bad self” feeling. The projection of this rage pain onto others is the hallmark of the shame/rage condition. In this way rage operates as a paranoid process, shifting in a fundamental distortion causing the perpetrator to believe that they are entitled to their rage. This license to rage exists because the person believes that he is the victim and therefore becomes the aggressor. The sado-masochistic character of shame/rage is evident in extremely violent behavior. The effects of rage and shame are seen in a disgruntled employee who empties his gun into what he believes are his enemies only to turn the gun on himself moments later. The chain of shame/envy/rage/guilt either toward the self or others transpires instantly, distorting reality to fit an unconscious need to rid the self of the shame/envy/rage. Once the rage is dissipated the reality becomes clear again and the recognition of what has happened becomes intolerable, stimulating guilt, rage and shame which is then directed at the self.

Christopher Bollas defines shame as an “unthought known.” What he means by the term is that on some level we know about our shame but we are too ashamed to reflect on it. The presence of shame compels us to hide it because the pain is so acute. Shame conceals itself from conscious recognition, because identifying it inflames the original wound, and it is instinctual for the mind and body to avoid pain. Human beings like all mammals and animals naturally avoid pain and move toward safety and security. The person who believes himself to be inferior, worthless, weak and powerless does not want to know this about himself because he does not want to acknowledge that it is true. To acknowledge the truth of his shame might stimulate feelings of self-hatred or abandonment terror.

Shame pathology is so intense, and generates such powerful negative feelings toward the self, that the shamed individual is unable to derive self-esteem from within. This means that most, if not all, access to self-esteem must be sought through contact with others. The result is that the person who is unable to feel good about himself will engage in relationships with others that seem to represent a cure for shame. Poor self-esteem is another term for shame feelings. The process of acquiring this kind of self-esteem from an intimate relationship occurs when the person meets someone that to him represents a fantasy of redemption. The abiding fantasy that one day someone will appear to release him from his shame. This fantasy can never be realized. No person can ever save another from his shame. When someone believes in this redemptive fantasy, it develops into a recipe for rage. For example, a man marries and yet feels deep within himself that he is inadequate and that no one could ever really love him. The origin of this feeling evolves out of a lonely childhood and develops into a fantasy of redemption that soothes him during the long hours of isolation. He has an image of someone who will appear someday to meet all his needs, deeply love him, and deliver him from his shame and loneliness. This condition is referred to as the “Golden Fantasy.” His wife feels trapped by his expectation that she will save him. She must constantly prove to him that she loves him, and when on occasion she fails, he rages. All of her efforts to please, to sacrifice, to be good to him, will evaporate in a moment of rage. She cannot win because she cannot live up to the ideal. There is no possible way to become the ideal because it is based on a fantasy. The rage energy builds until it cannot be contained and spills out through the conduit of entitlement. He feels entitled to rage because she has failed to demonstrate her love for him in accordance with his redemptive fantasy. The surprising quality of rage is that the perpetrator so often does not sense the power of the emotion itself. Because rage is unconscious and automatically stimulated, it can actually bypass consciousness through entitlement. This circumstance often leads to more raging because he may feel the reaction he is getting is unjust.

Adults experiencing rage typically feel that its origin is “out there.” They believe their anger is caused by the “other,” when it is really being stimulated from within. Indicators of shame and rage behavior or their defenses can be noted in domestic violence, racism, perversions, eating disorders, and major depression. It can be said that shame is the core issue forming the nucleus of most personality disorders. Each person responds differently to their personal sense of shame, but when Shakespeare wrote “Out damned spot!” he was referring to a common theme about shame, an emotional stain on one’s soul.

The phenomena of rage can be described as a psychological distortion based on the force of a primal shame wound. The active rage state customizes reality to create a means of expulsion. To illustrate, rage alters reality in a similar way that sexual excitement alters perception in the excitement phase before orgasm. Rage is produced by an active shame wound which exerts force from the pain that the person experiences from a negative act or a perceived negative act. Active shame pain feels like anxiety, fear, agitation, torment, depression or anger. There are several stages that precede rage within the person who is experiencing it. First, one may feel a rising tension inside through an experience that the person believes is shaming. Secondly, the mind reacts to this rising tension by unconsciously and automatically searching for an object to purge the system of the “toxic” shame. At this point the object could be anything from an anonymous person who cuts another off in traffic, to a wife who serves the dinner cold, or to a crying child. Thirdly, the psyche invents a rationalization to create a means to an end. The means to an end is identified as “entitlement to rage” or the switch that legitimizes the purging of shame from the psychic system. Rage is the ignition that propels the shame out of the structure and into the world of others. Since the shame/envy/rage/guilt system is the remnant of a regressed infantile wound it is pre-moral and without boundaries. The expelling of rage is a great relief to the pressure that rage produces from within the psyche.

“Shame-prone” individuals are quite fragile emotionally because they have given the authority for feeling good about themselves to someone else. Essentially, the forfeiting of one’s own responsibility for self-esteem, burdens the relationship with pressure both to be the savior and to be continually ideal.

To invest the power over one’s self-esteem to another produces destructive envy. Envy about the power we assign to another produces a desire to destroy the other and therefore the pain. Envy is at first converted into a reality by assigning the authority over self-approval to another and supporting the deeply held belief that the other has a capability they do not. To destroy the other has significance both to annihilate needs and to take back the power one has lost in investing the self-esteem potential in the other. Rage then responds to a deeper pain than anger. Envy stimulates shame and rage because the person believes that others are more adequate.

Envy

Envy is the feeling that someone else has something we lack. Envy causes pain because it arouses the shame of deficiency, weakness and worthlessness. It also engenders rage against the pain, as it attempts to destroy aspects of the object that are envied. The person who envies wishes to obliterate the source of envy as they seek to eliminate it within themselves. Investing this power in others relieves the shamed person of the responsibility for maintaining his own self-esteem, thus protecting himself from the fearful consequences of failure and rage toward the self. When others fail or even reject the attempts at redemption, rage or obsessional thinking may be directed at the unsuspecting “other” in an effort to control or change them to reconstruct or hold onto the source of self-esteem nurturing. A component of rage is a magical intention to reconstruct the fantasy. The raging person believes that their rage will magically change the other into their ideal. This intention fails because the victim of this treatment feels like an object, overvalued, overwhelmed and in some sense invisible. This notion would seem obvious to the casual observer but not to the person who is raging. They do not understand why their wife or children do not want to be around them. Obsessional thinking is tied to rage but is a distraction the psyche invents to avoid the terror of abandonment and the great depth of the shame agony.

The best defense against envy is to devalue the love object. To devalue the other person is to destroy the desire to need the other. In order to strip the other of their power to save us, and to protect against humiliation, rejection, failure and shame, we devalue them. When this person no longer holds value for us, we can eliminate shameful needs and take back the power that was lost in feeling inadequate. Obsession operates as a defense against profound fear, suicidal urges and deep shame concerning adequacy. In this way obsession attempts to hold onto a love object in fantasy to attempt to repair the lost connection and to keep the powerful unwanted feelings down. Obsession when unchecked can convert into violent fantasies which can be acted out.

Rage that is generated out of envy feels entirely justified. The person who is envied has held the power and has failed. Thus, those that envy respond to these failures with a sense of entitlement. The progression from inner shame to outward rage occurs instantly but is temporary in nature. The consequences of the resulting violence, however can be permanent. The pronounced effect of destructive rage is remarkable because it is boundless. It is a wild beast that can rip out the hearts of our loved ones.

Guilt vs. Shame

Guilt stems from a different source than shame. While the reference point of shame is the self, the reference points of guilt are the actions of the individual.  Shame is about the self while guilt refers to the activity of the self. While an act of guilt can be eliminated by changing the activity which causes the feeling of guilt, shame remains as an active personality trait. If a person believes that he is bad the feeling is that he was born that way, whereas with guilt it involves a value or an action, that can be changed. The activity can be eliminated, but the self remains. Guilt is connected to a behavior that is in opposition to a moral or ethical value system. Guilt attends to an activity, past or present, something a person does that has caused the guilty feeling. In ceasing the guilty activity, the guilt is usually relieved. In the case of child abuse the person may feel both guilt and shame. The child feels guilty about the act and ashamed for having been violated. In this kind of circumstance if the person is able to accept their innocence at the time of the experience, the guilt can be alleviated. Adult victims of child abuse tend to feel especially guilty because as children they believed that they were somehow responsible for the reprehensible behavior of the perpetrator. Since childhood is considered to be an egocentric period of development, children feel responsible for whatever is happening to them, either positive or negative.

Although guilt is very powerful and complex it is often relieved through the simple process of confession. Confession seems to neutralize guilt by giving the confessor some kind of forgiveness or understanding. Self-mutilation, flagellation and masochism are most often guilt related because guilt is relieved through punishment. The person feels that they have committed a sin or moral break and punishment is a source of relief for the bad act.

Guilt also represents a higher-order moral development because one must have a set of morals to even feel guilt. For this reason, guilt develops at a later developmental period than shame. Nevertheless, shame and guilt are frequently found operating together. They may coexist as “I feel guilty for what I have done, and I did it because I am bad.”

While shame represents a primitive wound which is generated very early in development, before the existence of a moral system, guilt develops in relation to a learned sense of what is acceptable behavior. From this we can extrapolate that shame although related to the self corresponds to basic impulses like hunger, need, sexuality and identity. For this reason the bond that develops between parents and children becomes critical in the development of healthy self-esteem and the sense that one is able to get needs met and what one wants from the world.

Empathy and Bonding

Empathy is often confused with sympathy. Sympathy is a condition of being in “sync” with the other person forming an emotional bond. Sympathy is defined by Webster’s Dictionary as:

Harmony of or agreement in feeling, as between persons or on the part of one person with respect to another, the harmony of feeling existing between persons of like tastes or opinion or of congenial dispositions, the ability to share the feelings of another, especially in sorrow or trouble, compassion, and commiseration.

Unlike sympathy which is emotionally based, empathy includes intellectual reasoning and is defined as the ability to grasp the experience of the other, which may or may not involve feelings.

Robert Katz defines empathy as: “the projection of one’s own personality into that of another in order to understand him better.” Theodore Reik defines empathy as a four-step process:

1.  Identification, the experience of projecting ourselves into the identity of another.

2.  Incorporation, which involves taking the experience of the other into ourselves.

3.  Reverberation, getting the feel for the experience through “vicarious cognition,” which may lead to new insights.

4.  Detachment, which is withdrawal from the other in order to gain “reason and scrutiny” through a more objective perspective.

Heinz Kohut described empathy as the ability to put ourselves into the mind of another, which he defines as “vicarious introspection.”

The bond between infant and mother requires compassion, empathy, sympathy and love which is strong and healthy. The infant experiences a “primary empathy” with the mother, a oneness, or fusion, a feeling of being in the same emotional space with the mother. This attachment, or empathic bond, is critical in the formation of identity and defines the basic personality structure for developing and maintaining significant relationships throughout life.

Empathy can have two intentions – one is the desire for the other person to understand how we feel, and the second is to comprehend how the other person feels. As stated, rage expresses a kind of search for empathy or symbolic effort to create in the other the pain that one feels or a kind of search for empathy but in only one direction. The act of rage delivers the internalized shame, but it is not a true empathic connection; it is a bond of pain. To understand that rage is an attempt to form an empathic bond helps the person who experiences rage to feel less ashamed and not as defensive toward seeing the origin of their rage with more clarity.

The child who experiences empathy identifies with these kinds of encounters and continues these behavior patterns with significant others in adulthood. However, if his parents failed to make an empathic attachment, or instead made rageful connections, he will yearn for empathic attachments but will lack the ability to achieve them. This concept perhaps explains why couples resist methods of eliminating rage in their relationship. They do not fight because they enjoy it, but because it is the only means available to create a powerful connection.

Empathic failures during childhood do not entirely rule out the possibility of having empathic experiences as adults. Adults who become aware of themselves and are knowledgeable about empathy can learn to develop these bonds. This task usually requires some support from a competent therapist because of the tricky nature and profound sensitivity of shame wounds. The strength of personal connections however, are often fragile. A mini-break in empathy will tend to sever the connection because shame-prone individuals have great difficulty sustaining a connection during such breaks. Shame-prone individuals desire love, but their efforts frequently backfire as they fly into a rage and uncontrollably break the connection. These rages refer out from infantile wounds lying deep below the surface producing pain and anxiety which builds until it must tear away from or destroy the connection with the other.

For children to understand the meaning of their feelings and needs, parents must verbalize that meaning to them. Parental empathy, communication and behavior build the child’s capacity to articulate needs, desires, fears and anxieties as well as the mechanisms for soothing and satisfying. This empathic soothing process enables children to express their needs and form healthy boundaries as adults. The ability to form boundaries and structure identity is consistent with the quality and quantity of interactions with parents and other significant adults. If a child experiences rejection after rejection each time a need or want is expressed to his parents, these impulses become “linked” to the pain of shame and rage. These empathic breaks stemming from rejected needs and wants develop into idealized beliefs that significant others “should” know our wants and needs as a defense against the fear of rejection.

Idealization and Devaluation

Two of the most powerful defenses that shame produce are idealization and devaluation. The intensity of idealized fantasies is directly proportional to the severity of isolation and loneliness that were experienced during infancy and childhood. In order to keep the rage and pain that shame generates safe and out of sight, the child concocts potent fantasies which operate as a defense against the deeper and more dangerous rage. Idealized childhood fantasies mature into romantic adult ideals that erupt into rage when these standards are not met.

Idealization pacifies the infant from the agony of isolation. When an infant is alone for too long, he may conjure an image of his mother to comfort him in her absence. This calming process is a normal developmental task and continues to evolve throughout life. However, if the infant experiences intense neglect, absence, or loss, he develops much more intense fantasies to ward off the fear of abandonment and rage. In this way the protective idealized fantasies not only comfort the infant, but also defend against expressing the rage which would result in causing the feared abandonment. The infant intuitively dreads that his mother will retreat even more if he dares to express his rage. This unconscious wish to fulfill the unrequited love continues in an abiding desire to complete what is incomplete, the acquiring of the fantasy mother in others, in order to vindicate the original loss. The shamed infant, having matured into an adult, will transfer this fantasy image to a love interest, child, or friend and will ultimately re-experience the original and inevitable disappointment. This causes the rage to break open from under the cover of idealization. His rage feels legitimate because his love object has failed to fulfill his redemptive fantasy. The regressed infant remains a force in the adult, amending reality without the person being fully aware that it is happening.

Children who experience neglect are in conflict about dependency needs. These needs can best be described as the natural desire to be nurtured, to belong, to be attached to a love object or a person who satisfies one’s needs. The best way to defend oneself against dependency needs is to devalue the importance of the other, or to devalue one’s own needs. By doing this, one is protected from needing anyone and therefore shielded form the possibility of humiliation or rejection. The defense against need can be accomplished in two ways: first, by devaluing the other for not living up to the ideal, and secondly, by making oneself grandiose and superior to the other. An adult whose parents were rejecting, uncaring and distant, will turn the tables and make himself superior to others, protecting himself from more of the same kind of treatment. The shame inside is so painful that devaluing others avoids the pain of feeling inferior.

Idealization begins as a means of coping with the pain of loneliness and progresses into such a fear of being rejected that the person is unable to make proper connections and through devaluation insures the very aloneness that they wish to be redeemed from. The end result is to remain emotionally desolate, languishing in the grandiosity of one’s own devaluations, either from envy or from the fear of dependency, ever searching in vain for the lost maternal care.

Summary

The inevitable consequence of the shame cycle is that instead of developing empathy or communication, it leaves in its wake, pain, fear, hatred, distrust and the certain death of love. Others are at the mercy of a violent act that they often do not understand. The conversion from shame to rage transpires in an instant, and cannot be understood until long after the raging ceases. Once the rage poison is dissipated and calm is restored, the perpetrator may feel tremendous sadness, remorse or guilt. So often these feelings come too late. If shame is the poison, then rage is its agent of dispersal, the transmitter of justice from messages that rage sends from the primal shame distortion. If rage is the symptom, then the pain of abuse is surely the cause. It is reasonable to assume that if violence, pain, and the paucity of empathy are the causes of shame and rage, then healthy, loving and empathic relationships are what cures. If knowing oneself is the key to personal understanding then it is clear that resistance to awareness must be overcome to become truly empathic and insightful.

Just as love binds us together, we know that hate drives us apart. Hate can be described as a constant state of rage. If health can be acquired through developing the balance of mental, emotional, physical and spiritual activities, then healing shame in the individual is the secret to finding a truly healthy emotional life. It seems that what ails humanity is “original shame” or the original sin of the shame wound which destroys the ability to feel compassion and empathy for all life forms. If we can heal the rage and shame that constricts our human potential and causes such destruction, perhaps we can obliterate this cancer of the soul. The most important element in the process of curing shame is to take responsibility for it. We need to see, look and understand how it effects our spirit and how we direct it at others. Gershon Kaufman writes:

Even though the aftermath of shame can be severe, the way to a self-affirming identity yet lies in the deeply human capacity to be fully restored, in the knowledge that one individual can restore the interpersonal bridge with another however late it may be and in the awareness that human relationships are reparable. Through such restoring of the bridge, shame is transcended. The significant other who was involved in the original shame-inducing experiences need not be the one who must restore the bridge. Someone new who later becomes significant, friend, colleague, or therapist, can become that person.

What Kaufman eloquently describes is true of shame. It is after all the dearth of human interaction that creates a shame wound. It would seem logical to assume that the cure for shame lies uniquely in the quality of our connections with others. If humiliation and neglect created the original wound then the cure would lie in empathy and love. The cure for shame is to finally unmask it and retrieve it from the jungle of the unconscious. If there is one factor that represents the most essential quality of human life, it is attachment. Loving attachments produce health. Rage is actualized from damaged attachments.

Importantly, there is a cure for shame, rage and the death of love. If a shamed person works to create attachments to healing people, brings the rage locked within the unconscious out into the light to be seen, looked at and understood, then what was once a system that operated on its own will be worked out. There will remain always a residue of pain because we cannot entirely separate ourselves from experience. To work out shame means that it will ultimately not interfere with our ability to form reliable and loving attachments.

The story of “Beauty and the Beast” well-illustrates the theme of this article. What was once a beast filled with rage becomes the prince when at last he is loved for whom he is inside. In this way we can all understand what makes us beautiful. It is after all love that forges beauty. It is compassion and acceptance that create health and heals the wounds of the soul created by shame and rage.

Important steps must be taken to discover what lies hidden inside us, to look into the origins of our pain, and to explore how, where, when and why the original wounding occurred. Then, and most important, we must learn to embrace our wounds. This embrace means that we keep the wound close to our hearts, and neutralize the poison. The antidote to shame is to become a support toward ourselves. To be an advocate toward the harsh voices from within will lead to a cure for shame. To actualize such a revolution takes time. We must learn to sense the hurt child inside, accept that something did happen to us, and respect our good intentions to process our pain, even if some of those methods do not seem to work at first. The secret to the cure for shame lies in our ability to relate to ourselves and others with compassion, respect, understanding, empathy and acceptance.

As long as we are unable to see or understand how our shame shape, shades our reality, distorting what we see, we will never be free of it. If we are able to reveal the beast within and expose ourselves to our deepest shame, we will ultimately come to understand how it affects what we see. Charles Van Den Berg writes that psychology is the “science of loneliness,” and surely what grows in the heart of the lonely child is shame and rage.

Finally, we must conclude that we need each other, not just for solace, companionship, love and caring, but for the insight that we share with one another. We cannot eliminate what we cannot see. It is through honest, accepting and nonjudgmental relationships that we are able to behold ourselves clearly and to lead each other from darkness. Only then can we allow the child to flow naturally into a fully actualized adult.

Find-a-Therapist Here

“Rage, Shame and the Death of Love” Copyright © 1998 William Cloke, Ph.D.

Posted by: Admin | October 20, 2009

Anxiety Disorders in Children: How Do They Manifest?

The human body is an amazing machine, providing exactly what you need at the very moment that you need it. When you exercise, your body produces sweat to cool itself off. When you need energy, you feel hungry, leading you to eat and supply the needed energy. Likewise, anxiety is a normal aspect of the human condition; it is a reaction to stress. It helps you cope with tense situations or remain focused for long periods of time. It also alerts you to danger in the environment. But when anxiety becomes an extreme irrational dread of everyday situations and begins to interfere significantly with normal functioning, it is no longer assistive and adaptive, but has become a debilitating disorder.

Anxiety disorders are among the most common emotional, mental, and behavioral problems to occur in young people. Today, four to five million children and adolescents have anxiety disorders that fall into a variety of categories. These include:

Separation Anxiety Disorder (SAD)

When a child is very young, a certain amount of separation anxiety is reasonable and expected. However, a child with SAD simply cannot be apart from a parent or home at all. In other words, this disorder is characterized by anxiety regarding separation from family that is excessive or inappropriate for the child’s age. In some children, spending the night at a friend’s house or going to summer camp would be totally out of the question; even just being alone can cause great distress. This fear sometimes focuses on the belief that something terrible will happen to the parent—even death—if the child is separated from that parent. SAD can become so extreme that the child is unable to attend school.

Generalized Anxiety Disorder (GAD)

The hallmark of GAD is excessive worry and clear physical symptoms of anxiety, such as sweaty palms and racing heart. Young people with this type of anxiety disorder worry a great deal about many things, including but not limited to, their grades, performance in sports, or even the need to be punctual. It is not unusual for them to experience health problems, such as nagging stomach aches or headaches, that have no medical basis but are caused by the physiological state of frequent anxiety.

Phobias

Phobias tend to develop in childhood. Whereas a child who is afraid of a snake is certainly not phobic, a child who is terrified of germs, harmless animals, or storms, probably is. A phobia is a fear of objects or situations that is so great, the child feels compelled to avoid them. Perhaps one of the most prevalent and damaging for young people is social phobia. Children and teens with social phobias are inordinately afraid of being judged, humiliated, or criticized. Just as an average person would back away from a live snake, an individual with social phobia begins avoiding others, especially in groups. This avoidant behavior drastically impedes social development, friendships, and dating.

Panic Disorder

At one time or another, most of us have said these words: “I was scared to death.” Unfortunately, when an individual experiences a panic attack, they often feel as if they are actually going to die. In such an attack, overwhelming fear is accompanied by sweating, an erratic heartbeat, dizziness, nausea, or extreme intestinal distress. For a child, perhaps the only thing more fearful than the actual panic episode, is the thought of it happening again. After experiencing a panic attack, a child goes to almost any length to avoid another one. This means they may refuse to go to school, or even refuse to leave the home.

Obsessive-Compulsive Disorder (OCD)

A child or adolescent with obsessive-compulsive disorder gets caught in a pattern of persistent thoughts or repeated behaviors, such as hand washing or counting or checking on something, like a locked door or window. As with adult OCD, the young person may fully recognize the pointlessness of the thoughts or action, but is unable to stop. A child may also begin to believe that she has magical control over things. For example, the child may believe that in order for her parents to remain safe, she must ask God 150 times everyday to protect her parents. The child believes absolutely that if she fails to do so, the parents will die. A difficulty with this type of skewed thought process is that it often seems to work. Everyday, the child prays, and everyday, her parents don’t die; therefore, the praying appears to work, and the child continues to do it.

Anxiety disorders are true illnesses; as such, treatment is usually required. If you have a child, or know of an adolescent girl who is struggling with anxiety, please get help before she, or her family, are crippled by the disorder.

Posted by: Admin | October 13, 2009

Why Do Relationships Fail?

As an outpatient psychologist, I have been in practice over twenty years. I see eight conditions every day and the one that stands out the most is “relationships.” This includes straight but also gay ones, and more often than not the longer-term variety. While short-term relationships present with their own specific problems, it is the longer-term relationship that is the focus of this article.

Relationships go through stages. Stage One is about novelty, fun, great sex, staying up all night and generally just doing things together. When we first get involved, it’s a big rush and lots of stimulation. If this blows up, we have had a short-term relationship. But what if “things” progress?

Stage Two is when there is commitment or “exclusivity.” Stage Three is usually about marriage or its equivalent. Stage Four is about separation or divorce if “things” go south. I’ve rushed through the stages because they are not the main point, here. But they do provide background to what happens when relationships fail, short-term or long-term.

In the beginning, the dynamic nature of the first few months of new relationships covers up our real selves. The “deep stuff,” as I like to call it, is who we really are, and this core set of experiences and values develop from our earliest experiences with significant others. Usually these folks are our parents, but in all circumstance, our caretakers bequeathed to us the values we espouse. Unfortunately, these proclivities do not come out in everyday activities, unless they are severe and/or profound. Instead, they lie in wait until the rush of the new relationship subsides.

When we get used to each other, the deep stuff can surface. This can but usually does not happen when there are the distractions of newness. But in Stage two, and even in the latter part of Stage One, and certainly by Stage Three, we know each other more than just as a new person to date. Our habits, patterns of behavior and other deep stuff emerge. We let our guards down and we “leak.”

Right about this time we start thinking whether or not we are compatible with our partner. If our unconscious patterns are adaptive and more  importantly, “jive” with our partner’s unconscious patterns, harmony is more likely to ensue. These people are “lucky” enough to be in a relationship with someone who is not only compatible with them on the surface, but also at deeper levels. Troubled couples do not have such luck.

When unconscious patterns collide, behavior changes from fun seeking to fighting, from good sex to bad or no sex, from approach to avoidance. Fixing such dynamics is the subject of many a marriage manual, including a new ebook just written by this author. But fixing such troubles requires more than simply pointing out maladaptive behavior, like yelling, failing to put away our socks, etc. It also requires digging a little into our past patterns, especially the unconscious ones about which we have little conscious awareness, unless prompted.

Prompting is what most couples start doing at this stage, and it does not always go well. Couples argue, usually about the yelling or the socks, but what is really contaminating the relationship is the crummy deep stuff working its way up to the surface; that is, increasingly playing out on the stage of daily experiences. These are the expectations or bad behavior patterns learned earlier in life, now projected onto our partners, more or less automatically. These can be quite bothersome and usually crescendo into not just arguments, but fights, or worse. This is why couples fail to communicate and relationships in general, fail. Couples fail to address the deep stuff, thinking that talking about the superficial issue(s) is sufficient. It is not.

To learn more about Dr. Steven Griggs and his practice please visit his online profile by clicking here.

When people get brief, structured, phone-based cognitive behavioral psychotherapy soon after starting on antidepressant medication, significant benefits may persist two years after their first session, with only modest rises in cost. Over two years, this treatment is cost-effective, according to a randomized trial in the October 2009 Archives of General Psychiatry.

“The most important reason to treat depression is to reduce suffering and improve daily functioning,” said Group Health psychiatrist Gregory E. Simon, MD, MPH, also a senior investigator at Group Health Research Institute (formerly called Group Health Center for Health Studies). “But our findings suggest that insurers or health care systems aiming to improve depression treatment in primary care should consider incorporating structured psychotherapy.”

The Journal of the American Medical Association (JAMA) reported earlier results from the same 600-person trial, the largest to date of psychotherapy by phone – and one of the largest studies of psychotherapy ever. 

Over two years, phone psychotherapy plus care management led to a gain of 46 depression-free days, with only a $397 increase in outpatient health care costs. The incremental net benefit of phone psychotherapy plus care management was positive, even if a day free of depression was valued as low as $9. 

By contrast, phone care management alone, with no phone psychotherapy, led to a gain of only 29 days free of depression, with a $676 rise in outpatient health care costs. The incremental net benefit of phone care management alone was negative, even if a day free of depression was valued up to $20. 

The trial enrolled 600 Group Health patients whose primary care doctors diagnosed their depression and (as is usual in primary care) prescribed their antidepressants without psychotherapy. 

The patients were randomly assigned to receive either:

  • Usual primary care
  • Phone care management: usual care plus a phone-based care-management program including three outreach calls from a bachelors-level clinician (assessing patients’ symptoms, antidepressant drug use, and side effects and referring to mental health specialty care if needed), with care coordination and feedback to the primary care doctor
  • Phone psychotherapy: usual care, plus phone care management, plus eight 30-40 minute sessions of structured cognitive-behavioral psychotherapy delivered by phone by a masters-level mental health clinician

The trial excluded people who were already seeing a therapist or intending to do so. The patients and mental health clinicians never met face to face, only over the phone. The mental health clinicians followed a structured protocol for psychotherapy. They encouraged the patients to identify and counter their negative thoughts (cognitive behavioral therapy), pursue activities they had enjoyed in the past (behavioral activation), and develop a plan to care for themselves. 

Few of the patients who received phone-based therapy - even fewer than those who did not receive it – sought in-person therapy. Phone-based therapy is more convenient and acceptable to patients than in-person psychotherapy, said Dr. Simon. 

Depression symptoms, including feeling discouraged and avoiding other people, can prevent people from seeking help, he added. Nationally, only about half of insured patients receiving depression treatment make any psychotherapy visit, and less than a third make four or more visits. By contrast, in this trial, three in four patients completed at least six phone therapy sessions. 

The National Institute of Mental Health funded the trial. The other authors were Evette J. Ludman, PhD, senior research associate, and Carolyn M. Rutter, PhD, senior investigator at Group Health Research Institute.

Posted by: Admin | October 9, 2009

Raise Up a Child

I like to think of parenting both in philosophical terms as well as practical “what to dos,” so my goal is to combine the two.

First, I would like you to think of what long-range goals you have for your children, rather than just what works for the moment. Also, think about separating your children from their behavior and make sure you give those expressions of love to the child while not condoning misbehavior. So often when we discipline children, we shame and guilt them rather than setting boundaries on their behavior. Our words cause confrontation rather than encourage cooperation. It is good to ask ourselves if what we are about to say to our child we would say to someone else’s child. Also, to ask ourselves, “If I talk to my friends the way I talk to my children, how many would I have left?”

What is discipline? The root word is “to disciple,” which means “to teach” or “to train.” Teaching and training in a respectful manner maintains the relationship with the child while setting limits and guarding precious self-esteem. We are to be role models for our children, showing them how to treat people with respect. We can’t expect them to be better than we are. We must model respect and then insist upon it. Notice that I didn’t say demand it. I don’t buy into the old adage that some of us were raised with that said, “Don’t do what I do, do what I say.” Neither do I believe that children should be allowed to run wild and rule the family. Where is the balance? It is in adults who act like adults and model respect, set clear limits, and give lots of love.

Parents frequently equate discipline with corporal punishment and automatically think they have to start spanking children when they are very young in order to “make them mind.” Also, parents will say that their parents spanked them and they turned out okay, so what’s wrong with it? Just because something works doesn’t mean it is desired.

I firmly believe that it is not only unnecessary to spank children, but that it is detrimental in several ways. First, parenting is not a role we play, it is a relationship process and hitting teaches children to fear the parent and breaks the strong attachment of love and bonding between them. Discipline is easier when the relationship is one bound by love. 

Hitting and spanking is shaming and often results in children feeling bad about themselves, particularly if they are sensitive. They may become passive if they don’t rebel. Some children will become rebellious and revengeful toward their parents out of their anger over the punishment and will do things to get even with them. A revenge cycle between parent and child is devastating to both. 

We want our children to develop self-discipline and self-control. Hitting is expedient and may stop the undesired behavior at the moment, but is an external form of control and does not help children develop self-regulation within. When hit the child often feels angry and resentful toward the parent, thus the energy is projected outward in the anger toward the parent instead of learning taking place from what has happened. 

Spanking does little more than to vent the anger of the parent. Usually the parent has lost control. Also, it models hitting when you are angry as the thing to do. Being hit tells children that it’s okay to hit people smaller than they are. The child may then think that it is okay for them to hit younger brothers and sisters and playmates. Studies show that the children who are hit the most are the most likely to purposely harm other people and things.

What about sparing the rod and spoiling the child? Actually, the shepherd’s rod referred to was used almost exclusively for guiding the sheep, not beating them. The shepherds would gently steer the sheep, especially the lambs, by simply holding the rod to block them from going in the wrong direction and then gently nudge them toward the right direction. It is also my understanding that the shepherd was careful not to hit the sheep for that could damage the wool or cause injury to the valuable animal. Aren’t our children too valuable to hit?

So what do we do when our children misbehave? We think in terms of limits and consequences. There are a number of things we can do in addition to the practical suggestions I described in my last article. I would like to begin with babies and toddlers. First, there is no reason to discipline an infant. The latest research shows that early spankings make for aggressive toddlers. This is a difficult age, as children are pre-verbal. I highly recommend the set of books by

Louise Bates Ames, and Frances L. Ilg, which has a book for each year of life up through age nine, when ages ten through thirteen are included together. The first one is Your One-Year-Old, Fun-Loving and Fussy, then Your Two-Year-Old, Terrible and Tender, etc. Each book discusses age-appropriate behavior and how to deal with undesirable behavior in a constructive way. More next time.

Written by: Jackie Pearson, LMFT
If you would like to learn more about Jackie Pearson please visit her online profile here.

Posted by: Admin | October 1, 2009

A Child Within Us Wants to Talk

Many of us have an “inner child” or an “inner younger part” who has not been heard, seen, or treated in a healthy nurturing way. As a result, whether it is an inner child, adolescent, or younger adult, feelings of being ignored, abandoned, or not loved may be retained. The memories of these unresolved feelings are carried into our adult life and often become buried in the subconscious. However, the “inner younger part” remains waiting to be found, to be listened to and to be nurtured, and keeps acting out in attempt to be discovered and attended to. 

Anna described having a deep sense of loneliness and depression. As she was searching for the answers to where these feelings originated, she used a visualization technique to contact her “inner child” and received an image of herself when she was nine years old. Her little girl was feeling lonely, bored, and sad while waiting in her room for her mother to arrive home from work. However, because her mother was wrapped up in her own worries and fatigue she had become blind to her daughter’s needs. During this time “little Anna” came to a few conclusions about herself, her parents, and the world around her. One conclusion was that she had to stay busy to distract herself from her pain. The other decision she made was to please her mother as much as she could in hope of getting attention and being loved in return. A pattern of having to please everyone and staying busy had been ingrained in her mind and remained with her to the current day. She eventually forgot where these habits came from. 

Anna decided to communicate with her “inner child” on a regular basis. Building a connection with her inner child took time and trust but after a while they both formed a beautiful relationship. Finally, little Anna was heard and was able to express herself. Although Anna’s childhood did not change, her habits and perceptions altered because she recognized that her habits were simply coping techniques that were formed in the past and had no functions anymore. As her relationship with herself improved, so did her feelings of lonesomeness, her relationships with others and the world around her changed in return. 

Depending on a child’s age, she or he does not always interpret their environment and parents’ actions correctly. When uniting with the inner child, false memories can be uncovered and give the child a chance to understand and make sense of something that was misunderstood in the past. For example, a pregnant mother told the story of her 4-year-old daughter Sophia who believed that she no longer was needed because her sister was going to be born in a few months. In a straightforward way Sophia claimed that it wouldn’t matter if she died. The surprised mother told Sophia that it would matter and that she is the best thing that ever happened to her. Her daughter replied “but you have Mikaela now”, to which the mother explained that Mikaela could never replace her and that she could love both of them. Children are not always able to make sense of their situation the way an adult can and therefore sometimes form beliefs that are not based on reality but their conceptual ability.  

Many leading authors such as John Bradshaw, Erika J. Chopich and Margaret Paul, Whitfield and 12 step programs have written about the importance of building a relationship with the “inner child” and found that it can help with many issues including loneliness, fears, depression and raising confidence. The journey of discovering younger parts within us can be surprising and awkward at first but may also be very rewarding.

Dr. Susanne Babbel, PH.D., LMFT is the founder of Integrative Trauma Therapy, a presenter, workshop leader, and author specializing in the area of trauma and post traumatic stress. If you would like further information please visit her profile at http://www.find-a-therapist.com/Provider/Susanne-Babbel.aspx.

As an outpatient child psychologist, I often am asked what are the most displeasing problems with kids. Here’s my list:

“Yelling, Doesn’t clean room, Doesn’t obey (defiance), Ignores me or Talks back, Disrespectful, Runs around too much (hyper), Lies, Verbally or otherwise manipulates, Whines, Critical of others, Plays too many electronic games, Poor grades, Destroys things, Physical fighting or is aggressive in general, Impulsivity, Noisy, Distractible, Curses, Lazy, Temper tantrums, Selfish, Dawdling, Isn’t trustworthy.”

Does that seem like too many things? These are general categories and there are a million “particulars” or variations on each theme. These represent about ninety percent of the complaints parents expound upon when they visit a  professional in this area.

So, what do we do with such a variety of concerns? The first thing is to recognize that these behaviors actually have a purpose (other than to destroy peace and quiet). Superficially, they may simply ground out tension, which feels good afterwards but not necessarily during the “episode.” Getting even is another “popular” reason to act out. It feels good to have others suffer, too. These behaviors may be designed to communicate something. Usually this is a “change it”  message, not obviously understood.

Kids do not usually have very good ways of communicating their feelings, wishes, etc., but they sure can act out with immediacy and intensity. Paradoxically, many children act out just to get parents to set some limits. Yes, that’s correct. Kids in point of fact need limits and will test caregivers to see where the parents set those limits. It is not particularly rational, but children need to know what territory is not dangerous and what is not. Setting a limit establishes this and doing so makes actually makes the child’s anxiety go down, even though the parent probably said, “No” to something (hence, the paradoxical part…). Young people will in reality act out to get the parent to set a limit. In general, these seemingly crummy behaviors may be the only way kids can tell parents that something needs adjusting. Our task as parents is to figure out what is the message.

How do we do that? A very vital aspect of children’s behavior is the feeling it expresses. One of the first things I teach children is a vocabulary of their feelings. I teach them what words go with what feelings. If they are very young, I use a chart that has sixteen feeling words. Above each feeling word is a face illustrating that specific feeling. Kids usually  cannot come up with a word to describe their feelings, but they right away can distinguish the right face. They point to it and I read the word. Bingo! They have an instant vocabulary (of one word) for that feeling. As I said, kids do not do this effortlessly, unless they have an exceptional parent that regularly verbalizes feelings. I rarely (almost never) see  parents do this.

Then I make it very gratifying for children to start using those words, out loud, in a sentence rather than cut up. For young kids, a Star Chart suffices. It’s entertaining fun and can be very creative, not to mention rewarding for the child. Kids get a star when they say the right word. Later, stars can be exchanged for prizes. Parents like it because it bonds the family and creates a sense of working together. Now there is a sense of family cooperation that is rewarded with each good behavior.

Older children (about eleven or older) are not as interested . They like video games or “screen time” (any electronic activity). Parents cannot treat them in the same regressive manner, but older kids still can be “shaped.” Older kids want gear. They want the latest designer clothes. They want to be taken to the mall. They want their own cell phones. They want later bedtimes and curfews. These are their versions of stars and parents can negotiate with older kids about
how many of these things they get in proportion to how much effective communication (vs. acting out) the parent gets.

Written by Dr. Steven Griggs

Posted by: Admin | September 29, 2009

The Power of “BEING YOU”

Giving too much of yourself and saying yes too often is something many people are accustomed to doing to avoid conflicts and feelings of guilt. A sincere desire to give is wonderful, however, there’s a distinction between giving of yourself and giving up yourself. Ignoring your own desires and views may not only deny “who you are” but, over time, may lead to resenting others, feeling fatigued or anxious, and experiencing stress induced physical symptoms.

The pattern of avoiding conflicts and pleasing others without considering your own needs is typical for someone who was not allowed to say no in his or her family – being criticized, yelled at, or abused in childhood. Bradshaw, an inner child specialist, adds that this pattern might also stem from not having been able to properly complete the toddler phase between 18 months to three years. While still feeling dependant, toddlers are trying to separate from their parents to explore their autonomy by opposing their parents. These interactions are often interpreted as power struggles by parents whose patience is pushed to the edge. If parents do not know how to model healthy ways to handle frustrations and set appropriate limits, children might not be able to test their power successfully. As a result they may end up having difficulty saying no to others or even asking for what they want without feeling great remorse or shame. As adults they might continue this particular pattern without knowing where their behavior originated.

One of the most helpful ways of gaining back a sense of “power of being you” is to spend time with your “inner child” that still needs to complete this toddler phase effectively. The best way to access your inner child is when you are still and quiet such as in a state of meditation or self-hypnosis. Before you start, set an intention of how you want to feel. Additionally, telling yourself that you are looking from the here and now is important so that you don’t regress during this exercise.  Also remember that you are not in the same situation you were during childhood. If going back to childhood memories brings up traumatic experiences, I would advise you to have the support of a psychotherapist.

When you are in a relaxed position, ask your inner child to come forward – the child that that holds the original pain of what you are currently struggling with. For example, if you want to resolve your issue of needing to stand up for yourself, you need to connect to the child that is linked to the time you learned not to stand up for yourself. Our subconscious holds “inner children” that are of various ages and therefore a different child may come forward at different times. With a little practice, connecting with your inner child becomes easier and you might receive an image, a sensation, or recall a scenario from your past where you were hurt or needed attention.

Once your inner child appears, do not push or force your inner child to do anything – just observe her and let him or her guide you for a while. Stay with it and notice what is happening as you pay attention. Even though you would think the child knows you, it needs to learn to trust and to get to know you. Often people are not sure what to do or say. Test out what your inner child responds to and value the child’s accomplishments. Say something nurturing and comforting like “I am here for you;” or “It is Okay to say no, to be mad or sad, and to explore;” and “I will make sure you don’t get hurt.” Be patient as all new skills require time and practice.

To help this process, try to gather information about each of your developmental stages and find out as much as you can about your childhood. Additionally, I encourage you to debrief your experience with someone that you can trust and who will support you. Once you have completed the toddler stage successfully, you can reclaim the power of being you and saying “yes” to your own desires and opinions. As you respect your own desires and boundaries and stop repressing them, you might experience increased energy, less anxiety, and less stress on your body. Even more, others have a chance to see who you really are and get to know you on a deeper level.

Dr. Susanne Babbel, PH.D., LMFT is the founder of Integrative Trauma Therapy, a presenter, workshop leader, and author specializing in the area of trauma and post traumatic stress. If you would like further information please visit her profile at http://www.find-a-therapist.com/Provider/Susanne-Babbel.aspx.

Older Posts »

Categories