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Jumat, 16 Juni 2017

Panic focused psychodynamic psychotherapy hard to say but may make life easier



Having panic attacks? Looking for an alternative to talk therapy or cognitive-behavioral therapy (CBT)? You might consider panic-focused psychodynamic psychotherapy (PFPP), a 24-week course of therapy that's kind of a psychological exposure therapy, helping the patient explore and manage the hidden psychological conflicts that are contributing to their panic. From the link:
The treatment is divided into 3 phases. In the initial phase, the therapist focuses on identifying the meaning and content of panic symptoms, derived from exploring the circumstances, stressors, and feelings surrounding panic onset. Elucidation of a developmental history, including previous panic episodes, helps determine early life experiences and self and object representations that may play an active part in panic. The initial phase aims at relief of panic symptoms.

In the second phase, the therapist works with the patient to identify core conflicts underlying panic disorder. Conflicts surrounding anger and autonomy, as well as other contributing dynamics, are brought to the patient's attention. Defense mechanisms, including reaction formation, undoing, and denial, are addressed as efforts—often unconscious—to avoid facing emotional contributions to panic symptoms. Emergence of the transference allows for exploration of these conflicts and defenses in the relationship between therapist and patient. This phase focuses on addressing vulnerability to panic and relapse.
In the third (termination) phase, mixed feelings surrounding anger, autonomy, and separation are addressed as they emerge in ending the therapeutic relationship. The therapist helps the patient articulate feelings about the loss of the therapist, allowing for further recognition of conflicts and a reduced risk of panic recurrence. Increased assertiveness, encouraged by this patient-directed approach, and an increased sense of safety in being more able to tolerate mixed feelings, helps improve psychosocial function.

Kamis, 30 Maret 2017

Do the Opposite of Your Parents but Get the Same Results



"Letters, we get letters
We get lots and lots of letters"




On my post of October 5, 2011, I tried my hand at writing a newspaper advice column.  As I occasionally get interesting queries in comments on my blogs or as e-mails, I figured it was time to try once again.  I'm sure I will get absolutely no invitations from any newspaper to write a regular column just like the last time, but what the hay?

A reader asked a very important question after reading my Psychology Today blog post, a version of which has also appeared on this blog, Does One Need to Forgive Abusive Parents to Heal?  With the writer's  permission, her question and my answer will be reproduced shortly.



The exchange mentions what I consider to be an extremely important issue – something I have also briefly discussed in previous posts:  the phenomenon of parents who were themselves abused as children making such an extreme effort to be and act nothing like their own parents that they go to the opposite extreme. They over-indulge and over-protect their children to the point where the children are smothered.  

The children are then induced to refuse to grow up and become independent, because they believe that their parents have a pathological need to control, manipulate, and/or take care of them.  They may appear to be incapable of doing many things for themselves which they are, in point of fact, quite capable of doing.  They just will not do so for the reason I just quoted.  It is a lot easier to fake incompetence than it is to fake competence.

This is an illustration and an example of a principle I discussed in my very first book, A Family Systems Approach to Individual Psychotherapy, that I call the Principle of Opposite Behaviors.   I will explain that in more detail after I present the letter and my response:

Thank you for your article. There is one point that you have not mentioned in your article and that is - beyond the forgiveness, how does a victim of childhood abuse go on in life?

I am in my mid thirties and I was physically, emotionally and verbally abused by both my parents. Strangely enough, they were also loving, kind and encouraged me and my sister to do our best. On the one hand I was taught I could achieve anything I wanted and on the other hand I felt like I was barely human and did not deserve to take up any space. I grew up to be relatively successful but I continue to be plagued by severe self doubts, lack of self confidence and self sabotage. I thought about suicide several times in my teens and twenties. In my late twenties I met the man who became my husband and he has helped restore me to being what I could have been if I came from a healthy home. However, I continue to find life difficult and struggle to be happy. 

My parents, especially my father, have changed completely since I left home in my late teens. They are now the kind of parents one can only dream about, and have supported and encouraged me in every way possible throughout my adulthood to date. They have helped me financially, emotionally and physically. They have said they regret the way they treated me and want to make amends. Whenever I do meet them now, we have a great time together.

The trouble is that I recently gave birth to a child. And when I hear their advice about taking good care of him and not letting him be sad, I can't help but remember how badly they treated me when I was a small child. Where was the consideration and empathy then?

My point and my question are as follows. If one reconciles with previously abusive parents who are now repentant, how should one act when one continues to suffer the effects of childhood trauma on a daily basis?

Should I talk to my parents and tell them how their actions have damaged me and continue to hurt me? Should I call out their hypocrisy regarding their advice about raising my kid?

How do I go on?

Hi Wondering,

That's a good question, but I am afraid I cannot really give specific psychiatric advice to you without seeing you and finding out a whole lot more about your situation.

I can say that it sounds, just from what you wrote and not knowing more, that you are well on the way to recovery. Having children and not repeating family patterns that have been passed from one generation to the next is, however, always a challenge.

Someone like you will probably benefit enormously and fairly quickly from seeing a knowledgeable therapist. So what kind of therapist?

If someone like you is still sort of torturing themselves with negative thoughts, there are in most cases two possibilities:

1. The person is still getting double messages from one's family of origin about something - say, about being a good parent - and the person is trying to satisfy both ends of a double bind. In my hypothetical case, the parents might feel even worse about themselves if their child manages to raise children well.

In that case, I'd recommend looking for the kind of therapist that I described near the end of my previous post, Finding a Good Psychotherapist.

2. The person has obsessive tendencies and cannot seem to stop replaying old "tapes" of internalized dialog from when they were a child, despite the fact that the family of origin has stopped reinforcing (that is, feeding into) them.

In this case, a good CBT therapist (which is much easier to find than the other type), can help teach you ways to ignore the "tapes" even if they keep playing. Particularly, something called Acceptance and Commitment Therapy" (ACT), can teach you that you don't have to believe everything that you think.

I do want to make one more point about your post. Of course, you do not want to MAKE your child sad, but it is a HUGE parenting mistake to try to protect your child from all sadness. Doing this will lead the child to act as if he or she is grossly impaired in their ability to tolerate any adversity. They will have great difficulty with autonomy, up to the point where they may become completely crippled.

Parents who were abused themselves have a tendency to try to go to this opposite extreme, and end up creating almost the exact same problem for their child that they had! I call this the principle of opposites. Certain patterns of behavior, and what seem to be patterns at the complete opposite extreme, end up creating a nearly identical problem.

Anyway, I hope that's helpful. I wish you the best in your efforts to differentiate yourself from your family of origin.

The paragraph about parenting mistakes just above is the one that refers to the principle of opposite behaviors: The use of extreme or polarized behavior (a list of behavioral polarities can be found on my post of 8/24/10, Polar Exploration) can produce the same end result as behavior at the exact opposite extreme.

In this case, abusing children can impair a child's independence, but so can overprotecting them.  Opposite behaviors leading to the same end result (or what I call the net effect of the behavior).  


I gave another example of two opposite behaviors leading to an identical outcome in my post of 8/20/10, Final Destination: the Net Effect of Behavior.

The principle of opposite behaviors is one reason why different generations of members of a particular family may seem to alternate between opposites on a genogram.  A generation of alcoholics can produce a generation of teetotalers which in turn produces a generation of alcoholics, or a generation of nose-to-the-grindstone working types can generate children who are more hedonistic and irresponsible, who in turn generate children who are workaholics.  This is one of the mechanisms by which dysfunctional behavior is transmitted from one generation to another. 

Selasa, 21 Februari 2017

Panic attack but can breathe


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