Life As A Table! Huh?

Don't panic. It is a metaphor, of course. A table usually has four legs. So does my life, at least as I am envisioning it this morning. Okay, maybe tomorrow it will be an umbrella, but today it's a table.

I have a strong sense of the physical; not that I'm a great athlete. In fact I have some arthritis in my knees and ankles. But that doesn't stop me from working out at the gym, or riding my motorcycle, or enjoying sex.

The Spiritual leg is also important. People associate various words with this leg. Some folk talk about "God", others envision a god who sits up in "heaven". There are many names, "Allah", "Gaia", "Paresha", "Shang Ti", etc. But it is not the name, the word, that is important, it is the experience of The Sacred. William James, who wrote the great The Varieties of Religious Experience (Note: not The Varieties of Religions) referred to "The More". Today and for me, a belief in a theistic "god", somewhere out there, is no longer tenable. But there is still something more and something Sacred that I experience in life, in the presence of death and, as much of a cliche as it may be, yes, on looking out at the vistas of Yosemite.

The emotions hold sway over our lives much more than most of us are aware. We learn anger, disgust, joy, and sadness as children. They control much of our existence and interaction with others and the world as a whole. Of course, we recognize our emotions on occasion, but most people live and react with them outside awareness most of the time. Others may recognize Mary's pain far earlier than Mary does. John functions coolly all day at his work, but then lashes out at the cat (Or worse, his wife or children) when he comes home. If someone asks, "John, why are you angry?" The reply may be "What? I'm not angry, the cat was just in the way."

A fourth leg of the table is the cognitive or intellectual. It takes various forms. For some it is directed and instrumental. Much of their cognitive function is "in order to." They need to fix the computer or a broken chair. Some are trying to solve a puzzle, whether Sudoku or space travel. Other's intellectual or cognitive inclination is simply to learn. They are curious about the cosmos, the great unified theory, or--as I tend to be--why people behave, feel and think as they do. My tendency is to want to know everything. (In fact my life motif is "I want to know everything about everything before I die." You needn't remind me of the impossibility of this.)

These table legs are all necessary to having a satisfying life. Most of us have known someone whose legs were unequal, unbalanced. We have all had the experience, in a restaurant, of sitting at a table whose legs were not equal. The table rocks and the coffee or water spills. The same thing happens with the table of life. Our lives can't be "the best that they can be" if they are unbalanced. Worse yet, at some point if one leg is even shorter, the cup will fall off the table, break and spill coffee all over the floor.

Of course in our life table, the legs are all connected by . . . connections. (I can only push the metaphor so far.) Our emotions control our physical, spiritual and intellectual aspects. In turn, cognitive activity controls our emotions. One of the great psychotherapy breakthroughs has been the discovery that emotions are largely learned (cognitive) and that they can be relearned; that we have automatic thoughts and habitual emotional states. It is as though parents teach their children how to feel. "In our family, when we are frustrated, we get angry. That's the Smith family way," or "We are Johnsons. When life is hard, we get sad." It works with the other legs too. Some people think better when they are working hard on the treadmill. Our behavior also controls our emotions and, obviously, our emotions control our behavior.

So what? I've been sitting here for a couple minutes and can't decide how to end this post. The best final message for today is to remind myself to keep my table well balanced and to work at becoming more aware of the legs.

Psychotherapy and Its Discontents, Part 2

I'm always amazed that people pay "therapists" for whatever it is that they do. If I had a pain in my hip and went to a doctor who said that the pain came from my stomach upset, I might be a bit skeptical. If the doctor explained that this was because I was drinking too much coffee and this was triggering nerve endings that ended in my hip, I would begin to look for the evidence--especially if I was a tea-drinker. At the very least I would find another doctor for a second opinion. Now, if the second doctor explained that the real cause was that I had a hidden desire to feel pain but he could give me a pill. . . I would now, maybe, try a third doctor who might offer still a third explanation.

This scenario would certainly trigger some major questions and force me to try to find some logical and scientific support for what these doctors had said. Finding none, would I now return to any one of them? Not a chance.

That is about what a "normal" client faces when approaching the therapy options (Despite my previously expressed objections to the word "therapy" I will use it because it is in common use and my Quixote syndrome has its limits.) for help handling the usual daily problems of life.

There are an almost infinite range of therapy theories, few of them with any real rigorous research behind them. With few exceptions, these theories are based on "clinical research." This most often translates to "Well. . . I've had three of my clients with this problem and I did [whatever the therapist's favorite thing] and they were happy and left after 20 sessions." Or, at best, the research is mono-modal without any control group(s), longitudinal studies, independent verification, or replications.

Of course, like all social sciences, it is much more difficult to create good research, than it is with physics or fluid dynamics. One cannot deny help to half the population. Still some real effort needs to be devoted to making sure that whatever we do really has some long-term positive effect.

That's the bad side. The positive view is all the research has shown that just deciding to deal with an emotional problem has a positive effect. So maybe we should invent "Intention Therapy" where we help people develop the intention to find help. We could even talk knowledgeably about "IT" ( (;-) --which means a winking big grin).

Beyond IT, are there real therapies that seem to be more effective than others? Yes there are. The best proven therapies belong to a group known as Cognitive Behavior Therapy. Some of these are Rational Emotive Therapy, Cognitive Therapy and Dialectic Behavioral Therapy. In over 400 major studies these have been shown to be effective for many psychological problems including anxiety disorders, depression, phobias, eating disorders. DBT is, at this point, the only demonstrated therapy effective with Borderline Personality Disorder. Cognitive Behavior Therapy is available from certified members of the National Association of Cognitive Behavior Therapists, some of whom are also trained to use hypnotherapy as an adjunct.

In the 1960's, a very powerful tool was developed to work with couples and other social groups. Transactional Analysis is rarely encountered in the popular psychology literature anymore but there are still some practitioners. TA focused on the interaction between people. The structure of thought and behavior was schematically described as Parent, Adult and Child. Interactions then could be seen as taking place between the Parent of one person speaking to the Child of another (Or from and to any of the parts.)

The results of TA were generally very good. The weakness came when therapists began believing that the metaphor of PAC was a reality. This led to debates and discussions which sounded like "How many angels can dance on the head of a pin."

In the '70s, Transactional Analysis fell victim to caricature as the media latched on to "I'm OK, You're OK" and created jokes based on this and other TA phrases. It was dismissed as "pop psychology". It was, never-the-less, a very effective mode of therapy and, combined with some of the techniques developed by Gestalt therapists, can make a real improvement in the interactions between people--especially marital couples. More information about TA is available from the USA Transactional Association and the International Transactional Analysis Association.

Other effective options for marital therapy include Emotionally Focused Therapy (The EFT acronym is also used by the Emotional Freedom Techniques "feel good method". This latter does not have the strong research that is, for me, an absolute requirement.) and another that doesn't have a handy 2-3 letter acronym. The work of therapists trained by the Gottman Institute in Seattle is far superior to most other options. The Gottman methods are based on a 35 year longitudinal research program of actual video recordings of thousands of real couple interactions correlated with how the relationships flourished.

Are there other good therapies? Of course, but they are far outnumbered by the "feel-good" therapies and the therapists who call themselves "eclectic." When someone says they are eclectic or "multi-modal" my hunch is that they really don't have any idea what they are doing that really works. It just means something like, "I do a lot of different things and eventually sometimes the client seems to feel better. If they don't it's because they really didn't want to. They enjoy their disfunction too much."

More in the third section.

Ciao, David