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Tuesday 26 April 2011

Happiness: On the Merits of Deinspiration

For many of my presentations on happiness I show a photograph of an impressively fit and tanned young man, dressed in sparkling white pants and tank top, shot from beneath, leaping into a clear blue sky, arms outstretched and with a gleaming smile on his face.

Then I point out the truth.

Most of us will never be this age again, we will never be quite this fit, if we have any awareness of skin cancer we will never be this tanned, and we may never be able to pull off this outfit.  We certainly won’t be spending our lives leaping into the sky like this.  Sooner or later we’d turn an ankle and wouldn’t look nearly so sexy.

I invite the participants to imagine what this young model did next.  Went back to his book or video game, waiting for them to set up the next shot?  Had his hair and makeup retouched?  Got into his car and drove home?  Ate a sandwich, trying not to get food on the tank top?  Went to have a poop?

The truth is, none of us will ever live up to the standards of our culture.  There will always be someone younger, thinner, richer, more fit, more intelligent, more spontaneous, more fashionable, more immune to fashion, more ambitious, more spontaneous, more focused on the future, more focused on the present.

The values of our culture are inherently contradictory and cannot be fully embodied by any of us.

So no matter how hard we try to live up to those standards, we will fail.  And by trying, we make ourselves failures.  We create failure not by being who we are, but by judging it as not good enough and by striving to be something else:  a mythical beast.  The man in the photo.  The man who could embody the image for the split second of a still picture.

A friend of mine works for a fading industry plagued by cutbacks, declining revenues, and, in his company's case, bad management.  Rather than treat the staff like human beings, they have taken to putting up “inspirational” posters around the office on topics like Leadership, Teamwork, and Success.  Predictably, the staff snigger at these, and many of the posters have been defaced.

These visions of success have been beautifully parodied by, a website that offers beautifully rendered photographs accompanied by jarring and somewhat pessimistic slogans ("No single raindrop believes that it is to blame for the flood").  If Erik Erikson is right and humour is truly the most adaptive of defense mechanisms, then these are a beautiful corrective to the silly and alienating “inspirationalism” of the workplace.  Take a look.  Laugh.  And see if you don’t feel better than you do when looking at the bland aphorisms of the inspiration industry.

Not that we should put these posters up in our own clinics, mind you.

Thursday 21 April 2011

Tuesday April 26: PsychologySalon on Asserting Yourself

7 pm to 9 pm at UBC Robson Square, Room C400
April 26th will be the fourth Tuesday of the month, meaning it's time for another PsychologySalon talk.  This one is on effective communication strategies.
Assertiveness is supposed to be a great thing, but what IS it, exactly? What are the differences between the aggressive, passive, passive-aggressive, and assertive communication styles? What is the relationship between the stress response and assertiveness? How can we express ourselves clearly, simply, and kindly, in a way that others can hear us? How can we regain a measure of control over our own lives?  
We’ll discuss several situations in which we might want to be assertive, and we’ll focus on some specific tips for improving our style. Our emphasis will be on:
• Offering your opinion 
• Saying "No"
• Making requests
We’ll consider whether assertiveness is more about controlling other people or controlling ourselves, whether aggression and passivity have their uses, what happens when we first practice assertiveness with someone who is used to our passivity, and whether it all gets easier with time.

Tickets are $15 at the door, or online at

Tuesday 19 April 2011

The Short Term / Long Term Problem

When treating depression and anxiety it’s always worthwhile to ask “What do you do when you feel especially awful and you want to feel better right now?”

Most people will have at least a few answers.  Some of these are pretty good:  Call a supportive friend, get outside, try to get something done.

But usually there are some unproductive things too.  Close the curtains.  Go back to bed.  Take more antianxiety medication.  Call in sick.  Binge-eat.  Unplug the phone.

Novice therapists are often mystified by these behaviours.  Who ever thought that sitting alone in the dark would solve an anxiety problem?  Isn’t it obvious, after months and months, that this isn’t working?  Frustrated family members sometimes arrive at what seems like the only possible explanation.  “You must like feeling this way.”

But even as the thought occurs to them, they know it’s wrong.  No one likes to be anxious or depressed.  So why do they do these things?  The answer is quite simple.

They work.

If you’re afraid of dogs and you want to feel better, it’s easy.  Just avoid places where you might run into dogs.  If you’re depressed and coping with the world overwhelms you, then stay home.

The problem is this:  Almost everything that an anxious or depressed person feels tempted to do when they feel especially uncomfortable will help them to feel a bit better in the short run, but has the cost of making them feel worse in the long run.

When people go to therapy, they know quite well that the therapist is not going to advise them to sit more often in the dark, or avoid dogs at all costs.  They know that therapy is going to involve turning around and doing the opposite.

Of course, any therapy that advises a depressed person to fill their schedule, exercise three times a day, socialize all evening, eat a perfectly balanced diet, adopt a rigidly healthy sleep schedule, and take on three hobbies is doomed to failure.  “Just go to the dog park and let all the dogs jump on you for three hours” is not going to work because it is never going to happen.  When therapists get the dreaded “Yes, but…” the problem is usually not the client’s personality but the therapist’s pushiness.

But therapy will usually involve taking note of our unhelpful temptations and gently, gradually doing the opposite.  You’re a bit oversensitive to light, so open the curtains.  You have no energy, so go for a short walk.  You fear dogs, so look at dog pictures on the internet.

Therapy, then, is inherently a pain in the butt.  The job will almost always be to make ourselves slightly more uncomfortable in the short run in order to feel less uncomfortable in the long run.

This is the short term / long term problem.  The question is not “Do you want to feel better?” but “When do you want to feel better, and how much?”

This is not just true in therapy, but in life in general.  On a daily basis we are faced with situations in which we have to make a choice between momentary relief and more lasting  happiness.  If we feel stuck, or if our behaviour seems self-destructive, we can ask ourselves “What am I doing to make myself feel better right now, and is this contributing to the problem?”

Tuesday 12 April 2011

Following the Other Path

Human beings have dozens of ways to increase their level of misery.  One of these is regret.  In essence, the person casts their mind back to a decision point at some time in the past, a moment when they could have chosen another path into the future, and made what seems to them to be the wrong choice.

The interesting thing about regret is how often the individual stuck with it seems to oscillate on the moment of the decision.  “I could have said no, but I said yes.”  But of course there are many moments that they could focus on:  the time of the decision and all the moments since.

I’ve often been tempted to remind someone that the decision they regret is long past, and that they do not own a time machine.  They cannot go back and make the other decision, no matter how much they think about it.  The past is utterly beyond their control.  The present and future, on the other hand, CAN be controlled – at least to a degree.  It makes sense to refocus on the present, and to use regret at a past decision as an impetus to think carefully about the decisions yet to be made.

This may make sense, but it seldom works as well as I would like.

The person is stuck on the regret, and a vague feeling that had they chosen the other fork in the road things would have been much better.  The hint about where a therapist can productively go lies in the fuzzy, idealized vision of the alternate path they sense.  They use the regret as a way of berating themselves, but do not carefully examine the path they wish they had taken.

In therapy, we can set aside the fact that the decision is over and done, and cannot be undone.  We can ask “What if?”  What if you really had made the other choice?  What would have happened?

Usually we get an answer that reflects a belief in a kind of heaven on Earth.  “It would have been wonderful.”  “My life would be so much better.”  But we don’t spontaneously get details.  So we can press for the full picture.  “So let’s imagine that you really did decide to stay with him.  Tell me how you think that first week would have gone…. What about the following year?…And the years since?...And where would you be now?”

Sometimes the overidealization continues, and eventually becomes so transparent that the person sees it.  “Sounds a bit exaggerated, doesn’t it?”  Their faith in the purity of the unchosen path begins to crack, just a little.

Sometimes the person follows the timeline and realizes that contentment was never going to be the destination.  “He’d cheated on me twice.  I guess that in the ensuing 20 years he’d do it again.  And probably again.  And eventually I’d be faced with the same decision I made 20 years ago.”

A gay man regretted not coming out earlier, and wasting much of his youth alone.  But when he examined the situation closely he realized he would have become sexually active around the time that the AIDS crisis was beginning, before it was really understood and before the present treatment options existed.  He knew himself and how he would likely have been if he had come out.  “Like a kid in a candy shop.”  The result may have been that he would not have lived through the decade.  Perhaps not; perhaps he would have been more fortunate.  But the possibility allowed him to let go of some of the regret.  “On balance, I’d choose the loneliness of those years, knowing that the result was that I’ve lived longer than some of my friends.”

All fantasies about the path not taken are just that: fantasies.  We don’t really know.  If you had gone off with Frank, perhaps you’d have been killed in an air crash the following month. But you DO know that you wouldn’t have taken the path you did – for better and for worse.  We can invite the client to reflect on whether there is anything on the path that they chose that they would not have wanted to miss.  If he had not married so young, he might have had a more adventurous youth – but it would mean never having met the daughter he now cherishes.  “So the genie appears, David, and he gives you the option.  You can go back and take the other path, but the price is your daughter.”

Sometimes, of course, the regret is perfectly reasonable.  We let a friend drive home drunk and she was paralyzed in an accident.  We allowed a child out on a rowboat alone and they drowned.  In the alternate future the friend would be able to walk and the child would be alive.  Here, the strategy of taking the other path might not work.  But it’s possible to be surprised.  Canadian Rick Hansen, who powered his wheelchair around the world and subsequently founded an important Spinal Cord Injury research institute, has said in interviews that some of the positive things in his life came his way precisely as a result of his injuries.

Where this type of conclusion is unlikely, the shift is from outcome to intent.  “What was your intention in teaching Andre to row?”  Often the intention was entirely honourable and appropriate.  “I thought he should learn responsibility, and that he needed confidence.  I made sure he had his life jacket on, no matter how much he hated it.  It never occurred to me that the moment he got round the point he would take it off.  My intention was to give him a better life, not for him to lose it.”  At this point we can encourage the client to honour the intention, and to mourn (really mourn) the outcome.

Friday 8 April 2011

Life Problems? We have a pill for that.

Another repost of a video courtesy of a member of the BCPA form.  Thank you Eric.

I should note that although I have seen many people who benefit from medications, I have also seen the result of treatment approaches like the one in the video.

Tuesday 5 April 2011

Disillusionment as a Goal for Therapy

How did the word “disillusionment” come to have such a negative connotation?

The literal meaning is to lose one’s illusions – to come into closer contact with and awareness of reality.  This is the function of much of psychotherapy:  to get over the happy myths that we tell ourselves to defend against uncomfortable but nonetheless essential realities.

Irvin Yalom titled one of his books “Love’s Executioner.”  On occasion, I have handed the book to a client and given them a quiz question.  “Why do you think he called it that?  Without looking at the book, who do you think might be Love’s Executioner?”

The answer, of course, is Yalom.  The therapist.  Romantic love is, as he and countless others have pointed out, a kind of madness.  A delusion.  The case that provides the book its name is one in which a client has fallen “madly” in love and it is in part the function of the therapy to bring her back to earth.

It’s not the therapist’s job to rain on every parade.  Most of us can remember the heady excitement of falling in love, and at least some of the time it has done us no harm.  In fact, sometimes the invigorating rush of a fresh projection can help people to make genuine – and positive – changes in their lives.

But every now and then we’re called to point out to someone that they are running toward a familiar cliff.  “It’s interesting:  You use the same words to describe this new man as you did with your abusive ex.  I wonder if they might be similar in other ways…”

A person I saw several years ago had seized with great interest upon a revenue scheme that he felt was sure to solve all of his problems.  I happened to know something about the area, but felt torn.  If he committed to the project it might pull him forward into other positive change.  But his ideas about the revenue opportunities were clearly mistaken.  On the other hand, people do sometimes “hit the jackpot” with questionable ideas – how was I to know?  And if I burst his bubble with some cautionary information, would I so damage our relationship that we would accomplish nothing else?

In the end, I shared my understanding of the field with him, along with my concerns.  He felt deflated, but returned shortly thereafter with a new plan that built on his past successes.  It was a bit less thrilling than the vision he had originally outlined, but wouldn’t bankrupt him if it failed and he wouldn’t waste a year of his life trying.  We discussed the issue as I strived not to push the decision I would make if I were in his shoes.  He arrived at the idea of starting out with the “surer thing” and collecting more information about the viability of his original idea.  As he learned more, the scheme crept into his discussion less and less.

I had, in effect, disillusioned him.  I think he would have preferred in the moment that I cheerlead for him, touting the likelihood of his success.  But I would have been flagging him onward, over a cliff.

Disillusionment is seldom fun.  But it is sometimes part of the job.

Friday 1 April 2011

So you want to be a clinical psychologist...

I am regularly called by undergraduates and asked for advice about becoming a clinical psychologist.  “Is it a good career?” they ask.  “How do I get in?”

Often people are a bit too starry-eyed about the profession.  They look at the fees we charge (almost as high as veterinarians!), and imagine being paid millions just to sit and dispense advice.

Recently a colleague on a listserve I subscribe to posted a link to this short video (thanks Alison M).  Though the psychologist being consulted is perhaps a bit more jaded than she needs to be, I like it.  

Let this be a warning to you, grasshopper.

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Want more information on operating a private psychotherapy practice? 

Check out my book Private Practice Made Simple.  It contains information on starting a practice, creating a space, designing a website, getting referrals, managing finances, avoiding burnout, and much more.

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