The Masks We Wear

Issues this post seeks to address:

  • How can hiding our perceived flaws make them even bigger problems?
  • What are some ways to be more vulnerable, even in casual relationships?

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Socializing as a Missionary

When I was 19 years old, I decided to serve a religious mission for my church. In the LDS faith, when you serve a mission, you agree to go essentially anywhere missionaries go. Whether you’re called to go to Osaka or Omaha, you’ll spend the next 18-24 months immersed in the language and culture of the people you serve. I ended up going to southern Chile, at the bottom of South America.

For many young people who serve missions, it’s a transformative experience. They can be simultaneously fun and challenging; discouraging and meaningful, novel and rote. Perhaps only parenting young children rivals my mission in how appropriately I can apply the first line of A Tale of Two Cities: “It was the best of times, it was the worst of times…” Continue reading “The Masks We Wear”

Enabling Problems

Issues this post seeks to address:

  • What does ‘enabling’ mean?
  • How can efforts we make to cause change maintain the status quo?

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Enabling Dissention

A few days ago, the New York Times published an anonymous opinion piece, written by an unnamed “senior official” in U.S. president Donald Trump’s administration. The title of the piece is, “I Am Part of the Resistance Inside the Trump Administration.” The author describes a growing contingent of dissatisfied officials within Trump’s own administration, who are ostensibly working from the inside to thwart elements of the president’s agenda. The identity of the author has been kept secret, though theories abound about who the most likely culprits.

The opinion article describes these administrators who are seeking to undermine President Trump’s influence as “unsung heroes.” The author seems to count themselves among these heroes, whose moderating influence on the president’s decisions has purportedly spared the nation from some of his more ill-conceived ideas. Continue reading “Enabling Problems”

Five Tips for College Student Success

Issues this post seeks to address:

  • What are some ways I can help my student/myself be more successful in college?

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This coming week, tens of thousands of students will descend upon the campus I work at, laying waste to the relative tranquility that tenuously came over the summer months. I’ve gotten used to the transition by now, but it still feels like getting ready for something big – like the eerie, green skies I’d see as a kid in Texas before a tornado formed.

At my work, the “tornado” comes in the form of a whirlwind of students who come pouring in to the counseling center, seeking help for their personal problems. While I’m a big advocate of therapy and seeking help for personal problems, I sometimes wish that I could implant a few ideas in each student’s mind, to help shield them from undue stress. After all, prevention is almost always better than intervention, and putting a few, basic actions into practice can have a tremendous impact on a student’s functioning. Continue reading “Five Tips for College Student Success”

Developing Self-Compassion

Issues this post seeks to address:

  • What is self-compassion?
  • How does practicing self-compassion reduce guilt?

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Internalized Guilt

I once had a Catholic friend tell me about something called “Catholic guilt.” It refers to a persistent feeling of guilt and remorse for having done something wrong. The perceived offense may real or imagined, easily identified or unidentifiable. “Catholic guilt” is a popular enough concept that it’s made its way into common vernacular, though research on the actual degree of guilt Catholics experience as compared to others has had mixed results.

I don’t know whether Catholic guilt is “real” or not; it wouldn’t be difficult to imagine that stricter internalized moral codes could be associated with more feelings of guilt, since there would be more opportunities to violate some aspect of that code. As with many western, Christian religions, the belief in the relative inadequacy of humankind to God promotes the idea of needing to be “better.” The drive for self-improvement, self-control, and discipline are virtues that improve a person’s moral standing, and makes them “better” than they would otherwise be. Continue reading “Developing Self-Compassion”

The Benefits of Mindfulness

Issues this post seeks to address:

  • What does it mean to be mindful?
  • What are some benefits to practicing mindfulness?

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Buddhist Roots

My 10th and 11th grade teachers would probably describe me as an unenthusiastic learner, at best; some of them might think I was just plain disinterested in school. Truth be told, I was pretty comfortable in school, and I found ways to get by with a minimal amount of effort. My ambivalence about school was perhaps most apparent in my English class. I once got a ‘B’ on a test about the novel Ethan Frome after reading the back of the book in the minutes prior to class – I felt proud of that accomplishment back then, but maybe a little more conflicted today.

At one point in 10th grade, my English teacher assigned the the class to read the book, Siddartha. It was my first exposure to Buddhist philosophy of any significance, and I found it fascinating. The tenets of the philosophy were pretty different from the European Christian philosophy I was accustomed to – they offered a very distinct way of looking at spirituality. Wisdom through asceticism; the quest for Enlightenment; the existence of the dialectic – statements that are simultaneously opposite and true. I enjoyed thinking about these ideas that were unordinary to me. Continue reading “The Benefits of Mindfulness”

Medication and Mental Illness

Issues this post seeks to address:

  • What role does medication have in treating mental illness?
  • Why does combining medication and therapy produce the best outcomes?

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Therapy vs. Medication

I’ve mentioned in one of my other posts that I’ve never taken psychotropic medication. I’ve considered it from time to time to help with my anxiety, but I’ve always ended up coming to the conclusion that my anxiety isn’t that bad – I probably don’t “need it.”

I count myself privileged to have never had to take these types of medications in order to function. I’ve worked with dozens, if not hundreds of people who have, and while most have had positive experiences, it’s been a journey to find the right medication and right dose in almost every case. Some people find that they experience debilitating side effects when they try medication; others don’t end up feeling less depressed or anxious at first. Finding a prescription that works well often takes patience, endurance, and trust in a sometimes too-long process.

Continue reading “Medication and Mental Illness”

The Gray Area – the Value of Nuance

Issues this post seeks to address:

  • What does “splitting” mean?
  • What advantages are there to having a nuanced understanding of personal problems?

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Splitting

The DSM (the diagnostic tool for mental disorders) has 20 categories of disorders; therapists who identify as “generalists,” like myself, will work with clients whose mental illness falls into almost any of these categories. However, one category of disorders has gained a reputation among therapists as being a particularly difficult one to work with – personality disorders.

One characteristic shared among several personality disorders, which has contributed to many-a-therapist’s headache, is called splitting. “Splitting” is a tendency to see the world in “black and white,” or “all-or-nothing” terms. You’re either my best friend or my worst enemy. I’m either amazingly fantastic or a complete and utter failure. It’s conceptualized as a defense mechanism – something that reduces short-term distress at the expense of long-term disruptions in functioning.

Splitting is similar to a train track – There are only two directions to go, and you eventually end up at the end of the line in one direction.

Continue reading “The Gray Area – the Value of Nuance”

Internalization

Issues this post seeks to address:

  • Why is it sometimes hard to do things that I know are good for me?
  • What does it mean to ‘internalize’ a thought or belief?

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The Competing Self

One of the most interesting and maddening things about being a psychologist is that there’s often a disconnect between personal and professional life. As a professional, I can to use my training and education to understand my clients’ problems, and help them work through them. As a person, when it comes to my own problems, it’s much, much harder to find solutions that make sense. There are always seemingly good reasons for keeping the status quo, even though I push my clients toward change in their lives on a daily basis.

Sometimes, I have to put on my “therapist hat” to figure out what to do when I have a problem. I’ll say, “OK, if I had a client who was saying x… what kinds of changes would help them with their problem?” For some reason, when I “externalize” the problem, it’s often easier to find a solution. Of course, I then run into my own defenses that have created the status quo in my life, which seem so much more legitimate than my clients’ defenses.

Continue reading “Internalization”

Will and the Subconscious

Issues this post seeks to address:

  • What is the subconscious?
  • How is decision-making influenced by subconscious processes?

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The Will Debate

I took a course as an undergraduate called “Principles of Learning.” One of the texts for the course was a book called The Illusion of Conscious Will, written by psychologist Daniel Wegner. The book details a series of experiments and naturally-observed phenomena wherein people believed they had control over the outcomes of events that were actually controlled by someone or something else. Wegner’s conclusion was that conscious will is an “illusion” – an experience our brains create in an effort to maintain a sense of control over our world. It’s an interesting book and idea, though it’s been met with a good deal of criticism (Nahmias, 2002).

Fast forward 10 years from that class, to a conference I attended where the keynote speaker was noted psychologist Roy Baumeister, widely considered to be a top expert in the concept of self-control. Baumeister’s 2011 book, Willpower: Rediscovering the Greatest Human Strength, describes a person’s ability to exercise their conscious will as one of the finest virtues a person can have. As with Wegner’s work, Baumeister’s has also come under fire in recent years (Hagger et al., 2016).

Continue reading “Will and the Subconscious”

Active Ingredients – The Mechanisms that Matter

Issues this post seeks to address:

  • Why do problems seem to affect some people more than others?
  • How does identifying the dynamics responsible for maintaining our problems lead to more effective long-term change?

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Active and inactive ingredients in medication

I work with quite a few people who take daily medications. Many of them take these medications to treat anxiety or depression. Some take medication for help with attention, to manage their Bipolar disorder, or to treat a variety of chronic health conditions. I consider it a privileged position not to have to take medication on a daily basis in order to manage a chronic concern.

When I worked with youth in a residential treatment program, I was surprised at how many different medications some of the residents were prescribed. I’d help with the disbursements of these medications when the residents got up in the morning and when they went to bed. Some of them took a pill or two once or twice a day to help them manage a specific problem. Others, however, would take a cup of 4 or more medications at a time, sometimes twice a day.

It takes a lot of knowledge and skill for a psychiatrist to effectively manage a prescribed cocktail of medications that target specific problems without causing too many side effects or harmful medication interactions. Each medication has one or more active ingredients that give that medication it’s particular therapeutic properties. Interactions between the active ingredients of different medications can stifle the intended main effect of the medications, or lead to problematic side effects.

Since active ingredients in a medication can’t be administered by themselves, they are often combined with a set of inert, or inactive ingredients (also called excipients). These ingredients are typically used to bind and preserve the medication, dye it, or flavor it, and have very little bearing on the therapeutic effect of the drug. As a result, it’s possible to have a dozen different pills, each containing 200 mg of the active ingredient Ibuprofen, of varying sizes, colors, flavors, and consistencies. No matter which pill you take, however, you should end up with a very similar pain-relieving effect, since the active ingredient is the same. In theory, you could put 200 mg of Ibuprofen into any edible substance and get the same effect, as long as the other ingredients don’t interfere with the Ibuprofen’s effect.

Application to personal problems

I find in my clinical work that personal problems often have “active” and “inactive” ingredients. “Active ingredients” refer to processes or situations that produce a particular effect consistently. It doesn’t matter what the “inactive ingredients” involved in the situation are, the effect – or problem in this case – occurs as a result of the “active ingredients.”

A problem arises when someone has difficulty identifying the “active ingredients” that perpetuate problems in their life, and instead targets one of the “inactive ingredients” for change. Here’s a simple example that I commonly see in my clinical practice:

I frequently meet with individuals or couples where there’s an identified problem with pornography use. Pornography use is particularly problematic among the predominantly-religious clients I work with in therapy, as significant stigma and shame exist for those who deal with this issue. The contexts of the problem vary, but the end results are usually similar: In couples, the partner who isn’t using pornography often feels betrayed, inadequate, and mistrustful, while the partner who views pornography often feels guilty, out-of-control, and insecure.

Prolonged pornography use in these situations can lead to mistrust, blaming, breakdowns in communication, impaired intimacy, and, ultimately, dissolution of the relationship. These are the problems that cause couples to come to therapy in the first place. The simple, most commonly-identified solution to these problem is to get the partner who is viewing pornography to just stop doing it. The narrative makes sense – pornography use inhibits emotional intimacy and leads to partner objectification. The problem is an individual one – it “belongs” to the person who is using pornography, and their partner is in the victim role.

The question I ask myself in these situations is, Is pornography the “active ingredient” in the relationship problems this couple is experiencing?

To answer this, we have to consider whether this “active ingredient” produces a similar effect when combined with different sets of “inactive ingredients.” In other words, does a partner’s pornography use always lead to problems with shame, intimacy, trust and communication in their relationship?

Of course, the answer here is no. It’s possible for couples to exist where, based on the shared values of both partners, viewing pornography does not necessarily indicate problems with trust, communication, or intimacy. I’ve worked with such couples in my clinical practice, which has been an eye-opening experience for me. In such cases, the identified problem of pornography use seems to affect the couple much less than it might a different couple.

If the “active ingredient” in a couple’s relationship issues isn’t the pornography use itself, then what else could it be? To answer this, we need to look at the mechanisms, or dynamics, of the relationship that predict different outcomes among different couples with pornography issues. The actual processes that serve as the “active ingredients” will vary from situation to situation. The following are examples of some of these processes that actually are active ingredients, where combining them with all kinds of inactive ingredients will still produce the same kind of effect:

  • Shame that inhibits open communication
  • Fear of hurting the partner, such that difficult emotions or conversations are avoided
  • Insecurity about how attracted the partner is to them
  • Use of avoidant methods of coping with stress generally
  • Anxiety about the partner’s “spiritual welfare”
  • Difficulty dealing with “mixed signals” from the partner, or an inability to communicate about these “mixed signals” effectively
  • Evaluation of the self or the partner as “less than” the other person, leading to a power differential
  • Objectification of the partner

There are certainly many other dynamics that can be associated with pornography use and that can lead to problems in relationships. In many of the above examples, particularly the last example, it’s very easy to draw a correlation between pornography use and the problematic process. However, it’s important to remember what the “active ingredient” actually is – it’s not the pornography use, it’s the tendency to objectify the partner. While these two frequently go hand-in-hand, it is possible to objectify others without using pornography, and the same relationship problems that occur with the pornography use would occur without it if there was still partner objectification. Thus, the objectification is the “active ingredient” here, and not the pornography use.

Conditional resolution

This isn’t intended to be a defense of pornography use. There’s no evidence that I’ve seen that using pornography is particularly healthy for a relationship, and I use this just as an example of how the “inactive ingredients” are frequently targeted for change. To be fair, many of the problems associated with pornography use that I see in the couples I work with could be “fixed” if the partner who viewed pornography simply stopped. However, this kind of “fix” creates a conditional resolution of the problem – the “active ingredient” is still present, and can easily be activated in the future in a different context (i.e. weight gain, loss of income, crisis of faith, etc.).

I’ve said this in several of my previous posts, and I’ll say it again here: People are complex, and it’s often difficult to see what the actual contributing factors to a problem are. It’s important to seek to understand the “active ingredients” that produce the problems we experience. These active ingredients are the “mechanisms that matter,” the processes that sustain the status quo. When we move beyond the simplest and most obvious explanations for our problems and examine the relevant dynamics, we become much more likely to implement change that successfully and sustainably improves the problems we face.