Category Archives: personality

Why Ask Me That? Part 1 of a Series on Questions in the Therapy Room

“It’s a lot of paperwork.” 

Yes, I agree, it is. And all that information is helpful and useful for me in what I presume is a shared project: making positive change in some aspect – or many aspects – of that client’s life. 

The number of people who simply skip sections, as if they were optional, or not relevant, is significant. This gives the opportunity to have some conversations about those questions, and their relevance.

For example:

If someone routinely shortchanges their sleep, health problems will develop. In the short term, irritability (which tends to mess up personal and work relationships), less efficient short-term memory (ditto), distractibility (ditto) and impulsivity (mega-ditto) are possible contributors to whatever the primary complaint may be.  So maybe we should address that, too!

If you are extremely extroverted and are working remotely and living alone, you have created a perfect petri dish for restlessness, depression, and dissatisfaction. Those are psychological and emotional factors that create problems across domains. Deliberately arranging adequate real interactions with others will be essential to meeting that basic need.

If you don’t have five or six people who you can identify as part of your social support system, such as friends, family, a mentoring colleague, etc., there may be a heightened risk for depression and anxiety.  That doesn’t mean you confide personal problems with all those folks; you might have someone who provides support and encouragement in career-related areas, some people you can pray with, people who you play sports or exercise with and enjoy lighter conversations.

There are no questions on my paperwork that are not rooted in helping the client and me have a grounded understanding of the client’s strengths, struggles, and emotional resources for making positive change. Just ask me.

I could tell you, but you’re not going to like it: Why doesn’t she leave?

Hint: whatever the reason is, odds are, she’s not “codependent.”

Your much-loved friend, your sister, your cousin – someone precious to you – is in a hellish relationship. Not a call-the-police violent relationship, but something similar: a toxic, gaslighting, crazy-making mess of a relationship that whirls up and down and around like a psychological roller coaster from Hell.  One day she’s fine, the next she’s a weepy, shaky, self-doubting shadow of her usual self. Over the days, weeks, or months, you’ve watched her change from confident, funny and insightful to anxious, depressed, maybe even physically ill. You can tell the problem is her partner; everyone can. Why can’t she?

I’m using the female pronouns because, although the torment can flow in either direction, research and the experts in the field indicate the pattern tends towards the victims being female and the dark-triad partner being male. 

Dark triad types – more often male, with antisocial, narcissistic, and Machiavellian traits, and often sadism thrown in – prey on victims. They assess the prey and find the way to quickly gain her trust.  The typical prey makes this easy, because it is her positive personality traits that will now make her vulnerable to this predator. The relationship started out fast – intense, a burst of attraction and an amazing number of similarities. In retrospect, you think, too amazing. The “too good to be true” turned out to be, well, untrue.  The cycle of drama – accusations, fights, threats of abandonment, and, ironically, your friend seeking forgiveness sometimes – keeps her off balance, on the ropes, without enough peace to think things through.

Very often, the women who find themselves in relationship with manipulative, emotionally and psychologically abusive, and often financially exploitative and sexually manipulative men, are the people you’d love to have for a good friend. They are high in the personality traits comprising the primary traits of Agreeableness and Conscientiousness.  Agreeableness includes traits such as friendliness, honesty, a willingness to put others first, and nurturing.  Conscientiousness includes loyalty, perseverance, and dedication. These people are often great parents and wonderful friends. These traits bite them in the butt when a predator exploits those very strengths to draw the woman into, and keep her in, a chaotic relationship that never settles down enough for her to have time to reflect and figure out what might be going on. Sometimes, her best hope is that she starts feeling like she’s going crazy and seeks therapy…and finds a therapist who sees, not codependence and a victim’s participation in the dysfunction to meet some unhealthy psychological need, but a person whose strengths have, in this unusual situation, become a trap.

Maybe you wonder, reading this, how good traits can be a trap…just think about your own history. Were you ever the team-member, at school or work, who dutifully did your share and more, while others slacked off and still got the shared credit? Has your loyalty been exploited by a “friend?”  Have you loaned money to a friend or family member on a word and a handshake – only to be avoided, and unpaid, later?

Part of the trap for your friend will be, ironically, compassion for the predatory partner, who has probably included in his story a carefully curated tale portraying him as a noble and heroic victim.  Her compassion, nurturing and desire to be helpful (those great-mom, great-friend characteristics) now propel her into fix-him mode.  His anger at her can all too easily be interpreted through the lens of his pain and frustration. Out of care for what she believes is a suffering fellow human being, she gets tangled in self-blaming, guilt and confusion. She easily believes his supposed distrust of her that seems to erupt out of nowhere is due to his attachment wounds, and buys into a notion that patient endurance and reassurance will heal him. And yet…sometimes he just lashes out, apropos nothing, and then denies anything even happened.  He berates her and tells her later she’s exaggerating, overreacting, imagining things. Stop making up lies about me, he rages.

So, if she wonders, half-rhetorically, on the few times you manage to see her alone, if she’s “going crazy,” don’t agree. Don’t accuse her of being codependent.  Listen, actively.  Gently question her: is it okay that he keeps texting while the two of you, who have known each other forever, have a cup of coffee? Does he do this a lot? Share your observations and concern for her (not criticism or blaming). Ask what keeps her in the relationship and, if she admits to feeling trapped, be kind and firm in your assurance that she has people to help her. She is not trapped, no matter how stuck she might feel.

The manipulative partner creates so much emotional turmoil and distress that it becomes almost impossible for the victim to think clearly.  Part of this is because of the cognitive dissonance the victim feels: the confusion and distress of holding conflicting thoughts of this magnitude: On one side are the “good” beliefs about the partner because of their seemingly perfect match and on the other, the anguished, distrustful, terrified thoughts because of the confusion of demands, accusations and threatened abandonment.  Your friend probably can’t think straight – for now – but, again, it isn’t because there is something “wrong” with her.  She is in the midst of a prolonged trauma.

Thus, the most obvious (to you) parts of a solution may seem overwhelming or impossible.  Moving the abuser out of her place? Not impossible.  Moving her out of the abuser’s place? Not impossible. While she may feel unable to cope with the finances, her pet rabbit/dog/cat/bird, and the task of moving possessions, her concerned friends and family can easily help slice this problem into manageable pieces.  Someone has a guest room or garage apartment or mother-in-law suite; someone can foster her pet at their home while the dust settles; someone has a truck for everyone to gather and load up so she doesn’t have to face the process alone; someone can coach her through changing all her passwords and un-merging her phone, etc., from the partner.

This situation is heartbreaking to endure. Keep reaching out; do not give up on your friend/family member/cousin.  Maybe it’s even worth having a little movie night – without her partner – to watch the classic film, Gaslight, starring Charles Boyer and Ingrid Bergman.

On Being “Beyond”

I’ve been thinking a lot lately on being beyond. Beyond what, you might ask, and I’m sorting that out. Basically, though, it started with realizing that I am now in that great blob of the population described so often as “beyond.” As in the headlines on the covers of women’s magazines,

“Get glowing skin! Customized tips for your thirties, forties, fifties and beyond!”

“Walking for Fitness at Any Age! Belly-busting strategies for your thirties, forties, fifties, and beyond!”

I don’t know the extent to which men are burdened with this. I can imagine, though:

“Get ripped! Washboard abs workouts for your thirties, forties, fifties and beyond!”

Yeah, I’m beyond.

It sounds sort of like a super hero, as if at 60 – when we enter into Beyond – we ought to get a cape. I have a cape – Irish wool, very warm. If you think that sounds more cozy than conquering, you haven’t met enough Irish women. (Note to would-be inventors of Beyond Woman action figures: spare us the wasp waist. We have the usual age-related spinal compression plus hormonally driven fat redistribution. Keep it real, that’s all we’re asking.  Because we are fine, better than fine, and in fact, beyond – just the way we are.)

It’s quite comical that the apparently youngish people who write so much media content put the newly 60s, the 60-year-olds’ mothers, their aunts, and centenarians all into one category, while the decades earlier are carefully delineated as if the difference between, say, 39 and 41 comprises dramatically more difference than between a 60-year-old and any given 80-year-old woman, and between that woman and a centenarian. It seems to reflect a silly and self-absorbed presumption about the nuances of midlife compared to the daily warfare of old age.

The implication is that, well, now you’re old and one old person is the same as the other. That is clearly ridiculous; there is far more difference between any two senior citizens than between any two 20-year-olds.  How could there not be? Life has been unfolding, every day full of experiences that compound the differences.  Every decision about habits, relationships, effort, sloth, etc., multiplies and intersects into complex and unintended consequences.  If you are 30 and reading this, consider how different you are from the people who were your best friends in high school, just 12 years ago. Wait another 30 years of daily choices and the ramifications of those choices, plus the unexpected and random events of life, and the differences between you will be inestimable.  

So, what does it mean, being beyond?  Well, the ones I speak with are beyond thinking they are in some sort of competition with the whole world.  They are beyond equally valuing everyone’s opinions; they stop craving indiscriminate approval. They are beyond getting aggravated about the minor speed bumps of daily life and getting tangled up in knots over every bit of bad news.  They are beyond thinking that social media alerts outweigh the person we’re talking with now. They have long been beyond pretending that cynicism is the same as wisdom.

All this means freedom: freedom to play freely with children without worrying about our dignity, sing in our cars, and ask questions without worrying we’ll look stupid. We adapt to what our bodies can and can’t do today. We can be creative because it doesn’t matter if other people don’t like what we paint or draw or bake or build. And, out of that freedom, we can offer encouragement and hope to people who are still trapped in the completely voluntary constrictions of being not-yet-beyond.

And so, here’s to being beyond, with all its freedom, challenges and gifts. 

What about you? What does being beyond mean – and will you wait until a magazine editor says you’re there to enjoy it?

Too busy!

People brag about the strangest things.

Not getting enough sleep is one; are Americans in some sort of dysfunctional competition to see who can get by on the least possible sleep – regardless of the effect on their mental and physical health?

Another is being busy – so very, very busy – that one could not possibly do anything healthy, or creative, or refreshing in any way.

Is it real busy-ness? It’s hard to say, but I have my suspicions that it often comprises some combination of underestimating how much time is frittered away on time-wasters, taking on a lot of extra and unnecessary tasks, and, sometimes, more than a hint of pride. You know, the people who find out you actually read books in the evening or squeeze in a date night with your spouse and give that little smile and a hint of a sniff when they say, “Well, it must be nice…” Well, yes, actually, it is. Very nice.

Pride, or arrogance, aren’t necessarily obvious. Healthy humans have a normal, natural need to feel needed and wanted. This is a good, but the fear that somehow your absence will cause all of creation – or at least your workplace or the kitchen at home – to immediately crumble into dust is not good. Even Jesus and Moses sometimes sneaked off for some very necessary R&R, either to be alone with God or also with some of their most loved, trusted friends.

Some people are going through a stage of life that is very busy. People with school-aged kids who each  participate in one extra activity will indeed be temporarily overly busy, driving to practice or lessons. They check homework, look under the sofa for shin guards, and use their vacation time for pediatric appointments for yet another ear infection. This stage is transient. Even too-busy parents, though, often hide time-wasters into their day.

When someone asserts always being “too busy” to do things they claim they really want to do, then I suspect that perhaps they don’t actually want to do those things. It would be better to say, “Oh, no – last thing I want to do is be stuck in a gym five mornings a week,” then to dodge exercise by pretending they are just too, too busy. Once they are honest about the issue (apparently they would rather do something else than spend hours on the human version of a hamster wheel) they are free to figure out how to meet the essential need (enough exercise to stay healthy) and stop dodging reality with brag-worthy busy-ness.

It’s hard to give up the busy excuse to oneself. It might be a polite dodge to other people (but remember that “let your yes mean yes and your no mean no” admonition?) but it’s just pointless to lie to oneself.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

A little out of sync…

Intellectually gifted children are a challenge for grownups.

Their ability to learn and apply information may be far ahead of their peers but their emotional and motor skills may be completely normal (read: average and right on schedule). So your highly gifted six-year-old, who can visualize Johnny Depp’s pirate ship but whose little fingers can only manage 5-year-old’s motor skills, will be angry and frustrated to the point of tears over a boat that looks perfectly fine to you. Your gifted twelve year old will, with the emotional fragility of a middle-school-aged heart, grapple with the existential questions peers more often face in college.

This kind of asynchronous development is hard for the child, too…and will continue to be so, until adulthood. It’s easier for adults to find a few intellectual peers with whom to deeply connect. The more gifted the child, the harder this will be, simply because of the mathematical odds. Intellectual giftedness comprises only 2% of the population. Highly gifted persons are less than 1/1000 of the population; for them, the odds of finding someone on par, or, an even happier event, encountering someone sharper in intellectual terms, is slim. It’s important for grownups to be aware of the interior struggles gifted children face and provide opportunities for support, encouragement and sometimes some careful education on why they feel so different from other kids.

Add to this gifted kids’ tendency to need a little less sleep, be a little more bouncy, be in a hurry to learn and do, ask a lot of questions…or, conversely, be very quiet, observant and introverted, and the challenge for parents and teachers becomes clear.

Interested in learning more? There are a lot of resources out there: American Mensa and SENG are two excellent sources of information and support for the gifted child (or grownup) in your life.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Avoidant Personality Disorder, Social Anxiety, or Just Shy?

Simple shyness? Social Anxiety Disorder? Avoidant Personality Disorder? What’s the difference? Are we just pathologizing normal behavior? Why so many labels?

Well, the labels exist to help professionals differentiate between constructs. That’s what most diagnoses are: categories put together by committee, identifying particular experiences or patterns of behavior, thinking and/or feeling that tend to co-occur. That’s an extreme simplification, but it’s a good jumping-off point for us.

Shyness is normal-people-speak. It’s the way we describe someone, or ourselves, when we are a little reluctant to “blow our own horn” or “put ourselves out there” (whatever THAT means). A little shyness means some mild worry about doing the right thing, not embarrassing ourselves, and wanting to avoid being a nuisance.

Social Anxiety Disorder (SAD) is a psychiatric label that covers a level of shyness that interferes with someone’s daily life. That’s the test: whether the person’s regular life is constricted by worry about saying/doing the wrong thing in social settings and a tendency to avoid social gatherings or work or school related activities. It’s anxiety: there are both physical symptoms of fight-or-flight (elevated heart rate, for example, or more perspiration) and psychological symptoms (worrisome ideas about being in the spotlight and doing something “stupid,” for example). People with SAD usually have close relationships and get through daily life pretty well, with bumps along the way when big events or unusual circumstances – public speaking at a work meeting, for example, or large gathering – looms.

Avoidant Personality Disorder (APD) is sometimes confused with SAD. ADP is markedly different, though, because it encompasses a global low self-esteem and fear of being judged and found wanting in just about every way. So, for example, the person with some social anxiety has close friendships but might feel a bit anxious about going to a wedding reception with a lot of people s/he doesn’t know. The avoidant person has few close relationships out of fear of people finding them just not good enough to be friends. The APD person suffers anguish before annual performance reviews, and even gentle constructive criticism is received as devastating evidence of how deficient they are.

The fear is not “just in their head.” Fear is always a full-body experience. When a situation seems to be a threat (for the person who suffers with APD) to be judged and found wanting, the body responds before the logical, higher brain has even identified what is happening. So the amygdala has sounded the general alarm – the endocrine system flies into action, and as a result logical assessment is curtailed. Telling someone whose heart is pounding, whose blood is full of adrenaline and a massive dose of glycogen and is primed to run away that they are just overreacting is not helpful. Learning how to manage this, how to recover from the old messages of being “less than” and “not good enough,” is a process, not an instant fix. It can be healed.

There’s much more to these labels and to the details of treatment, of course, but perhaps the useful take-away today is: help is available. A lot of people will find that solid self-help approaches based in cognitive-behavioral therapy research (David Burns, MD’s books are excellent examples of these) quite sufficient for mild to moderate social anxiety. When that anxiety is all-pervasive, and there are few relationships out of fear of being found wanting, and loneliness and fear of being judged rule one’s life, the additional support of a counselor might be more helpful than trying to struggle through alone. Ironically, group psychotherapy can be quite effective for these difficulties – but it’s hard to find them.

If you know someone who is struggling, try to help them get help.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Why are personality disorders so difficult to treat?

Why are personality disorders so difficult to treat?

Well, there’s a complicated question! This post attempts to present an overview response.

A personality disorder, like just about all mental disorder diagnoses, is made based on a checklist of complaints, symptoms, and observations. However, personality disorders are very different from what we normally think of as emotional problems.

Consider, for example, depression. “Depression” is diagnosed when 2 weeks have passed and certain criteria have been met (and there’s no “pass” given for grief or other traumatic events in the new diagnostic manual, although we’re supposed to note it in the records). Most people know when they’re sad, irritable, unhappy, and hopeless. It feels awful and they want to get that bad feeling off of them. Some people might not think of it as “depression.” They might identify it as a “low time,” or it might be grief, or a normal adjustment to a new phase of life such as marriage, an empty nest, or graduating from college. It might be a normal but very painful response to some new curveball life has thrown at them: an illness, a layoff, retirement, etc.

A personality disorder is different because it is pervasive; like the personality of any person, it is part of everything. Your personality impacts how you interpret everything that happens, the way you react to people and events, the emotions you experience. This goes for healthy people as well as those whose patterns are far enough from the big, wide range of normal to merit a “disorder” status. So, when someone seems to have a personality disorder (say, narcissism), they are not experiencing their diagnosis as a messy, icky experience to be stopped. They are rolling along (over other people) and having their life. Everything comes through a lens that assures them that they are special, entitled to preferential treatment and to have their way, and, well, let’s face it, just better than us. Problems are experienced as due to the outside world and their own role in those problems is not apparent.

From a therapist’s perspective, when someone comes in with depression, even if that’s not what they, or we, might call it, they know they are unhappy and they want very much to feel like themselves again. They are hopeful that a counselor can help them push through this difficult time.

When someone who meets criteria for a personality disorder comes to treatment, it’s usually because of some other issue, such as work or relationship problems. Remember that each of us is walking around, seeing the world through our own eyes and interpreting everything we experience, including our own thoughts and feelings, through our unique mental structure. You build that mental structure from the earliest moments of life. Is the world safe? Are my needs met? Are the grownups who tend to me patient, gentle and kind? Babies are already sorting out information and creating a set of basic assumptions about the world that will become essential aspects of their personality. It’s so deep, it’s hard to not take for granted that our way of making sense of things isn’t necessarily the only, or best, way. So when patterns of problems arise with colleagues, bosses or family, it’s hard to believe that the problem is fundamental to our mental structure; it defies logic and could be very insulting. The person may be suffering terribly, every day. This is definitely the case with some of the personality disorders, such as Borderline Personality Disorder, Avoidant Personality Disorder and Dependent Personality Disorder. Whether these or any of the personality disorder diagnoses, the person did not choose this burden and it isn’t their fault. However, presenting it as an internal problem – to them – can feel like blaming and attacking – which is definitely not the therapist’s intention.

Imagine if something terrible happened to you: a tsunami. Your workplace is destroyed. You lose your house. You lose your stuff. You catch a mosquito-borne illness and suffer long-term ramifications. It’s a series of terrible events and you find yourself traumatized and perpetually anxious. Is that anxiety your fault? Certainly not. Just so, the early life experiences that set people up for the challenges we call personality disorders are not their fault. However, it’s a problem that they can learn to heal, but that can sound like blaming the victim. Thus, if someone meets criteria for a personality disorder, trying to sell them on dealing with the personality disorder is pretty much like saying, “Look, an awful lot about the way you think and respond to things is kind of messed up. But, never fear! Together we can bulldoze your personality and how you think, feel and behave, pour a new slab, and then we’ll rebuilding you from the ground up. You’ll learn new ways of thinking, feeling and behaving.”

Even when it’s dressed up in tactful, compassionate psychological language, that, my friend, is a very hard sell indeed.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Oh, the drama!

It’s about 2/3 of the way through the spring term, so it’s time again for my intro psychology students to learn about the various personality disorders, as defined by the American Psychiatric Association. One interesting one – and not necessarily in a good way – is Histrionic Personality Disorder (HPD).

Traditionally, HPD was estimated to occur in perhaps 2-3% of the population. You know these folks; you’ve known them all your life. They’re exciting, intense, and fun; the life of the party, the center of attention…and they can’t turn it “off” when appropriate. It’s the “friend” who wears a very well-fitted white dress to your wedding; the family member who always has to make it “about them,” when it’s very, very much about someone else; the middle-aged parent who is trying to compete with a teenaged child to the point of embarrassment (for the child, that is). They lack empathy for anyone but themselves, but can emote with the best of them. Recent studies indicate that incidence of HPD is exploding – with some estimates as high as 27% of the young adult (under 35) population now meeting criteria for the psychiatric diagnosis. It’s thought that the two-generation long emphasis on having high self-esteem absent any achievement of good character or performance might be involved, as well as the current culture that elevates attention (any attention) as better than just chugging along, living your life happily with the people you love.

Which of our grandparents would ever, in million years, have imagined everyday people talking about how many “followers” they have, as if they were Jesus?

Like almost all psychiatric diagnoses, HPD is defined by a checklist; meet enough criteria according to the clinician holding the checklist, and you’ve earned the label. Of course, someone with HPD isn’t coming for therapy for help with HPD. Others may come for help with them, or it may become apparent within the context of counseling for some other issue: relationships, work conflicts, etc.   It’s sad, really, that it can be so difficult to realize one needs help, because at the root of this is a small child, still jumping up and down crying out, “Mommy! Watch this! Mommy – look at me!” and that small child in the unconscious just doesn’t realize that all the jumping up and down cannot make them feel “seen,” and they need to find other ways – more adult, meaningful ways – to feel connected and recognized. After all, everyone wants to be seen by eyes that love them; didn’t the film Avatar touch on that well, where the most intimate thing people could say to another living being was, “I see you”?

Like some of the other personality disorders, particularly Antisocial Personality Disorder, Borderline Personality Disorder, and Narcissistic Personality Disorder, the person with Histrionic Personality Disorder will seem fine…in fact, better than fine. All four can be very charming, interesting, and fun. They can seem special and their attention can make the next victim caught in their vortex feel special until all heck breaks loose.

Be compassionate but beware. No matter how wonderful, loving and patient you are, healing the wounded heart under HPD is not a one-man or one-woman task.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.