Tag Archives: personal growth

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.

The Cancellation

Another day, another call or email: a couple whose first appointment was scheduled for later this week has cancelled. They have “found a doctor who takes our insurance.” That would be fine but for one detail: the appointment was for marriage counseling.

This could create a dilemma for the doctor who “takes our insurance,” if the clients turn out to be shopping for marriage/relationship counseling. This is because unless one member of the couple is diagnosed with a mental disorder, and the treatment rendered in those conjoint appointments comprise empirically supported treatments for that disorder, it is probably not covered by their insurance, whether the doctor “takes it” or not. No doubt this will be part of the discussion during their first appointment, when they inform the doctor that the problem is not helping Partner A cope with depression or anxiety (or some other mental disorder diagnosis), but rather some sort of relationship problem. Now, if Partner A is depressed, and the treatment involves communication skills combined with cognitive-behavioral therapy, or another empirically supported form of therapy that can involve the spouse as a coach/partner in healing, that’s excellent and ethical practice; not so for relationship problems.

At least I found out in advance, sparing the mutual aggravation of patients who imagined somehow that their marriage counseling needs are someone else’s financial responsibility and of a psychotherapist who expects to be paid for services.

This sort of retraction prior to a first appointment happens sometimes in my practice. “I found someone who takes my insurance.” This, despite my spending 10-15 minutes on the phone before setting that appointment and providing this information about my practice. I don’t contract with health insurance companies: it’s clearly stated on my website, and I tell people during that first, free, fifteen-minute consult.

Why bother mentioning it? There are ethical issues at hand.

To be perfectly frank: health insurance is for health problems.

It ought not to be used to get a discounted rate, subsidized by every other person paying premiums to that health insurance company, for marriage counseling, or premarital counseling, or vocational counseling, or any other normal, problem-of-living, life phase process.

My website clearly states my position on health insurance: I don’t contract with insurers because the bulk of what I do is not billable. I do not want my work with couples to be tainted by ethically questionable gymnastics in which we justify treating the relationship because it will indirectly help with a mental disorder. I will not label children with a brain disease because their grownups are getting divorced and upsetting the children, resulting in a custody evaluator referring the children to me. I will not participate in diagnosing people when I am concerned it is not in their best interest – a position supported, as it happens, by the American Counseling Association.

So, no, I don’t “take” insurance. Insurance cards are not debit or credit cards, anyhow: there’s no “taking.” There’s submitting paperwork and hoping one is eventually paid, or being denied payment and then having to bill the client, who may have been discharged months ago.

I don’t diagnose people for the sake of billing. If a client meets criteria for a diagnosis, what we’re doing is aimed at treating the symptoms of that diagnosis and, after being provided information about the process, the client chooses to submit the information to his/her insurance company, I will provide the appropriate form for the client to try to be reimbursed.

I work with human beings who are having problems in their lives (provided they are in Florida, where I am dually licensed for mental health counseling, and marriage and family therapy), and who want life to be better. They want better relationships and a hopeful outlook; they wish to live with purpose and meaning.

Those are not mental disorders. They are signs of health and hope.

 

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.

What are you waiting for?

The American Association for Marriage and Family Therapy asserts that the typical couple coming in for counseling has had difficulties for over five years…which makes me wonder, what are they waiting for?

There are a lot of seemingly perfectly sensible reasons to postpone counseling when things start to go awry:

“It’s expensive.” This is true; counseling does cost money and relationship counseling is an out-of-pocket expense. Still, most therapists are cheaper than two retainers, two divorce attorneys, a mediator, a parent coordinator, etc…

“I don’t want to be told what to do.” Well, a good therapist isn’t just going to tell you what to do. A therapist is going to be asking a lot of questions, having you fill out a lot of questionnaires, and trying to develop a very clear picture of your relationship’s specific strengths and the particular types of problems each of you identify. That way, research-recommended approaches can be matched to the problem(s) of the particular couple.

Fear. Don’t a lot of people fear that it’s going to be like that old Simpsons episode, where, after Marge vents for hours, the therapist turns to Homer and says something to the effect of, “I’ve never said this before, but it really is all your fault.” That’s not what happens in real life.

Shame. So many people suffer with shame over the difficulties they are having. Marital difficulties feel like a failure. Yet, if marital problems were some rare, shameful thing, why are there so many marital therapists? We have our own doctoral programs, professional licensure, and organizations. Beyond that, other non-specialists in the mental health professions also offer couples counseling.   Shame can be overcome by getting help and feeling less alone in the suffering.

The Ostrich. Just try to ignore it and hope it goes away: the addiction, the affair, the endless disputes about parenting or money or values and ethics. Some things, ignored, will go away: a minor cold, a pimple, a minor aggravation of the day. Other things, though, just fester and turn into a nasty emotional infection: resentment, trauma, guilt, hurt.

If your relationship is suffering from feelings of distance and disconnect, or seems to be a vortex of repetitive arguments, counseling could be very effective. Often, five or six appointments, spread out over four to six months, can make a world of difference when both parties are willing to work at changing patterns of behavior and experimenting with new ways of interacting.

It’s important to find a counselor who is a good fit. Call a few of us; talk for a few minutes; get a sense of style and see who seems like a good fit for the two of you.

Be bold. Push past shame and fear; challenge your inner ostrich. Then start to feel happy again.

 

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.

Toxic Myths, revisited

A lot of people ask about toxic myths: what does that mean? Why “myths?” (I’d like to say, well, buy the book, and sometimes do).

The toxic myths are examples of lies dressed up as truths. Our culture is seething with them, but in Toxic Mythology, I only addressed a few.

For example, consider the myth that people can compartmentalize their lives. Someone can, within this myth, be an absolute scoundrel in their personal life but supposedly be capable of being completely trustworthy and honorable in their public/vocational role.   Conversely, they can (per the myth, at least) be a sociopath in their professional life but be kind, tender and good in private.

So…if you buy this myth, you have to be willing to:

Vote for someone who swears to uphold a particular principle while having a personal and/or professional life littered with betrayals and a habit of acting on expediency, not principle;

Believe your child who promises she didn’t really cheat on that exam or plagiarize on the paper (despite the software evidence) after same child was grounded for “borrowing” money out of your wallet without permission.

Keep on an employee whom you overhear lie to customers because you haven’t caught that employee lying to you.

Convince yourself that your gossipy acquaintance never, ever would talk about YOU behind your back.

Does any of that sound reasonable? Of course not; these are, however, the toxic myth in action. Our culture tells us that it’s perfectly reasonable to believe that compartmentalization of character is possible and (further) that we should be “judgmental.” That’s another myth for another day.

 

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.

Mental Health, Well-Being, and Responsibility

More about personal responsibility in regards to mental health and well-being…

Have you noticed how often people talk about things they do as if they were events that happened. It’s as if “stuff happened,” and they were just hapless victims of circumstances. Note, I am talking about the things people actually DO – not things that really do happen to them.

“I got to work (or class, or church, or wherever) late.” A more accurate description would be, “I decided to do (some category of activity) rather than leave on time.” Maybe it was staying in bed, maybe it was “one more chore,” but the person decided to do something and thus the lateness.

Someone complains, “I woke up with a hangover,” when, of course, the reality is, “I decided to drink to a point where I knew I would feel lousy today but last night it seemed like a really good idea.”

“The (whatever task – homework, a chore, etc.) didn’t get done.” What really happened? The person decided to do something else, or a whole bunch of something elses, rather than that pesky task.

So, one way to improve one’s well-being is to simply start taking responsibility for choices. I might decide to have a brownie ice cream sundae for breakfast, and if so, I should say I am deciding to have this instead of scrambled egg whites with cheese. The brownie sundae, in all its wonderful deliciousness, will not just happen to me by accident, without warning.

I can decide to sit and stew about something that bothers me or I can decide to try to focus on some other activity and decide that I will figure out what to do about a particular problem when I’m in a better frame of mind. I get to decide; an hour spent stewing is something I can choose, or maybe I can choose to do something else instead.

You can decide to be in a relationship with someone who is toxic and mean, or not.

You can decide whether to seek help in parenting strategies, or throw up your hands in despair, or try the consequence-of-the-week approach except for when you’re too tired to argue.

You can decide whether to join a grief support group or suffer in silence and loneliness.

The act of owning a decision gives a greater sense of control, because if you decided one thing today, you might decide something else in five minutes, or tomorrow, or next week. If stuff just happens to you, you have no control, and thus must sit around being helpless, hoping for better luck next time.

Luck is an iffy plan.

It would be better to decide.

 

 

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.

Personal Responsibility and Mental Health

This is another reflection on the Florida Adlerian Society’s annual conference last Friday. One of the primary speakers emphasized the role of personal responsibility in mental health. I can imagine, taken out of context, how brutal that might sound. “Are we now blaming victims and ill people for their woes?” the person exposed to just that sound bite might wonder. “Is that what mental health professionals believe?”

The short answer is no, that’s not what we believe.

Embracing free will and the dignity of each person, however, ineluctably leads one to emphasize the role of personal responsibility in how one deals with what happens in life. This isn’t something new: it is ancient philosophy dressed up in psychotherapy clothes. So, while someone may suffer terrible misfortunes outside of their control, the impetus to decide what to do about it is within them. Seek help, or sink into despair? Reach up to grasp a hand, or reach out for a bottle, or needle, or some other vial of trouble?

Sometimes people do have some personal responsibility for what happens, and indulge in magical thinking in which bad things just randomly happen to them. I recall a person I met many years ago who got into trouble for buying drugs. He complained about the injustice of the level of trouble; he didn’t mean to do it. It just happened. (I’m pretty much quoting here.) I asked, how do you buy drugs by accident? How do you take a peaceful stroll around your neighborhood and accidentally end up lurking behind a shopping center chatting with the type of entrepreneurs who set up shop near dumpsters and concrete walls? Acting like there is no personal responsibility means that there is no effort to make things better. It’s just a lot of bad luck, from his perspective; no reason to change because you can’t change “luck.”

Often, though, human suffering is due to others’ actions. Just the same, an adult has some power to effect change. The responsibility is not for others’ bad actions, but to take some sort of action to help oneself. Sometimes people evade taking responsibility to make change because it will be uncomfortable, or embarrassing, or mean that they have to admit that at some earlier point they were wrong. Breaking off a destructive friendship or leaving a toxic work environment can be very challenging for a host of reasons, and leaving an abusive relationship can be dangerous. Reach out and get help. If the first, or second, or third person you go to for help is clueless – keep looking for the right help.

Typically, people do things that undercut happiness and health in some way and evade responsibility. People have habits that cause insomnia, for example, and complain, as if poor sleep side-tackled them in the hallway due to no fault of their own. We take on extra activities and complain about being too busy. People fail to set limits with their kids and then yell and throw consequences around when their children are irresponsible, disrespectful and unpleasant to be around. People make choices all day, often on auto-pilot, and a great many of us are prone to griping about all sorts of situations that result, as if stuff just happens without cause. Yes, of course, sometimes, stuff does happen…but, if you’re always five minutes late…that’s you. Not the traffic, not the cat, not the dog…it’s you. If your friends are inconsiderate, that’s not your fault, but it is your problem if you keep tolerating it. If you do tolerate it, then take responsibility for it and stop complaining. “Yes, good old Joe is always late but that’s just him; it’s not personal.” You’ve decided to accept it. Stop griping. If you can’t stop griping, you haven’t accepted it. If you can’t accept it, then do something: leave when he’s late. Put your foot down. Tell him off. Lie about what time you’re meeting and get there late yourself (it might work, once). Whatever; if you’re not prepared to do something about it then face that you have decided to let Joe be chronically late without regard for your preferences or schedule because you have decided tolerating it beats the alternatives you’ve identified of annoying Joe or losing his friendship.

Narrowing it down to mental health, whatever a person is suffering, help is available. How one lives is always part of healing. Proper amounts of exercise, sleep and nutrition are part of it, and things for which most people can take some responsibility. Seeking right guidance requires making choices. Unless you belong to a professional mental health association, your friends might not be the best source of professional advice on the specific strategies, to, for example, use mindfulness training, exercise and specific cognitive therapy techniques to rewire your brain and reduce obsessive-compulsive symptoms. You get to choose. That’s not blaming you for your suffering, but it is saying that you have the freedom, responsibility, and capacity to move towards healing.

 

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.

Cognitive Behavioral Therapy: So Much More than Positive Thinking

It’s more than just positive thinking

A smart, thoughtful person mentioned the other day, in conversation, that Cognitive Behavioral Therapy (CBT) seems to be just “the power of positive thinking.” That’s probably what it sounds like when it gets boiled down to a sound bite…but in reality, it’s so much more. There are many excellent resources out there, so I won’t attempt to tackle the whole topic here. A brief example, though, on the difference between CBT and simple positive thinking, might help.

In CBT, we are indeed looking for patterns of negative thinking. These are identified, and then we dig down to the underlying thoughts. From there, the challenging and reforming of particular thoughts begins. Then comes the hard work of rehearsing those new thoughts.

Consider, for example, an adult who is very anxious about grades in college. This student is up late studying, preoccupied with grades, and anxious to the point of headaches and nausea before tests. The student feels terrible, of course. The top layer of thinking probably includes themes such as, “I have to do well,” or, “This is too important to fail.” The level of distress the client feels, though, seems out of proportion; the client is sick and nauseated over A- or B+ grades. Digging deeper, the client turns out to have buried beliefs such as, “Perfect or failure – no in-between,” or, “Hero or zero,” or, “No one loves a loser.” Thus, the A- feels like a failure and even a threat to love and security. Those aren’t conscious thoughts: no reasonable grownup thinks, “Oh, no one can love me because I got an A-!” It’s more of a personal belief, often acquired early in life, which became the background to many experiences.

You can see that trying to be “positive” about the top layer thoughts might seem silly: “Oh, it’s fine to fail,” or, “It’s OK for me to not do well.” The client cannot buy into that. However, a deeply held belief – that one is either perfect or a complete and utter failure – merits serious attention, and probably underlies many difficulties for this client. Thus CBT starts it work – which is much more complex than presented here – by seeking the foundational troubling beliefs that are leading to the negative thinking.

As I noted – this is a cursory glance at one aspect of CBT. It is a well-researched method of treating anxiety, OCD, depression, and other difficulties. If it seems as if it might be helpful for you, please see appropriate professional guidance.

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.