December 6, 2009

Out, Out, Belief System!

One important therapy tool in Cognitive Behavioral Therapy is exploring thoughts and beliefs that contribute toward an emotional or mental health disorder.

Thoughts can be viewed as relatively simple ideas or statements that guide our self-talk. For people suffering from depression, for example, these thoughts tend to run toward negative, discouraging themes. They may seem quick and random, such as,

I'm never going to get this right!

Or, What is wrong with me?

Or, There's no point in trying.

Cognitive therapy involves paying attention to these automatic negative thoughts, or cognitions, and coming up with healthier alternatives. That is, ultimately changing them or replacing them with more accurate, positive, uplifting, and/or calming thoughts.

Often, in therapy, we CBT psychologists look a little deeper for underlying belief systems that influence our clients' moods and actions.

These belief systems, or beliefs, for short, can be made up of a single powerful statement, such as the following examples,

I'm destined for failure.

I can't say no. I hate letting other people down.

Nobody will ever love me.

Something is wrong with me.

Or they can be made up of a series of thoughts that clump together:

Why is my life so hard? At this rate, I'll never get ahead. Why keep trying? It's no use. Every time I take one step forward, something happens that sets me back. I may was well give up.

Belief systems are typically made up of a complex pattern of thoughts that group together to feed and maintain the one, highly charged belief.

Let's take for example a common underlying belief found among people experiencing anxiety and depression symptoms:

Nobody loves me.


I am unworthy of love.

This belief is usually fueled by dozens or hundreds of smaller impact thoughts.

Look at me! I'm in terrible shape.

She won't come back, I just know it.

I need him. There is noone else out there for me.

I'm not going. What's the use? There's no point in trying to meet anyone.

I'll never find anyone else.

Why would anyone want to go out with me? I have nothing to offer.

I feel so fat and horrible.

I'm disgusting. No wonder he hasn't called me.

All of these thoughts could be related to the core, underlying belief, Nobody loves me. Or, I am unloveable.

One of the keys of CBT is uncovering dysfunctional belief systems, bring them to the light, and helping the client let go of their powerful hold, and move forward.

Sometimes dysfunctional beliefs are formed in early childhood. An abusive, neglectful parent can contribute to their formation. A group of teasing, bullying kids in the neighborhood can do the same.

Sometimes beliefs get started in adolescence or later in adult life, say, when a cherished lover or spouse is abusive, unfaithful, or abandons.

Whatever their origins, the good news is they can be outed and purged using CBT techniques.

More examples of dysfunctional belief patterns to come.

November 25, 2009

bumper sticker of the month

Saw this one today on the back of a pick up truck:Happy Thanksgiving, readers.

And please, do not bring your bartender to our therapy sessions. I wouldn't want to have to prove you wrong. The power of positive thinking and all that.

November 9, 2009


There are many reasons I am a big proponent of Cognitive Behavioral Therapy.

Chief among them is the freedom to overcome the unhappy elements of our past.

Freedom to decide that, at this moment, change begins.

Freedom to let go of our former selves.

Freedom to let go of patterns that bring us distress.

Freedom to move forward into wellness.

Today marks 20 years of another, equally profound, form of freedom. Freedom from political oppression.

Twenty years ago today the Berlin Wall came down.

Twenty years ago today 16 million people were united with the west.

How is Germany celebrating?

A long string of dominoes mark the former placement of the wall. Germans will line the colorful wall and watch as the dominoes fall, one by one.

An angel watches over the Berlin dominoes:

The celebration began one month ago when giant marionettes walked through Berlin:

You can see more pictures documenting the event, here.

Congratulations, Germany! Wir gratulieren!

October 5, 2009

finding friends

In my last post, I talked about being new in a city and the struggle to find friends.
Years ago, I read a research study dealing with social support. It found that the variable most predictive of a friendship developing between any two people was, simply, time spent together. Not common interests, like I guessed. Not same background or religion. Not age. Not level of education.

Greater length of time spent in each other's company was the factor most associated with friendship bonding. Either long periods of time in one space (think weekend workshop or jury duty) or repetitive intervals across time (weekly art class). Time that allows for talking and getting to know each well enough to break down the barriers and move to a point where calling each other for a get together feels acceptable. Safe. And eventually easy.

I wish it were faster. I wish we could attend a party, walk up to someone new and say, "Hi. I overheard your conversation and you seem like someone I could be friends with." But this rarely happens. It might have been this easy in kindergarten. The older we get, though, the longer it usually takes. We grown ups are a leery lot.

Place of employment is a common venue for making friends. We can see the "time spent together" factor at work here. Many of my clients in this friendless predicament report the social scenerio at their jobs is lacking They might have made slight inroads or none. "Everyone is married." Or, "They're all older than me." Or, "They all do the bar hopping scene. I don't like bars." When friends don't arise in the work place, it can lead to looking around and wondering, "Now what?"

Well, here's one idea for the now what. Remember this one goal: Put yourself into situations where you are likely to see the same people again and again.

Visiting a museum one afternoon is not going to cut it. Signing up for a book club where the same people will be meeting week after week might.

What kind of situations? Start with an interest. A hobby. A creative outlet. An athletic pursuit.

What do I like to do? What am I interested in doing that I've never done before? What have I long wanted to try but haven't made the time to do so? Gardening? Creative writing? Volley ball? Woodworking?

Thumb through the newspaper in the local/metro or life section. Check out informal classes or adult education available at nearby colleges. Read over the available class schedules as a way of getting ideas or jogging your memory: photography, landscaping, stained glass, salsa or country western dance, yoga, walking tours, home improvement, bridge, dominoes.

Look for events that meet repeatedly, once/week or every other, where it seems likely you'll see the same faces on a repeat basis. A one-time seminar on a Saturday is better than sitting home and meeting no one. But a class or support group that meets regularly is a better bet for getting in the time needed to develop a friendship.

Some venues encourage interacting, such as team sports, creative writing classes, support groups, walking clubs. Others are more of a solitary pursuit. Avoid the latter. We want to optimize our recreation and volunteer time. Go where the opportunity for getting to know others is made easy.
The beauty of my plan is this: Even if your pursuit doesn't result in friends, let's say you're not interested in anyone who shows up, you are spending time doing something entertaining, challenging, and fun. You might be learning something.

Another benefit? You become more interesting this way. So when you do meet someone who has friendship potential, you're more likely to have something to offer. To be found friendship worthy.

So starting with something you're interested in is one friendship finding avenue. I'll have more to offer in a later post or two.

September 24, 2009

Feeling Friendless

Lonely Walk Home
by Michael Pickett

Living in a large, popular city, I see quite a few people coping with transition. One of the common requests for an initial appointment will go something like, "I'm new in town," or "I've lived here about a year now," followed by their complaint, typically something to do with depression or anxiety.
Many clients, particularly those beyond their mid-20's, are shocked, at a loss, or somewhat ashamed when they realize they are struggling in the friendship department.
Maybe they were used to making friends easily. Or they remember that reaching out to make friends never was easy but they somehow stumbled into a group of chums.
And now they find themselves feeling friendless. They start to feel the panic rise. How do I do this? Where do I start? What's wrong with me that I haven't found friends yet?

At some point in therapy, it becomes apparent to me that they are struggling to establish friends. It might take us awhile to reach the stage where we decide the client needs to target socializing. It's seldom a problem area people feel comfortable bringing up. People feel awkward admitting their lack of affiliation. The worry about the stigma of appearing friendless. The fear of being judged as a social dud.  
In therapy we explore the client's friendship history. How did they make friends in the past? Did it feel easy or was it a struggle? What types of friendships did they enjoy? Close confidantes or more distant acquaintances? Feel a part of a close knit group or often like an outsider looking in?
We often talk about the ease of making friends in high school and college, in particular. Life surrounded by hundreds or thousands of same-age, similarly situated peers. Mostly single, working part-time jobs, flexible schedules, with a variety of clubs and avenues available to study, exercise and socialize. To make friends. Dorm life is a friendship building tool at the ready. Close to campus apartment living is another. Potential friends all around, within arms reach, even.
Sometimes friends come in a bundle. A sports team. A choir group. A work team. Or we start to date someone and they have a big group of friends. Gradually they become our friends, too. Though not always easily. This wriggling into and feeling accepted by a pre-existing set of friends can feel awkward for many. Especially when those friendships go back to their days in the nursery. It's a situation ripe for feeling odd-person-out.
Which brings me to relationship break-ups and divorce. These are transitions where friendships are often lost. Partners exit and take their friends with them. You see this in a large group of couples. After the break up, maintaining friendships with those remaining in the couples club is a logistical nightmare. Seeing and hearing about The Ex can be too painful. Too close a reminder of what is lost. Learning about their new dating interests. Ouch.
Sometimes the friends appear to take sides. Or they don't know what to do and in their uncertainty, fail to reach out. This can really hurt the person left behind. Loss on top of loss can leave someone with profound self doubt, feeling sad and lonely.
It is well documented in the research literature that socializing on a regular basis is associated with positive physical health and emotional wellbeing. Feeling connected and cared about, laughing and going places together, keeping busy, exercising together, having someone to confide in: These are all benefits of friendships. It is no wonder, then, that finding oneself in a suddenly-friendless situation is associated with the onset or exacerbation of depression, anxiety, or a number of psychological conditions.
So how does one go about finding friends, exactly? Stay tuned. In my next post we'll talk about the goal of meeting new people and making friends.

Sandy Andrews, PhD  is a Clinical Psychologist / Therapist who provides CBT in Austin, Texas  

September 13, 2009

this is your brain on stress

The New York Times reported on a Portugese study which demonstrated that persistent stress changes the structural makeup of the brain. And not in a particularly helpful way.

According to Dias-Ferreira and his colleagues at the University of Minho, brains under chronic stress show an increase in the neurological pathways associated with doing familliar, repetitive, rote kinds of responses, even in the absence of success.

Think of the end of an intense and tiring work week. You find yourself channel surfing, up and down, dozens of times, even though you know nothing is on.

Circling around the kitchen, searching various cabinets, fridge and freezer for a salty/sugary/creamy treat, coming up empty each time.

Then there's the supervisor who schedules yet another staff meeting where the same, tired ideas are passed around, the same ineffectual instructions are issued. Where everyone leaves muttering, "Why do we think it's going to work this time?"

According to the article, brains under longterm stress also show a decrease in neurological connections in "regions of the brain associated with executive decision-making and goal-directed behaviors."

A shortage of problem solving circuitry, in other words. The light bulb burns out. We stop thinking creatively. We shrink away from new and different ways to respond. Instead we retreat into old, familliar and comfortable habits.

We get ourselves into a big, fat, rut. (Pass the Oreo cookies, please?)

The good news is, relaxation helps undo these stress induced changes. Taking brisk walks. A friendly game of hoops. Talking it out with supportive listeners. Thinking positively. Deep breathing. Contemplating nature. Getting away for the weekend. Creative outlets. Good nutrition. A full night's sleep, or two, or three. Exercise. Meditation. Yoga.

So turn off the TV. Stop circling the kitchen. Do something different. Step outside and take several rounds of full inhales and full, emptying exhales. Gaze at the stars. Resolve to get to bed earlier and engage in a healthier self care routine. Talk more respectfully and assertively to loved ones and co-workers. Eventually (four weeks, in the case of the rats in the study) your brain can revive and new connections can branch out.

Recharged, you might just find that the light bulb flickers back to life.

August 24, 2009

Six Psychology Myths

Cracked doesn't exactly have a reputation for scientific journalism. But they hit the nail on the head with their six mistaken facts, therein referred to as BS, about psychology that people tend to believe. And spout off at cocktail parties when they don't know they're talking to an actual psychologist.

You can read the whole piece here and I urge you to do so because the writers at Cracked have a way with words that I can't duplicate here.

But I'll summarize:

BS #1: So angry you want to smash something? Think you'll feel better afterwards?

Fact*: Don't. It won't help and will probably lead to more anger down the road. We're better off managing our anger, controlling it, letting go of it, deep breathing and changing the way we think about the situation that is leading to our anger. Less anger is better than "getting it all out" in some kind of aggressive rage. Kind of undercuts one of the selling points of Sarah's Smash Shack. Sorry, Sarah. (But I still wouldn't mind giving it a shot.)

BS #2: You can do anything you want to do as long as you believe in yourself.

Fact: Better success can be had with learning self improvement skills. Take lessons. Practice. Practice some more. And yes, work on improving your self-image while you're at it. Drop negative self-talk. Give yourself affirming messages. But increasing your "self esteem" alone? Probably not gonna cut it, unless you already have a good skill set.

BS #3: People who join cults are naive idiots.

Fact: Cult members are no less smart, on the whole, than you or me. Cults target people who are in transition, vulnerable, feeling desperate, and in need of social affiliation.

BS #4: Subliminal messages cause us to buy things we don't want or need.

Fact: Nope. There's no conclusive evidence that it works.

BS #5: Lie detectors work.

Fact: Slightly better than flipping a coin, yes. Which means, too many times it says we're lying, when we're not. There are ways to beat polygraphs. There are variables that interfere with producing reliable results. They're not admissable in court and with good reason.

BS #6: All homophobes are secretly gay.

Fact: Again, no real evidence supports this widely circulated belief. People who hate or fear homosexuality report a range of reasons. Yes, there are some who are secretly harboring homosexual impulses and they are too ashamed to deal with it. But there are others who rant and rage for the effect or because they've grown up being fed a lot of negative messages about gays and lesbians, not because they're deep down attracted to same sex individuals.

*refers to what is widely believed in the psychological community at this moment in time.

Image source: John Malkovich in Burn After Reading (see it for his performance alone).

Sandy Andrews, PhD , Clinical Psychologist and Psychotherapist in Austin, Texas

August 4, 2009

Are you Shoulding on Yourself Again?

In the cognitive part of cognitive behavioral therapy (CBT) we look for thinking patterns that get in the way of healthy feelings and behavior. Thoughts associated with unhappy feelings.

Sad, anxious, angry, shameful, hurtful feelings.

One of the easiest thoughts to identify and change are those that contain the word "should."

Should statements, as they are called.

You should go check on your neighbor. He hasn't been out much lately.

I should
exercise more.

She shouldn't talk to her in that tone of voice.

Should statements are one form of automatic negative thoughts, or ANTS. Should implies that someone has done something wrong. Or bad. That someone behind you is shaking a finger, going, "tsk, tsk, tsk, bad person."

The shoulds are often immediately followed by subtle feelings of shame and guilt. Sometimes not consciously detected. But it's there. The essence of it. Building up throughout the day, if you happen to be a daily should-er. Many of us use should statements dozens of times a day, if not hundreds. Out loud or silently, to ourselves.

I should be able to figure this out.

She should be more careful.

You should buy the red sweater.

Shoulding on oneself. Shoulding on others.

The examples above aren't all that toxic, granted. But the effect is insideous. Disapproval. Judging. You're doing wrong. I'm unworthy. These feelings can add up. At the end of the day, we feel more stressed out. More hostile. More _____ (fill in the blank with an unpleasant feeling). Its cumulative. It adds up. I know this personally. I know this professionally.

Even the innocuous, commonly heard response to receiving an unexpected gift, "You shouldn't have!" It delivers an entirely different message when, instead, we say, "You are so thoughtful. Thank you."

How to remedy this common thinking error? In some cases, change should to want. Or wish. Or like.

I want to figure this out.

I wish she would be more careful.

I like the red sweater. I hope you buy that one.

The idea is to change the negative, judgemental idea to something with a positive message. Or more positive. More upbeat. More hopeful.

Below are a few examples that are a little more toxic. Try to change them yourself.

You should watch what you eat.

He should take better care of his car. We're not made of money!

I shouldn't be having these thoughts. She just died, afterall.

And how about the image at the top of this post. Vanity Fair cover of teen television star, Miley Cyrus, aka Hannah Montana, of Disney Channel. Does this image of a 15-year-old bring up a should statement or two?

I don't know about you, but I feel slightly better when I say, "I wish young stars (and their agents) didn't feel pressure to pose in such a sexually suggestive manner." Instead of, "She should not be posing like that. What were her parents thinking?"

July 24, 2009

Working Out. Must Have Music.

When I work out, which is to say, when I climb on top of a stair master type contraption in order to get my aerobic exercise, I must have music. Or, better put, I greatly prefer to have music.
These days it's a small mp3 player. No, not an iPod. I can't afford one of those. Only my kids can. Go figure.

Working out with my favorite tunes, selected for their fast paced beat, I get a better workout. I don't think about how tired I feel, or how hard I'm breathing, or how my heart feels like it might explode out of my chest. The music entertains and distracts me. I work out longer and harder.

Today I got to the gym only to discover that I had left my mp3 player in my gym bag, on my kitchen table. Damn. It's always something that gets forgotten. If it isn't my towel, it's my bottle of water. Today it was my music.

I also like to read when I work out. Music plus reading material. I'm in that bad of shape, ya'll.

So I did remember my reading glasses. I grabbed an Oprah Magazine, picked a stairmaster that had one of those plexiglass book holders, found an empty eliptical machine between two gym rats, climbed on, hit QuickStart, and away I rode.

It was then I discovered another reason why I prefer earphones. The guy next to me.

My earphones block the sound of nearby exercisers. Heavy breathing, throat clearage, coughs, sputters, growls, grunts, and groans. And then there was the piped in muzack. Loud enough to be a nuisance, not loud enough to be of any incentive.

Reader, what helps you get a better workout?

July 5, 2009

night owls get a name and a test

One evening while walking along a pasture, I looked across toward a giant live oak tree. In the tree sat three large owls. They were perched on two branches, all in a cluster. They made the most picturesque silouette. Still as statues, all facing east, the sun setting behind them. Three sentinels waiting for the darkness to decend, harbingers of a post I had been working on about night owls.

I have long believed I am a night owl. Or as sleep experts would now say, I suffer from
Delayed Sleep Phase Syndrome (DSPS).

"Delayed sleep phase syndrome (DSPS) is a disorder in which a person’s sleep is delayed by 2 or more hours beyond the socially acceptable or conventional bedtime. This delay in falling asleep causes difficulty in waking up at the desired time...Most with DSPS describe themselves as "night owls" and say they function best or are most alert during the evening or night hours. If they were to keep a sleep log it would show short sleep periods during the school/work week (with few or no awakenings during the night) and lengthy sleep-ins (late morning to mid afternoon wake up times) on the weekend."

I can remember struggling with insomnia when I was in grade school, lying awake at night singing to my menagerie of stuffed animals. In high school, the singing was replaced by listening to late night radio, The Dr. Dimento Show being one of them. Due to my difficulty waking in the mornings, I was often late to school despite a five minute walk.

It seemed to become more pronounced over time. In college, as I chose my courses (no morning classes, thank you). In graduate school, I wrote the bulk of my dissertation between 10pm and 4am.

When I was offered a job in a psychiatric hospital I was told by the HR staff: "The only problem is that the hours are 4pm-10pm."

Problem? What problem? I loved it. I earned extra pay for late shift, even. I left my job in plenty of time to hit the college pubs, which really didn't get hopping until 11pm anyway. Close the place down and sleep in. Ahhhhhhh. Fit me to a tee.

I recall feeling energetic during this period of my life. I exercised enthusiastically. Typically a walker, I started to jog.

I knew this nirvana night schedule couldn't last forever, though. Eventually I did a one year internship at a medical setting, for example. It required the standard 8am-5pm hours. Oh dread. It about killed me.

But I was hopeful, deciding this was a good experiment: early morning wake up call, everyday, for a whole year. While it did get a bit more tolerable once I caved to the earlier bedtimes, it never, ever, EVER, felt easy. Or natural. I hated mornings as much as always.

So this confirmed night owl wasn't exactly surprised when she learned that researchers identified a particular gene, a mutation, they call it, that determines circadian rhythm. But she did feel vindicated. No, I'm not lazy. No, I wouldn't wake up easier if I'd just go to bed earlier. Okay, well maybe that one is true.

Naturally it's described as a mutation, rather than a variant of normal. But that's okay. I, and plenty of other night owls, have lived our lives feeling like we missed the normal boat.

Back to the gene. The night owl gene was first identified in a
mouse, and later in more mice.

This mutation was kindly named the "after hours gene" (AFh). Very aptly named, I would argue, since it's a universally accepted, scientifically verified truth that things happening "after hours" are way more fun and exciting than things happening, say, at 7am (snore).

Everyone wants an invitation to the after hours party, right?

And now one more giant step for night owls. It's been announced there is an official
test we can take, a simple mouth swab, to determine if we are, in fact, a morning lark or a night owl.

For more information about night owls, check out the DSPS blog.

Image source: owls, here.

June 26, 2009

cognitive behavioral therapy, 101

I get a lot of phone calls from new clients who want to schedule with a therapist who specializes in Cognitive Behavioral Therapy (CBT). They've been told by their doctor, attorney or friend to seek out CBT but they don't know what it is, exactly.

I welcome these questions. When clients are more informed about their treatment, they tend to feel more comfortable in our sessions and do better when they get home. And I don't believe clients who ask these questions are dummies, just so you know (I can't speak for the authors of the book). I expect that most people have little idea what CBT is and I'm happy to explain.

CBT refers to two different components: Cognitive is the thinking part of therapy; Behavioral is the doing.

Very simply, CBT aims to help us change how we think and change how we behave. To recognize patterns of thinking that lead to unpleasant
feelings. To change what we do so that we feel better more of the time.

The example I give most often: You're depressed because you've gained a lot of weight. You feel hopeless about ever losing the extra pounds. Your depression leaves you feeling unmotivated to exercise more.

The cognitive piece of CBT will help identify faulty thinking patterns
that contribute toward gaining weight and feeling depressed:

"I'm never going to lose this weight. Why even try? I give up."
"All I can think about is food."
"I deserve to eat this dessert."

"I can't stand how I look."
"I feel just awful."
"I want to crawl into bed and stay there."

The behavioral component will help identify small changes in behavior that will help you reach your goals (exercise more, eat less). Tweaking the goals in such a way that you are more likely to succeed. Small, doable steps replace lofty, out-of-reach goals.

There are many common, nearly universal thinking patterns that I listen for and teach my clients to hear within themselves. And to change. We'll get to those in later posts.

1st image source here
2nd image source here, but originally found here

June 11, 2009

mars and venus and all that

Questions by my "single and looking" clients that leave me most bewildered go something like this:

"He gave me his phone number. What do you think he meant by that?"


"Do you think that means she wants to go out with me.... or not?"

According to the old school rules of dating, women are supposed to play hard to get and men are supposed to ask a woman straight out, right? And that mars and venus guy? Even he tells us we're looking for different things in a relationship.

Does any of this conventional "wisdom" hold true?

Wisdom, by the way, is codeword for advice given by people who have lived a whole lot longer than you but really have no clue how the dating game is played, either.

But thanks to a couple of dating studies summed up by the good people at BPS Research Digest we don't have to rely on antiquated advice. And we may now be able to say that we are finally beginning to meet up on the same planet.

In 2006 researchers studied what types of come-on lines women see as most effective when a man is trying to show he is interested.

Women, according to this study, are positively swayed when men demonstrate their helpfulness, generosity, athleticism (really? this works?), "culture" and wealth (again with the really?). They are unimpressed by jokes, empty compliments and sexual references.

And how about the guys? What works for them? A 2009 study found that men are most convinced when women use straightforward forms of communicating compared to more subtle lines. So the direct, "Let's go out sometime," is seen as more effective than the indirect, "Is that an iPhone in your pocket or are you just happy to see me?"

And here's where the common planet comes in. Neither men nor women find sexual humor and innuendo to be all that helpful in figuring out whether to expect a follow up phone call. Or text. Or email. Or Facebook friend request. Let alone a date for Saturday night.

So according to the latest in dating research, if you are really interested in a particular someone you are chatting up, here's some potential applied advice.

Women, you might say something like this:

"Want to go out sometime?"

And men, you would say something like this:

"Thanks to my speed and strong throwing arm (athleticism), I caught a little old lady (helpfulness) who stumbled in my Buddhist meditation class (culture). She was so appreciative that I offered her a ride home in my Porsche (wealth) and donated a sizeable chunk to her charity fundraiser (generosity)."

And then you would suggest a night on the town.

Actually, I added that last piece of wisdom. Because it kind of seals the deal, doesn't it?

If you want to read these studies for yourself, in their entirety, you can either go to your nearest university library and look for the journal called Personality and Individual Differences, or, click on the links below and pay $31.50 each to purchase the studies online. You can also read a more in depth explanation here at PsyBlog.

Bale, Christopher, Morrison, R., & Caryl, P. G. (2006). Chat-up lines as male sexual displays. Personality and Individual Differences, 40(4), 655-664.

Wade, Joel T., Butrie, L., & Hoffman, K. (2009). Women’s direct opening lines are perceived as most effective. Personality and Individual Differences, 47 (2), 145-149.

Image source: Oil on canvas by Illingworth, 1971, found here.

June 3, 2009

male or female therapist?

I am often asked by someone who has decided to seek out therapy whether to select a male or female psychologist. Psychologists discuss this very question among themselves because professional opinions vary.

My answer is typically that it's really up to the preferences of the individual. It's a very personal decision. Some people think they would feel more comfortable with one gender or the other.

Women often tell me they prefer to see another woman. They think they would feel more comfortable sharing the frank details of their lives with a woman, particularly when sexual issues or a history of sexual victimization are involved.

Choosing a psychologist or therapist is not unlike choosing an ob-gyn. Some prefer a doctor of the same sex believing she will be more understanding and knowledgeable because she's been there.

Or like choosing a massage therapist. Some people want to avoid any semblance of a sexual vibe. Whether that points to a male or female therapist depends on you and your inclinations.

Many guys prefer female therapists. They find it easier to open up to a woman. There aren't many settings where men allow themselves to be emotionally vulnerable in front of other men. They don't want to start on the couch.  Or maybe that is exactly what they are after.  The ability to relate on a more emotional level with another man.  

Sometimes the preference depends on experiences growing up. I recall one friend who had a particularly critical father. She decided to go with a female psychologist. She didn't want to start out fearing or assuming negative judgements.

Other times our adult experiences shape our preference. An abusive female boss may lead a patient to choose a male therapist. Again, to avoid feeling judged. This is often referred to as "negative transference." When we make assumptions about or react to a therapist in a negative way because she reminds us of someone we don't like.

Sometimes it makes sense to choose a psychologist who is the same gender as the abusive or critical parent. Give yourself a chance to feel accepted, to feel comfortable with and understood by someone of the same gender as the critical parent. Therapy, for many, is often, in part, a re-parenting experience. Where the parent figure, this time around, accepts us for who we are and the decisions we have made.

I've been in the position of conducting psychological evaluations for children in need of therapeutic intervention and asked whether the child should see a male or female therapist. I recall one boy who had repeated negative experiences with various males in his life. I suggested a male therapist to help the child gain a positive, nuturing experience with an adult male. To help undo.

So it really just depends on the preferences and experiences of the patient. Of course, one of the most important considerations in is the expertise of the therapist. How experienced and expert they are at therapy. Feeling comfortable with the therapist is another. Does it feel like a "good fit?" Do we seem to "click" when we're in session? And no one will be a better judge of this than you.

Sandy Andrews, PhD  is a Clinical Psychologist / Therapist who provides CBT in Austin, Texas  

May 11, 2009

first session: what to expect

Clinician's differ to some degree, of course, but the first session is generally part "getting to know you" and "getting you to sign paperwork."

After the initial forms are signed, very often therapy begins with me explaining a little bit about my practice, my theoretical orientation, as it's called, which means the type of therapy I use in treating patients. I suggest my clients Google "Cognitive Behavioral Therapy" or CBT to learn more about my approach. A well informed client often has a head start in healing. I encourage questions throughout our meetings.

Then I move on to asking for a brief description of the "presenting complaint." What problem area brings the client into therapy?

The moment we've all been waiting for.

Sometimes I get pieces on the phone but will want to hear about the therapy issues in greater detail. This is where the box of tissues might come in handy.

From there I begin an evaluation that could take one to three full sessions.

I like to get the following, give or take:

- a history of previous therapy, counseling and psychiatric visits; what felt helpful; what didn't

- medical history including prescription medications, over the counter, nutritional supplements

- family of origin including history of mental illness

- education and work history

- relationship history: who have been the most significant romantic relationships and friendships

- trauma history

- current symptoms

- expectations and preferences for treatment; for example, individual (one on one), couples or family therapy; this could also include specific therapy expectations, such as a request for dream analysis or stress management skills

Not all mental health clinicians will begin this way. I cannot speak for all therapists, but most psychologists (who must have a Ph.D. in a psychology field as well as a list of other requirements) have been instructed (or should have been) to be thorough in assessment, diagnosis and treatment planning.

If you are contemplating starting therapy and wonder what you can do to help move things along, thinking about your family history can be a plus. Many people prefer to keep their therapy quest private and that's understandable. But filling in the blank spots of the "who's who" in your family of origin can help the therapist in the diagnostic process. Any parents, grandparents, aunts, uncles, siblings, cousins who have been diagnosed with a mental health condition? Someone who has been prescribed psychiatric medications? Antidepressants? "Nerve pills?" Has anyone had a "nervous breakdown," an unofficial term that can range from a depressive episode to a psychotic break? Blank spots are not uncommon and can be worked around.

The important thing is showing up, being yourself, asking questions, thinking about goals, being willing to consider recommendations, and trusting that this can work, that you can find a caring, listening, non-judgemental ear, and ultimately you can feel better.

April 28, 2009

begin at the beginning

Greetings. This is my first post at "blogging behavioral." I hope this is the start of a long and satisfying ... oh, forget all that. I'd like to get right to it.

So are you ready for something truly original? I shall begin ... at the beginning.

Which is the first session.

Many people express nervousness and uncertainty at the thought of their first therapy session. They do not know what to expect and are understandably wary.

Some people have never sat in a room and disclosed private details to a stranger, professional or otherwise. It can feel daunting, at the least. What will I say, exactly? How will I start? How do I ease into potentially embarrassing details? Do I just spill my guts or do I start with the healthier aspects of my functioning?

People worry, in other words, about forming a good impression in the midst of sharing the troubled chaos that has become their life. It's not easy walking into a situation where the emphasis in on our low-lights.

Some are worried about intense emotions expressed during the initial session. It is not uncommon, for example, for clients to shed tears very early on. I often hear something dismissive, like, "I don't usually cry like this." Or, "I'm sorry. I don't know why I'm crying."

But I do. I understand. I expect it. And for this I am prepared. With the most critical tool in my therapeutic arsenal: a box of tissues. I consider this emotional outpouring a normal part of the therapy process.

Most people enter therapy because they have an overwhelming amount of emotional distress. Predictably, and typically out of necessity, they want to unburden. As a professional, I welcome this. There is no judgement.

Next post, I will talk about what a patient can typically expect from me as part of an initial evaluation.

Image source, here.