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