Studying and learning can take you so far in life yet it can feel so hard to get down to it. Whether it’s college study or you need to be studying to advance your career; studying can be one of the most important things you’ll have to do.
Difficulty staying focussedon the assignments is the major complaint among students.
You can have all these distraction/displacement activities – stuff you do instead of getting down to studying or finishing your writing assignments.
“The moment I sit down to start on my essay, I feel like to doing something else… like feeding the cat or calling a friend,” says Maggie, 23.
Self-control is hard…
Practicing discipline and self-control is a logical step in getting anything done to completion. This is, however, much easier said than done.
Oftentimes, pushing oneself with self-discipline is painful and futile. The experience can feel like swimming in a river against strong current. A the effort builds up, we feel overwhelmed and “drowned” in the work.
Getting to know the currents you’re swimming against makes you more productive
A swimmer who takes time to study the current before he/she gets in the water saves him/herself the stress of the fight against opposing forces.
Similarly, if you’re finding yourself fighting with getting important things done, it is well worth the effort to consider this: What are the opposing currents that keep you from the tasks?
To find the answer, is to work towards awareness of the self.
If you’re working alone, do some meditation before embarking on the task. Feel deeply in your body for points of tension and stress. Breath into these parts, and try to relax. If memories or flashbacks pop into your head, allow them to happen without judgement. Observe yourself with understanding.
Getting support from a counsellor or psychotherapist is an effective way of overcoming issues related to hinderances in getting important tasks done.
What My Study Motivation Coaching Sessions offer:
Individual Personality Assessment using the Enneagram Method.
Identifying emotions / thoughts and bodily sensations that precede distractive thoughts.
Identifying emotions / thoughts and bodily sensations that cause lack of motivation or feelings of insecurity in getting the assignment done.
Assignment-by-assignment emotional guidance.
Raising academic performance through time and space planning.
Number of sessions needed and intensity of sessions depend on individual needs.
Contact for Information and/or appointment:
Price per 45 minute session (in English and German): EUR 68.
Sessions are also available over Skype.
This article is a reflection on the lecture series on the topic of addiction. The focus here is that of nicotine addiction.
Nicotine addiction seems less serious to law enforcers than addiction to other “hard substances” like opioids, for example. However, for the many persons who need to quit the cigarette for health reasons, addiction is an important issue. This short paper addresses some of the different aspects of nicotine addiction that warrant attention. Through this overview, we can appreciate how one “habit” transcends over many fields of science, and how psychotherapy, within these fields that can support cessation.
The Social Norms of Smoking Initiation
The habit of cigarette smoking is observed to be most often developed during adolescence. Qualitative studies were thus conducted by Peters, et al. (2005) involving high school students who are smokers, regarding the latter’s beliefs in smoking initiation and nicotine addiction.
Questions posed to the subjects were like, “who was with you the first time you smoked?”, to which the answers were largely peers and family members of the same age-group like cousins. Smokers from both genders regard “curiosity” and “peer pressure” as motivation for starting the habit, while for boys, the added motivation is for “cool / image”.
Other means of modelling and encouragement given to teenagers as motivation for initiation of smoking are:
Self medication and coping: “My parents were arguing so I went in her car and saw her cigarettes there, I wanted it to calm me down” and “Because I was having problems at my house and my friend told me if you want to feel better you should start doing it.”
Peer Pressure: “Because someone asked me if I have ever done it”, “because he (boyfriend) kept telling me try it, try it” and “because everybody was smoking one at the bus stop.”
Curiosity: “We were just curious”, “something to try” or “I was curious to see if it was an effect.”
Other Modeling Recurrence: “Because I saw my friends doing it”, and “Because everybody else was doing it, so I wanted one.”
The majority of the subjects revealed that the next time they smoked after the initiation is within 48 hours of the first smoke. This recurrence of smoking crystallizes the behavior into an addiction:
Craving/Withdrawal: “I was craving it and I wanted to be with my friends”, “I had to have another cigarette”, “When they are shaking.”
When asked “how long does someone have to smoke before they are hooked?” The first 3 times emerged as the most frequent response from the subjects. Most subjects also say that one pack or less is all it took for them to get hooked on the smoking habit. This is also the topic of question for Birge, et al. (2017), “What proportion of people who try one cigarette become daily smokers?”.
At the mention of “being hooked on the habit” or eventually “becoming daily smokers”, it is interesting to also note that it may not necessarily mean that the subjects were actually spontaneous addicted to the substance, nicotine, per se. This would have only been clearer had the subjects who were just initiated, were induced to try to “quit” after the 2nd, 3rd (and so on) smoke after initiation.
Smoking Regularity and Nicotine Addiction in Adolescence
Selya et al. (2013) worked on the little-known time-varying effects of smoking quantity and nicotine dependence on the regularity of adolescent smoking behavior. The findings indicated that, in adults, smoking quantity and extent of nicotine dependence is significantly related to regularity of smoking during adolescence. Nicotine dependence is found to increase over time as the effects from regularity of smoking decreased with time. This indicates implicitly also that the initial phases of smoking have more significance in causing nicotine addiction.
A Brief Neurobiology of Nicotine Addiction
From the above studies alone, one gets the impression that, for adolescents at least, smoking is an addictive habit from the beginning. What is not so clear is to what extent, and which time frame does the biological effects of nicotine take over the psychological need to light up a cigarette. The students cite mainly psychological factors (e.g. image and peer pressure), rather than physical factors (e.g. pain management) in getting initiated to smoking.
Nicotine molecules target neuronal nicotinic acetylcholine receptor (AChRs) of cells, in particular neurons. Activation of these receptors is involved in a chain reaction that regulates the system related to dopamine (the dopaminergic system). Consuming of Nicotine regularly causes an “up-regulation” of these receptors. This means that the cells are genetically stimulated to produce more or more effective AChRs receptors. This change in biological structure in neuronal cells changes the normal homeostasis of the intercellular environment of the brain. This process of up-regulation is known to be responsible for the initiation of nicotine dependence (Ortells & Arias, 2010).
The motivation for smoking, like other drugs and addictive behaviors, relies on neurons in the brain’s reward system, based in a brain region called the ventral tegmental area (VTA). Obtaining a reward leads to excitation of these neurons and the release of a neurotransmitter, dopamine. Dopamine transmission from the VTA is critical for controlling both rewarding and aversive behaviors. The degree to which the reward system can be activated is normally tightly controlled by a neurotransmitter called GABA which inhibits excitatory signaling in neurons and keeps the system in balance. Figure one pictorially represents how the main neurotransmitters are held in homeostasis in living cells (in particularly the brain). When a substance like nicotine affects the effects of a neurotransmitter— in this case, Acetycholine— the system would adjust itself to regain balance. Chronic exposure to nicotine leads to the cells adjusting permanently to the imbalances. Such changes are adaptations that occur at a genetic level (since it involves receptors, which are proteins). When the addictive substance is no longer in the system, the imbalance caused by the adaptation would be felt.
Figure 1: (Tretter, 2018)
Researchers have also discovered enzymes that disinhibits dopamine neuron action with chronic nicotine exposure (Buczynski, et al., 2016). Pointing further to the biochemical action of nicotine that leads to the addictive phenomenon.
Nicotine Effect on Metabolism
The negative side-effect of smoking caused by tar and “smoke pollution” (figure 2) that causes lung damage is well known and quite easily grasped. However, the effects of nicotine in itself on the biological system – especially on the metabolic system— is relatively not well understood by the general public. This has likely given rise to the misconception that chewing nicotine or smoking nicotine vapors are the answer to countering the negative health effects of smoking. In fact consuming nicotine only adds to the metabolic issues in the body.
Figure 2 (Ambrose & Barua, 2004)
The effects of cigarette smoking on metabolism is illustrated through a recent Japanese study by Kang, et al. (2009). Fasting blood insulin, glucose and lipid levels were measured in 2 groups of women. One group consisted of regular smokers and the other non-smokers. Fasting levels of these substances are indicative of the efficiency of the metabolic system. During fasting, insulin levels and glucose levels in the blood should ideally be low. Since there is no food entering the body during fasting, one would expect that glucose that had entered the blood from the previous meal to is already removed from the blood stream. The hormone, Insulin, is produced by the Islets of Langerhan cells of the pancreas immediately during food consumption to signal to the other cells in the body that glucose released into the blood from digested food needs to be quickly removed from the blood. High levels of glucose concentration in the blood is toxic to the body, and this process of insulin release is a form of homeostasis. During insulin release, fat cells convert glucose to fat, muscle cells convert glucose to glycogen, and cells stop releasing glucose (gluconeogenesis) into the blood stream. After a period of time, the blood glucose level is supposed to be lowered, and Insulin levels in the blood will drop to safe levels (Eckel, Grundy, & Zimmet, 2005).
As with the above study by Kang et al., when comparing the blood profiles of the group of cigarette smokers with the group of non-smokers, the results showed significantly higher mean Insulin and blood glucose levels while lower mean high-density lipoprotein (fats molecules) in smokers as compared with non-smokers. This indicates that nicotine affects the functionality of Insulin by making this hormone inefficient in reducing the glucose levels in the blood. With nicotine, fat cells do not respond as effectively to insulin by storing fat, muscle cells do not respond as effectively to storing glycogen, and cells do not respond to Insulin as effectively to inhibit gluconeogenesis. So blood glucose after meals take longer time to return to safe levels, causing more Insulin to be pumped into the blood. This conditions mimics that of type 2 diabetes or metabolic disorder.
There are many papers that have highlighted the link between smoking and cardiovascular-related illnesses. The above study is an example that explains to us that nicotine affects blood glucose regulation and the function of insulin. Impaired blood- glucose regulation is related to a pre-diabetic condition also known as insulin resistance.
Weight Gain and Smoking Cessation
A better-known cause of insulin resistance is not smoking, but high carbohydrates and/or alcohol in the diet coupled with sedentary lifestyle. However, cessation of smoking leads to a “similar” phenomenon of gaining weight. This phenomenon is unpleasant, and it is a signal that nicotine consumption messes up the function of insulin in glucose metabolism.
Figure 3 is an illustration from a paper by Nogueiras et al. (2015) that examines the biochemical link between insulin resistance and nicotine use. If more attention is paid to educating the general public (and doctors) on metabolism, the medical field can perhaps help people with smoking cessation.
During cessation, nicotine is suddenly “deprived” in the system, fat cells no longer become insulin resistant (which is a good thing). Fat cells start to “hear” the insulin signals, and mop up the glucose from the blood (also a good thing). Since there is excess insulin in the blood, blood sugar levels become very low and fat cells begin to hold on to the fat (which causes one to put on weight).
It could be, that one possible way out of this situation is to maintain a very controlled diet that does not cause more insulin to be released in blood. Since Insulin is mainly triggered when sugars enter the blood stream, it might just be that a very low intake of carbohydrates may be the answer. With time, the body would cope by producing less insulin. Less insulin means that the fat cells do not absorb more sugars but actually start to burn off the fat. This is how the biochemical aspect of metabolism becomes paradoxical and really interesting, but this is a big subject in itself.
Figure 3 (Nogueiras, Diéguez, & López, 2015)
Smoking addiction begins with the initiation at mainly adolescence, which opens up a whole potential field of education, and psycho-social influences. There is also biochemistry. Biochemistry is many-factorial and complex. There is the harmful effects of tar and other chemicals other than nicotine.
Nicotine, being known as the addictive substance is significant to the field of neurochemistry and pharmacology. What is interesting and important is nicotine on metabolism. This could be relevant in psychotherapy, since it involves lifestyle and effects of hyperinsulinemia or a diabetic-like situation. Hyperinsulinemia is incidentally linked to as well to depression (Löwe, Hochlehnert, & Nikendei, 2006) (Vogelzangs & Penninx, 2007).
For psychotherapists, this is a common addiction of functioning (and also paying) clients. Knowledge of the different aspects of this addiction lends itself to a multifaceted way of providing therapeutic support.
Ambrose, J. A., & Barua, R. S. (2004). The pathophysiology of cigarette smoking and cardiovascular disease: an update. . Journal of the American college of cardiology., 43(10), 1731-1737.
Birge, M., Duffy, S., Miler, J. A., & Hajek, P. (2017). What Proportion of People Who Try One Cigarette Become Daily Smokers? A Meta-Analysis of Representative Surveys, . Nicotine & Tobacco Research.
Buczynski, M. W., Herman, M. A., Hsu, K. L., Natividad, L. A., Irimia, C., Polis, I. Y., & Roberto, M. (2016). Diacylglycerol lipase disinhibits VTA dopamine neurons during chronic nicotine exposure. Proceedings of the National Academy of Sciences, 113, pp. 1086-1091.
Eckel, R. H., Grundy, S. M., & Zimmet, P. Z. (2005). The metabolic syndrome. . The lancet, 365, (9468), pp. 1415-1428.
Kang, Y., Imamura, H., Masuda, R., & Noda, Y. (2009). Cigarette Smoking and Blood Insulin, Glucose, and Lipids in Young Japanese Women. . Journal of health science, 55(2), 294-299.
Löwe, B., Hochlehnert, A., & Nikendei, C. (2006). Metabolic syndrome and depression. . Therapeutische Umschau. Revue therapeutique, 63(8), pp. 521-527.
Nogueiras, R., Diéguez, C., & López, M. (2015). Come to where insulin resistance is, come to AMPK country. . Cell metabolism, 21(5), 663-665.
Ortells, M. O., & Arias, H. R. (2010). Molecular mechanisms of nicotine dependence. Journal of Pediatric Biochemistry, 1(2), 75-89.
Peters, R. J., Kelder, S. H., Prokhorov, A. V., Meshack, A., Agurcia, C., Yacoubian, G., & Griffith, J. (2005). Beliefs and social norms about smoking onset and addictions among urban adolescent cigarette smokers. . Journal of psychoactive drugs, 37(4), 449-453.
Selya, A. S., Dierker, L. C., Rose, J. S., Hedeker, D., Tan, X., Li, R., & Mermelstein, R. (2013). Time-varying effects of smoking quantity and nicotine dependence on adolescent smoking regularity. Drug and Alcohol Dependence, 128(3).
Tretter, F. (2018, Feburary). Neuroscience and Genetics. Private lecture at the Sigmund Freud University. Vienna, Austria.
Vogelzangs, N., & Penninx, B. W. (2007). Cortisol and insulin in depression and metabolic syndrome. Psychoneuroendocrinology, 32(7), p. 856.
What can you expect from your couples therapy or marriage counseling session? In this article I shall endeavor to give you an overview on psychotherapy with couples in my practice.
I am influenced by the principles introduced by Bob and Rita Resnick, who together with their faculty of GATLA have been my mentors for many years. I have personally experienced their work by being a model couple at a workshop in Slovenia, 2015.
“Two becomes one, and then there is none.” Bob Resnick
This quote explains how almost all relationships begin with blissful passion only to evolve with time into something less — often much less.
Falling in love involves meeting a person different from ourselves
Falling in love is about meeting someone, and realizing a “chemistry” with that person. In love, all you want to do is to be with the person to feel his or her presence. There exists interest, curiosity and need. This is a time of exploration and fun. Sometimes it is also a time of anxiety of being with someone new. These emotions make us feel fresh and somewhat alive.
Two becomes One
Passions fade with newness. How come?
As the relationship progresses, two very different people become more and more alike. This seems to be a “natural” process in most intimate relationships. “Successfully” married (especially elderly) couples, often look and act like each other, oftentimes even being able to read each other’s minds and/or finish each other’s sentences. For that reason perhaps, we’d think that “two becoming one” is the path to take in relationships.It , after all recited in most marriage vows.
…then there is none
Resnick argues, however, that when two become one, there’d be none. The passion arising from the meeting and the curious exploration of two different people is doesn’t exist anymore, when these two different people become the “same person”.
It would then seem like an ideal if both persons in a romantic relationship can stay together as unique individuals, different from each other.
Changing the Other or Changing for the Other
With attachment comes reliance. There is mutual responsibility attached to serious relationships. We need this kind of mutual responsibility. Caring mutual responsibility is healthy.
What unfortunately gets mixed up with caring responsibility, is the idea that we have to give up our needs altogether, or that the other person is expected to give up his/her needs likewise.
With personal needs unmet, both parties begin to make silent demands on the other. This circle of needs and demands go unnoticed in the undercurrent of the relationship. There is dissatisfaction as one tries to change him/herself to fit into a relationship role, and there is conflict when one tries to change the other person in to his/her role.
Maintaining a Mutually Nourishing Relationship
To be ourselves and to be with the other. To be for ourselves and to be for the other. To be taken care of by the other and to be take care of the other. Movement between being for ourselves and being with the other is the premise of a mutually nourishing relationship.
Oftentimes, though, we are not moving, we are really stuck.
We can only “be ourselves” if we are aware of who we are. We can only be well taken care off, when we are fully aware of our own needs. We can be for the other only if we are able to listen to what the other person is saying. Without awareness, both parties can only rely on guesses, expectations, silent resentment, and conflict.
Couples Therapy Approach
When couples come to the practice, the “client” is the relationship. Relationship functions through communication. Couples therapy will then be centered around communication between two persons in the relationship.
Questions to ask are: How do we perceive our needs? How do we express what we want? How do we hear the other? How do we react to the other person’s needs? How do we compromise? What do we want the other person to know? How important is the relationship to us? Who are we? …
During therapy, an assortment of themes arise. The focus is on how the couple deals with these themes. How do they communicate with each other in situations. The focus is on dialogue.
Each person gets his/her space and voice. The background of each person in the relationship is considered, validated and heard. What has he/she been through? What is he/she going through now? What do both persons want for the future?
Contact me if you have questions regarding Couples Therapy
This page features a collection of video lectures on the subject of self harm orNon-Suicidal Self-Injury (NSSI) and it’s connection to emotional pain. These resources, I hope, will provide some personal and professional answers in dealing with, or appreciating the phenomenon of self harm.
The aim of this learning is to bring awareness of what is possible and what is needed to assist others with the same issues. Self harm is a behavior to be respected, because it serves the person. It is also a behavior to be taken seriously, and with compassion.
Willis, J. on “Bullicide”
Willis tells us about the impact of bullying on people who self harm. He also explains with neuroscience that both physical and emotional pain activates the same area of the brain.
Lewis, J. on his personal experience with self harm
Lewis’ sharing of his experiences of self harming may resonate with many people. As in the above video, bullying is known to be a trigger for self harm. Lewis tells us of the value of loving people who are suffering from emotional pain.
Working with Self Harm in Psychotherapy
Self harm is a clear indication of the need to cope with un-bearable emotional pain. The most important aspect of treating clients who have learnt this coping strategy is to authentically respect the person, what he/she does and feels.
The therapy sessions will then deal with the emotional turmoil that underlies the need to self harm. Therapist and client work together to understand the origins of difficult feelings. Reminiscing past experiences in a secure therapeutic environment bring up emotions attached to these experiences.
As Lewis explains, it is the cutting that silences the emotions. Therapy brings the voice back to these emotions. This voice is also heard by the therapist who respects the process.
Scapegoating is a phenomenon that happens in almost all human groups. A. Colman (video below), begins the above talk by saying that it is the root of evil in humanity. Is he exaggerating this? Or are there truths in his remark?
What makes a group?
A group is made up of a bunch of individuals (and we are referring to human individuals here), who have to be together because of a certain task or function. A company of workers is a group. There are social groups, church groups, political groups, hobby groups, support groups and the like. Families are also groups.
In my article Bion: The Function of Myths in Groups, I explain that a group is a body that has a mental state and creates a phantasy. The group becomes more than the sum of people that come together to form it. The group has its own dynamics and it is its own organism.
Groups are like organisms, and they strive to keep themselves intact
The group connects the inner worlds of people. Narcissistic tendencies and psychological traumas get played out in groups. Like a living organism, the group strives to keep itself intact.
In order to do so, any form of aggression that naturally and unconsciously arises from the group becomes a threat to the status quo of the group. There is a tendency then for the group to move towards “doing something” to maintain harmony and equilibrium. The individuals then strive to retain their own idea of their “good self” and deny their part in the aggression that threatens the group.
Groups need scapegoats so that the members can disown their responsibility for the group’s destruction
The aggression that is latent in the group becomes disowned by the individuals (who do not want to be blamed for their group’s destruction), and transferred on to an external object of blame. This object of blame is the scapegoat.
Oftentimes the scapegoat is a member of the group. Sometimes it appears in the form of someone from outside the group– people from another culture, immigrants, women, etc.
Scapegoating in Groups
Scapegoating is the most ancient human rituals. It used to come in the form of practices such as child & animal sacrifice, adult sacrifice, witch hunting. Large groups of people can also become scapegoats, as we have witnessed during the Holocaust, Apartheid, and other genocides.
A Scapegoat is a person, subgroup, collective idea … who is made to take the anxious blame for the other people in their place.
The process of scapegoating is done in order for the rest to feel more comfortable, or to be more efficient, and whole.
The scapegoat embodies the transformational, creative and/or destructive potential within the group.
The scapegoat has often creative potential, and is often different from the others in the group. Sometimes this person has the potential to make changes in society.
Scapegoating is victimization of the other
Many who have been young victims of bullying in school or in the family have experienced from a young age, what it is like to be in the position of the scapegoat.
The scapegoat is usually the different / outsider. Not being able to bear the difference. Potential scapegoats are usually people who are racially different.
In order to survive being scapegoated, the person either turns into the
victim /patient (as in children who develop illnesses or develop behavioral problems in school).
avenger (someone who takes revenge)
the messiah / prophet (someone who saves the group)
09:10 Colman, in the video above provides us with literary examples of some of these scapegoat transformations.
In Families, the child who becomes the Scapegoat is also the Symptom Bearer
Scapegoating happen in almost all families. Most of the time a child in the families bears the brunt of the scapegoating. If the family is relatively harmonious, the scapegoat feels simply like a “black sheep”, and grows up to be an adult who can function well.
In families that are dysfunctional, or in families where mental disorders and/or addictions or illnesses exist, the scapegoat child develops symptoms or syndromes that affect his/her ability to function emotionally as an adult. Some of these scapegoated children develop psychological issues like depression, anxiety, eating disorders. Some also develop the tendency to self harm.
This is usually seen (which I witness in practice) in a families where parents strive to stay together, despite the fact that one or both parents are abusive or psychologically unstable. What would have been a natural course of action, a break up, is avoided by members of the family at all costs. A superficial picture of stability is often seen in these families.
The “only” problem this family seem to have is a problem child — a child who is doing poorly at school, has behavioral problems, has eating disorder, self harms or has other emotional difficulties. When as therapists we see such children, we understand them to be symptom-bearers.
The experience of being a child scapegoat is one of Childhood trauma. There is immense feeling of loneliness because his/her feelings towards the family are negated by their own parents and siblings. These are the children who’d take the blame for their parents’ worries. Many grow up believing that they are flawed. Many introject the blame. Self blame lead to self hatred, self harm and sometimes suicide.
Psychotherapy for Child Symptom Bearers
Usually families bring themselves into therapy because of a “problem” or “sick” child. In successful family therapies, the therapeutic work centers around the relational dynamics between the family members, and not focussed on the “problem child”. Helping the parents and other members become aware of their roles in the family system releases the afflicted child of having to bear the intrinsic problems that exist in the family.
Psychotherapy for Adult sufferers of Scapegoating
One does not always know that one is being made a scapegoat. In the working environment, the scapegoat may simply find work in the office stressful with conflicts.
Sometimes, of course, in the course of therapy the client realizes that he/she was his/her family’s symptom bearer, or that he/she was a scapegoat in a group.
Being a scapegoat brings with it feelings of loneliness. You are being targeted as the cause of problems. Because of this, there’ll also be feelings of having done something wrong, or being flawed. This progresses to self blame. Psychotherapy involves
addressing these feelings of loneliness, shame, fear and betrayal
re-aligning oneself by being awareness of the group reality,
finding oneself again being independent of the group,
finding resources outside the group
getting support from others
Contact me freely for more information on this topic, or for therapy.
This article discusses what is means to experience crisis and dealing with crisis. The word, “crisis” has its Greek origin, krinein, which means, “to judge”. In Chinese, the word for crisis is 危機– the first word 危 means danger and the second word 機 means opportunity. This indicates that to be in crisis is to be in a state of having the possibility to make choices. This requires evaluation and re-evaluation of what used to be, or what we have been used to.
To be in crisis, is to experience a loss or a possibility of a loss of something that was important, that had a meaning in your life. The loss can be something that is tangible, like the loss of a loved one or loss of health, or something spiritual / mental, like loss of trust in someone/something.
Dealing with crisis is a process of creatively adapting to the crisis situation.
The Change Process in Dealing with Crisis
The loss usually translates into very meaningful changes for the person in crisis.
It is possible that such changes are impetus for growth; though that is not always the case. Experience of crisis can be extremely disturbing and anxiety provoking. When we go through crisis, there is also the feeling of being very alone in it.
Types of Crises
A crisis may be the result of loss of one’s previous identity or role. The loss of (or the expected loss of) a significant person, often changes how the individual sees him/herself in his/her world. The loss of health or a body part impacts likewise.
Crises occur with the natural course of life: puberty, leaving home, emigrating, having a child, getting divorced or approaching middle-age. These are some events in life in which people find themselves leaving familiar territory and having to make choices.
Getting Help in Times of Crisis
Help, to a person in crisis, is not a matter of giving advice or providing treatment. The best form of help comes in the supporting of the person through this difficult time of change.
Time is a main and stable resource. Stressful experiences occur when we expect a quick way out of the difficult feelings. Effective help comes in the form of one who is patient enough to be present with the person in crisis till he/she can fully integrate with the losses, and can come to terms with his/her new way of being.
This is also the “paradoxical theory of change” adopted by gestalt therapists.
Dealing with Crisis with Someone’s Help
If you are going through crisis yourself, find others who are able to provide you with the support to integrate the new meaning into your life. You can help them to help you, by telling them what you need and what you don’t need.
If you, for example, do not find the advice/consolation of well-meaning friends useful, say to them (if you can muster it), “I need you just to be with me, we do not have to find solutions right now.” Find someone to speak with about your difficult feelings of anxiety, guilt, sadness, grief, etc.
Certainly, getting professional support from a therapist or counsellor is also a good option.
What is the difference between grief and major depression, anyway?
For one thing, grief is a natural, healthy reaction to loss. It is an emotional response to something that has happened in our lives. We cannot escape encountering losses, and we cannot escape feelings of grief when it happens. Just because one feels terrible in a state of grief, does not mean that one has a mental / psychological disorder.
My reason for highlighting this, is with the hope that in grief, one one learns to find the right kind of self-support: find someone to talk to, try to not be alone, cry, find creative outlet and let time heal the wound (although it may leave the scar).
A potentially detrimental method of avoiding grief is to turn to drugs or narcotics, blame the self/self judgement for feeling bad, or any kind of harming the self or others.
Here’s what is written in the DSM-5 footnote:
“In distinguishing grief from a major depressive episode (MDE), it is useful to consider that in grief the predominant affect is feelings of emptiness and loss, while in a MDE it is persistent depressed mood and the inability to anticipate happiness or pleasure. The dysphoria in grief is likely to decrease in intensity over days to weeks and occurs in waves, the so-called pangs of grief. These waves tend to be associated with thoughts or reminders of the deceased. The depressed mood of a MDE is more persistent and not tied to specific thoughts or preoccupations. The pain of grief may be accompanied by positive emotions and humor that are uncharacteristic of the pervasive unhappiness and misery characteristic of a MDE. The thought content associated with grief generally features a preoccupation with thoughts and memories of the deceased, rather than the self-critical or pessimistic ruminations seen in a MDE. In grief, self-esteem is generally preserved, whereas in a MDE feelings of worthlessness and self-loathing are common. If self-derogatory ideation is present in grief, it typically involves perceived failings vis-à-vis the deceased (e.g., not visiting frequently enough, not telling the deceased how much he or she was loved). If a bereaved individual thinks about death and dying, such thoughts are generally focused on the deceased and possibly about “’joining” the deceased, whereas in a MDE such thoughts are focused on ending one’s own life because of feeling worthless, undeserving of life, or unable to cope with the pain of depression.”
This 1966 article, The Pathogenic Secret and Its Therapeutics, by Henri F. Ellenberger may explain why psychotherapists are bounded by strict confidentiality in their work.
Ellenberger highlights what he calls the “pathogenic secret”. This is a secret of what has happened to us, or what we have witnessed first hand, or what we have been told, that is so “heavily-disturbing”, thus unbearable for us to come to terms with. This is the secret that we keep to ourselves. Sometimes it is a secret that we keep from ourselves, out of our consciousness. Oftentimes belongs to an an event that had occurred in early childhood.
Under certain circumstances, the confession of the pathogenic secret has been known for time in memorial to have healing qualities.
The Concept of the Pathogenic Secret
Pathogenic secret manifests itself as chronic neurosis resulting in symptoms like “melancholia, neurasthenia, hysteria, or even psychosis”, i.e. what we know today as psychopathology.
“The nature of the pathogenic secret can also differ widely. In certain patients, it is the matter of secret thwarted love or some other suppressed passion, such as jealousy, hatred, or ambition. Sometimes it is a matter of physical illness or infirmity, of which the patient feels ashamed. Frequently the secret is related to some kind of moral offence which can range from petty theft to murder, but frequently also it is of a sexual nature (adultery, incest, abortion, infanticide, etc.). The secret can also be the painful remembrance of some traumatic event, sometimes connected with a secret of another person (for instance a young girl discovering her mother’s adultery).” There is often experience of shame involved in the pathogenic secret. The type of the pathogenic secret can differ widely, and it’s effect varies with how the individual attaches meaning to it.
Healing Power of the Confession
Working with confessions is not a new concept. It is observed within ancient healing practices. Confessions of sins or taboos have been documented as healing methods in ancient civilizations in places like Mexico and Mesopotamia.
In the Roman Catholic religion, confessions are practiced, as a form of the self reconciling with the social world. In Catholicism, confessions are sealed in secrecy to the point that under no circumstances is the confession revealed. Once absolved from sins revealed in the confession, the confession is free from his/her sin.
In the Protestant religion, the concept of “Seelsorge” or “cure of souls” as the result of being in the presence of another in a dialogue that can be an exchange and containing of a secret.
The Pathogenic Secret in Literature
Ellenberger also cites examples of the destructiveness of the pathogenic secret and it the healing effect of the secret’s revelation in literature like Nathaniel Hawthorne’s The Scarlet Letter, Jeremias Gotthelf’s Wie Anne Babi Jowager haushaltet und es ihm mit den Doktorn ergeht, Ibsen’s The Lady from the Sea, Marcel Prévost’s L’Automne d’une Femme (The Autumn of a Woman), Heinrich Jung-Stilling’s Theobald oder die Schwarmer.
The Pathogenic Secret in Criminology
Then there is the confessions of the pathogenic secret in criminology. The author cites 19th century literature,Philosophie Pénale, published in 1880 by Gabriel Tarde, documenting the effect that the confession of the crime has on the person who committed it.
“A problem which seems to have attracted less attention is that of the long range effects of the burden of the secret upon the criminal, should his crime not be discovered. It would seem that the secret exerts a permanent and profoundly disturbing effect on certain criminals.”
Another literature cited was that of Austrian criminologist, Hanns Gross, in his textbook of criminal psychology in 1898.
C. G. Jung (12) tells the story of a woman, unknown to him, who came to hisoffice, refusing to divulge her name, and told him how twenty years earlier she had poisoned her best friend in order to marry her husband. But the husband died soon after she married him, the daughter of this marriage disappeared in turn; even animals turned away from her so that she could no longer ride horses nor own dogs and finally she fell into an unspeakable loneliness; this was the reason why she felt that she must make a professional man share the knowledge of her crime. Jung never saw that woman again and wondered what happened to her. Actually the long-range disturbances caused by a secret of that kind in the mind of an undetected criminal are one of the least-known chapters of criminology.
Hypnosis & Pre-psychotherapy
The notion of the burdening secret became known to magnetists very soon after the discovery by Puységur of the state of “magnetic sleep”, now known as hypnosis.
Moritz Benedikt (1835-1920) in the late 19th Century was already able to explain how symptoms like hysteria was cured with revelation of a pathogenic secret in the individual’s “second life” and thus “inner life”.
Freud’s Psychoanalysis and Psychotherapy Today
Freud’s earliest publications illustrate the curative process of revealing of innermost difficult-to-bear secret to a trustworthy professional in a therapeutic dialogue, or “talking cure”. In psychotherapy, this pathogenic secret is something in the unconscious that is revealed in the course of therapy. This revelation is the curative change that occurs in therapy.
With the further development of psychoanalysis, the concept of the pathogenic secret became gradually absorbed into the wider frame of reference of traumatic reminiscences and of repression, and later in the concept of neurotic guilt feelings.
Psychotherapy Law of Confidentiality
It is law in Europe that psychotherapists are committed to confidentiality in their work with clients. This means that whatever the client tells his/her therapist is bounded to confidentiality. The therapist has duty and also the right to maintain this secrecy. The therapist cannot be forced or tricked by anybody– regardless of power or authority– to reveal information given to him/her by his/her client.
The only consideration to break confidentiality is when it concerns the welfare of children and if lives are at risk. Even so, the therapist would consult their counsel of psychotherapists for advice and support.
Being trained in Austria, I am not sure at this point if this rule is applicable to other parts of the world. However, in this article, I would like to highlight the importance of confidentiality for the effectiveness of psychotherapy itself. The wish is that there is a worldwide recognition of the special role of psychotherapy as a profession, and respect for the autonomy of psychotherapists in keeping confidential the material obtained from their clients. As a therapist in Austria, I am committed by the license and by the law to keep all information of my clients secure. Documents are locked up, and information are encrypted so that no client information is compromised. When doing research or case studies, the information that is provided is altered in such a way that no person can be remotely identified in the work. All this is monitored by ethics commissions and peer groups.
This code of the psychotherapeutic profession, it’s protection by law of the therapists and clients, in countries like Austria, creates an environment safe for people to use psychotherapy as a means of healing.
Ellenberger, H. F. (1966). The pathogenic secret and its therapeutics. Journal of the History of the Behavioral Sciences, 2(1), 29-42.
A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.
Mental disorder is a syndrome
The definition describes what mental disorder is. It is a syndrome, which is a group of related symptoms that the individual might encounter. Mental disorders are observable as clinically significant disturbances. This means that if the emotional regulation, behavior or cognitive processes of an individual is not clinically seen as significant, it is not a mental disorder. The mental disorder has to reflect a dysfunction that has underlying causation.
Mental disorders affect daily functioning
A mental disorder is considered as such only when it has consequences to the daily functioning of the individual. This means that even if a person suffers from schizophrenia, if this individual is able to work, live, have relationships and play, he/she does not have a mental disorder.
Distress Caused by Life Situations are Not Mental disorders
Distressing events e.g. death of a loved one, or a divorce can cause emotional /and physical pain. These emotional setbacks that a person faces are unpleasant but is does not mean that the person has a mental disorder.
Socially Deviant Behavior is Not Always the Result of Mental Disorder
Socially deviance is not considered a product of mental disorder unless this behavior is accompanied by a person who has the above-said mental disorder.
Psychotherapy is not only in the business of working with mental disorder.
Psychotherapy is different from psychiatry in the sense that it is not a profession that works only in the face of mental disorder. Even if mental disorder diagnosed, the therapy is focussed on the persons’ emotional state and self support.
Most of my clients are not in my office because of a mental disorder, but because of life events that they need to cope with. Psychotherapy lends the client a space to be heard, to introspect, interact and experiment; so that he/she can realize the choices he/she has to live a stable, functional and even thriving life.