Category: Watch Videos

Transitioning. This is an important interview.

This is a necessary, informative interview for all involved; candidates who are seeking gender reassignment surgery, their family members, and their therapists. Deal with the underlying psychopathology first. Take no irreversible medical measures till the mental health issue is resolved.

How Psychotherapy Works

How does psychotherapy work? What is the difference between psychotherapy, psychiatry and CBT?

Here is useful information for those interested in engaging a psychotherapist.

Transcript of this video:

Psychiatry, CBT and Psychotherapy

When one is in a bad place in one’s head the modern world offers three main sources of help: Psychiatric meditation, CBT and psychotherapy. Each one of these advantages and drawbacks. Medication can be exemplary in a crisis that points when the mind is so under siege from fear, anxiety or despair that thinking things through cannot be an option. Correctly administered without requiring any conscious cooperation from us, pills play around with our brain chemistry in a way that helps us get through to the next day and the one after we may get very sleepy, a bit nauseous or rather foggy in the process, but at least we’re still around, more or less. Then there is cognitive behavioral therapy or CBT. Normally administered by psychologists and psychiatrists in six to ten hour-long sessions which teaches techniques for arguing rationally with and with any luck at points controlling the ghoulish certainties thrown up by our internal persecutors: paranoia, low self-esteem, shame and panic.

Lastly, there is psychotherapy, which from a distance looks like it has only drawbacks. Psychotherapy has a very hard time showing its efficacy and scientific trials and it has to plead that its results too singular neatly to fit the models offered by statisticians. Also, it takes up a large amount of time demanding perhaps two sessions a week for a couple of years and it’s therefore by far the most expensive option on the menu. 

Finally, psychotherapy requires active engagement from its patients and sustained emotional effort. One can’t simply allow chemistry to do the work and yet psychotherapy is a hugely effective choice which properly alleviates pain not by magic or chance, but for three solidly founded reasons.

Our unconscious feelings become conscious with psychotherapy

A founding idea of psychotherapy is that we get mentally unwell have a breakdown or develop phobias because we are not sufficiently aware of the difficulties we’ve been through.  Somewhere in the past we’ve endured certain situations that were so troubling or sad, they outstripped our rational faculties and had to be pushed out of day-to-day awareness. For example, we can’t remember the real dynamics of our relationship with a parent. We can’t see what we do every time someone tries to get close to us.  Nor trace the origins of our self-sabotage or panic around sex. Victims of our unconscious, we cannot grasp what we long for or a terrified by. In such cases, we cannot be healed simply through rational discussion, as proponents of CBT implicitly proposed, because we can’t fathom what is powering our distress in the first place. 

Psychotherapy is a tool for correcting our self-ignorance in the most profound ways. It provides us with a space in which we can in safety say whatever comes into our heads. The therapist won’t be disgusted or surprised or bored. They’ve seen everything already. In their company we can feel acceptable and our secrets sympathetically unpacked as a result crucial ideas and feelings bubble up from the unconscious and are healed through exposure interpretation and contextualization we cry about incidents we didn’t even know before the session.  The ghosts of the past are seen in daylight and a laid to rest.

The importance of working with one’s transference relationships in psychotherapy

There’s a second reason why psychotherapy can work so well. Transference. Transference is a technical term that describes the way once therapy develops a patient will start to behave towards the therapist in ways that echo aspects of their most important and most traumatic past relationships. A patient with a punitive parent might for example develop a strong feeling that the therapist must find them revolting or boring a patient who needed to keep a depressed parent cheerful when they were small might feel compelled to put up a jokey facade whenever dangerously sad topics come into view. We transfer like this outside therapy all the time but there what we’re doing doesn’t get noticed or properly dealt with. Psychotherapy is a controlled experiment that can teach us to observe what we’re up to, to understand where our impulses come from and then adjust our behavior in less unfortunate directions . A therapist might gently ask a patient why they’re so convinced they must be disgusting or they might lead them to see how they use of jokey sarcasm is covering up underlying sadness and terror. The patient thereby starts to spot the distortions in their expectations set up by their history and develops less self-defeating ways of interacting with people in their lives going forward

Psychotherapy provides “the first good relationship”.

The third reason why psychotherapy works it is the first good relationship. We are many of us critically damaged by the legacy of past bad relationships. When we were defenseless and small we didn’t have the luxury of experiencing people who were reliable who listened to us who set the right boundaries and helped us to feel legitimate and worthy. However when things go well the therapist is experienced as the first truly supportive and reliable person we’ve yet encountered. They become the “good parent ” we so needed and maybe never had. In their company we can regress the stages of development that went wrong and relive them with a better ending now we can express need we can be properly angry and entirely devastated and they will take it, thereby making good years of pain. 

One good relationship becomes the model for relationships outside the therapy room. Some moderate, intelligent voice becomes part of our own in a dialogue.

We are cured through continuous repeated exposure to sanity and kindness.

Psychotherapy won’t work for everyone. What has to be in the right place in one’s mind? 

One has to stumble on a good therapist and be in a position to give the process due time and care. But all that said with a fair wind psychotherapy also has the chance to be the best thing we ever get around to doing.

Let this video of an impala being rescued teach us about trauma and trauma treatment in psychotherapy

I watched this video about an amazing rescue of an impala, and cannot help but feel a tremendous sense of wonder for the nature of the nervous system.

This video shows us an animal’s natural response to a traumatic event, being stuck in a situation which is life threatening. Then it comes across rescuers who saved its life.

How is this connected to trauma treatment?

Well, if we observe carefully the behavior of the impala, we may be able to learn something very valuable about treating post-traumatic stress disorder and complex trauma in humans. Let’s take this video as a metaphor: the impala as the client who seeks the help of a professional, the rescuers. The impala is not aware of its traumatic situation. It only knows that it wants to get out of being trapped. Clients too come to therapy seeking help to get out of a “stuck” situation. They have often little awareness of the big picture. In therapy, the therapist and client find out together what the big picture looks like.

When clients come to therapy, there is anxiety. Just like in the video, as the rescuers approach the impala. It becomes more afraid. Client’s wonder, “Can he/she help me?”,” Will I be hurt by this person?”,”Is therapy a waste of my resources?” “What is he/she doing?” “Is he/she judging me?” etc.

The therapist is there for the client exclusively. In the video, the rescuers genuinely want to save the impala. Hence, it is really important that the therapist is there, in the session, only for the client. Realistically, this can only be possible with therapists who genuinely love the work and who are adequately remunerated for it. Reasons why professionals in the helping professions burn out and become ineffective can be attributed to this point: giving is a two-way process, and overt charity is neither kind nor sustainable.

The therapist’s empathy. A genuinely present therapist will put in the effort and strength to be with the client; just like the man who would put his body in the mud for the impala. The therapist would experience what the client is going through. This is how we can understand empathy.

Therapists also need other therapists to support them. That is why we attend workshops, therapy, supervision and inter-vision. In the video, the rescuer does not work alone. When he is stuck in the mud with the animal while his friends are there with the rope to help to pull him out when the need exists.

A part of therapeutic treatment is about doing nothing together. This is a recovery phase for both therapist and client. When the rescuers finally manage to pull the impala onto safe ground, they take time to be with the animal and to give it some comfort by washing it. We can see in the video that the body of the impala is really still at this point.

The stillness seen in the animal’s body is not merely calmness. It is possibly a somatic response to a highly frightening situation. The body shuts down. It fatigues. The work is far from over. Trauma-focussed therapist will not overlook this. Human clients in this state have varied symptom: of being depressed or numb, get panic attacks, lack focus, forget things, feel the need to throw up or cut themselves, feel like they are dying, lose their sense of reality (…the list goes on). The client needs then to physically recover. For this to happen, he/she needs the support of the therapist. In the video, this process seems natural and smooth for the impala. The rescuers pat the animal on its back, pulls it up and encourages it to get up and go. This is the act of bringing the beast back to its senses. The animal gets on its feet, trembles, pants and bolts.

In human beings, this process often does not happen so smoothly. Steven Porges explains why this is so with the polyvagal theory.

Treating clients at this phase involves a sometimes a long-drawn and difficult process of working through the client’s very difficult feelings despair, fear, guilt, grief plus the bodily reactions accompanying it. Human beings are afraid of these reactions in themselves. Such reactions are somatic, and may include panting, trembling, screaming, hitting or pushing, bolting, crying, and sometimes throwing up. We try, most of the time, to allow this energy to come out in tiny steps. Peter Levine calls it “titration”.

Therapists would also encourage clients to do body-focussed activities like yoga, weight-training, dancing or tai-chi to get more in touch with their bodily sensations.

Trauma-focussed therapy, for whom?

The animal, stuck, finds itself in a panicked state. It’s muscles tense and it tries to fight its way out of the situation. Being really stuck in the mud, all its efforts fail. Its body fatigues. Looking at us human beings, when we find ourselves in a threatening situation, our first impulse is to flee or fight back. In events that cause trauma, this instinct to fight or flee does not lead us anywhere. These traumatic events trap its victims. There is a sense of impending death. Such events can often occur in childhood, as victims of child abuse and neglect are trapped in a life of a child; helpless, vulnerable and dependent on its caregivers. This existence can go on for years.

Many clients come for therapy without the awareness that they are survivors of trauma. As adults, they come to therapy because they encounter symptoms like, depression, suicidality, anxiety, compulsive behavior, rages, emotional dysregulation, feeling numb, fatigued, loss of memory, relationship problems, eating disorders (…the list goes on). These symptoms are now known to be likely somatic reactions to past trauma. Trauma-orientated therapists will pick up on this.

Medication to treat trauma?

Medication stabilizes the body, but it unfortunately does not help the client work through the source of the problem. Medicine does not empower the client with awareness of the self. It does not lead the client towards self-agency. Meds lose their effectiveness with time, when the body adjusts to the chemicals through homeostasis. Imagine the rescuers in the video giving the animal meds, and not doing anything else. The animal will no longer be in distress. It would simply live trapped until it dies.

Conclusion

I hope this article enlightens you the reader on what psychotherapy can look like, and how your symptoms can be perceived and treated.

Psychotherapy, especially therapy that is humanistic, relational and is focussed on empathy, is a great profession because it opens doors for the possibility of healing from the otherwise life-sentence of trauma.