So many couples come to therapy and rehash
their complaints. They get angry and have one
more complaint. It doesn't change anything!
While its good for me as a therapist to know
the complaint list, that's not what change is
about. The first question I have is: What do you
really want in your relationship? The second is:
How hard are you willing to work to get it?
Third: How will you attempt to sabotage our
every effort?
A major blockage in couples work is constant
referencing of past grievances. Its important
to "grieve the grievances". Ultimately we must
let them go and replace them with something
more satisfying. This brings us to the "most
important thing" in couples work: Finding the
fun, joy, and pleasure you are looking for.
If you are going to "work" on your relationship,
the relationship must become intrinsically
rewarding. That is the motivational key.
Friday, February 15, 2008
Monday, February 11, 2008
Couples: The Communication
Its almost a given in my couples work that the
"most important thing" couples say they receive
regarding communication is the capacity to hear
and be heard and to understand and be understood.
That's the core issue in their communication.
It sounds so simple. So how do we go about not
accomplishing this very or most important thing?
Well, that takes assuming you know what your partner
means or what the meaning of something is for them.
Sometimes you only know what the meaning is for you
and you attribute it to them. You end up relating
to your own thought or emotion rather than to the
person you are with.
So, ask your partner what they mean or what something
means to them. Make very few assumptions and really
listen to what they say. Tell them what you think you've heard
and get their confirmation. Now you are actually relating to
them, not the idea you have been carrying around in your
head.
"most important thing" couples say they receive
regarding communication is the capacity to hear
and be heard and to understand and be understood.
That's the core issue in their communication.
It sounds so simple. So how do we go about not
accomplishing this very or most important thing?
Well, that takes assuming you know what your partner
means or what the meaning of something is for them.
Sometimes you only know what the meaning is for you
and you attribute it to them. You end up relating
to your own thought or emotion rather than to the
person you are with.
So, ask your partner what they mean or what something
means to them. Make very few assumptions and really
listen to what they say. Tell them what you think you've heard
and get their confirmation. Now you are actually relating to
them, not the idea you have been carrying around in your
head.
Friday, February 1, 2008
Injury Prevention in Sports
Its fascinating that predictors of injury in athletics
are similar to predictors of performance. For example,
an athlete's ability to mitigate a stress response during
competition allows them to play more effectively.
The stress response also contributes to injury. How
does this happen?
During the stress response, performance concerns,
overly tense muscles, anxious sensations (butterflies,
etc.) pull the athlete off task. They are not as focused
on what they have to do. A lack of proper focus or task
appropriate muscle tension can pull an athlete off track.
Performance is hampered and worse, you may not be
aware of things happening around you or even your
physical trajectory. Then accidents are more likely to
happen.
A basic question becomes, who is more likely to be
injured let alone suffer poorer performance than
their skills and training would suggest? Some athletes
more easily focus on task. Focusing on competition
and winning counts. But, when an athlete is more
focused on the win, the end result, and less focused
on the task, the play by play, of getting there,
then injury and sub-par performance are more likely.
The good news is that athletes can enhance their focus
and task orientation through sports psychology skills
training. They can improve resilience to the stress
response through mental skills training as well. By
enhancing mental skills, they can reduce injury
incidence.
Once an injury occurs, the athlete can also enhance the
recovery process by embracing rehabilitation as "part
of their game". Injury and recovery are just part of
what an athlete prepares for, deals with, and in most
cases overcomes. Mental skills training can also
optimize recovery time. Having clear goals for rehab,
carrying out the plan, good support from family,
friends and the sports medicine team all make a
a difference.
Pain, setbacks, and anxiety can be big challenges
for the athlete. Mental skills are crucial to over-
coming obstacles and dealing with the emotional
roller coaster that sometimes accompanies the
ups and downs of physical recovery and return
to competition. Athletes can learn psychological
skills to manage pain, stress, and anxiety during
rehabilitation from injury.
are similar to predictors of performance. For example,
an athlete's ability to mitigate a stress response during
competition allows them to play more effectively.
The stress response also contributes to injury. How
does this happen?
During the stress response, performance concerns,
overly tense muscles, anxious sensations (butterflies,
etc.) pull the athlete off task. They are not as focused
on what they have to do. A lack of proper focus or task
appropriate muscle tension can pull an athlete off track.
Performance is hampered and worse, you may not be
aware of things happening around you or even your
physical trajectory. Then accidents are more likely to
happen.
A basic question becomes, who is more likely to be
injured let alone suffer poorer performance than
their skills and training would suggest? Some athletes
more easily focus on task. Focusing on competition
and winning counts. But, when an athlete is more
focused on the win, the end result, and less focused
on the task, the play by play, of getting there,
then injury and sub-par performance are more likely.
The good news is that athletes can enhance their focus
and task orientation through sports psychology skills
training. They can improve resilience to the stress
response through mental skills training as well. By
enhancing mental skills, they can reduce injury
incidence.
Once an injury occurs, the athlete can also enhance the
recovery process by embracing rehabilitation as "part
of their game". Injury and recovery are just part of
what an athlete prepares for, deals with, and in most
cases overcomes. Mental skills training can also
optimize recovery time. Having clear goals for rehab,
carrying out the plan, good support from family,
friends and the sports medicine team all make a
a difference.
Pain, setbacks, and anxiety can be big challenges
for the athlete. Mental skills are crucial to over-
coming obstacles and dealing with the emotional
roller coaster that sometimes accompanies the
ups and downs of physical recovery and return
to competition. Athletes can learn psychological
skills to manage pain, stress, and anxiety during
rehabilitation from injury.
Wednesday, January 30, 2008
Hypnosis for Depression?
Hypnosis may be a useful adjunct to the treatment of depression.
For example, some people are both de-energized and chronically
tense over extended periods of depression, particularly when
waiting for their medication to "kick in" or the right prescription
and therapeutic dosage. They also report feeling very "stuck",
unable to make headway with their cognitive therapy while their
minds continue to spin with negative thoughts. Particularly
frustrating are the thoughts that "this will never stop" and a
sense that they are not getting any help.
When hypnosis is considered as an adjunct to their treatment
several things can happen. First, if a combined relaxation/self-
hypnosis training is accomplished, the individual can experience
periods of relaxation and calming that they have not experienced
in many months or longer. This can instill a sense of greater
efficacy and control, combating the sense of helplessness and
hopelessness. In addition, some people may apply the technique
to insomnia and night time waking to aid in their sleep. Second,
the individual may experience a degree of variability, even if only
slightly, that contrasts with the ongoing drone of their depressed
mood.
Another utility of hypnosis is combining the procedure for
relaxation and focusing with the cognitive-behavioral exercise
of challenging negative thoughts. It can be very difficult to focus
and do the cognitive exercises. Hypnosis is a relaxed state of
focused attention. Utilizing this state may help the individual
develop some focus to do the cognitive work.
As can be seen from the above, hypnosis is not a treatment that
necessarily removes depression by suggestion. Rather, it can be
a tool the individual uses to strengthen their resources to cope and
to accomplish their treatment program. Many hypno-therapists
complain that it is very difficult or "impossible" to get their clients
into a "relaxed and safe inner space". The challenge can be lessened
by understanding that one should not send some people directly to
an inner experience since this may simply lead them to focus where
they already unhappily are. They may need to transition through
a number of progressive mental states to get to or create a "positive
relaxing place".
For example, before doing any hypnosis at all and especially with
younger clients, its sometimes useful to discuss the things they like to
do, see, listen to, feel, in short what sensory experiences give them
relief. For other people, it is their pets that accomplish the beginning
shift out of sameness. Then a therapist can help the client creatively
utilize their experience as a resource to build a state of mind that
varies from depression. Working first with eyes open helps too. So,
first you help the client gather their internal and external
resources. Then they build an experience. Then, having constructed
something durable and comfortable, they may open the door, go
inside that space, and perhaps even invite you along.
When I feel really stuck with a patient in training self-hypnosis I
want to know everything about their environment in terms of who
and what is stressful. Working with this who and what may be
necessary before any hypnosis training is possible. Finally if the
clinician hasn't assessed hypnotizability in some fashion, he or she
may be leading themselves and their client down the path of
frustration and disappointment. I like informal methods of
assessment ("arm-drop","eye roll", etc.) to begin with as they
may be less draining in terms of time and energy for the client
while standard scales and techniques (HIP, Harvard, etc.) may
be added.
There are some new cognitive techniques (C-BASP) for depression
coming along and I have corresponded with one of the researchers
about combining a new technique with hypnosis and visualization.
I have had preliminary anecdotal success by adding this on to
existing techniques, by self-report from clients. The point is, don't
give up either as a patient or clinician. Be creative while building on
to what works rather than discarding the foundation of
cognitive therapy and medical intervention.
Resources: Books and articles by Dr. Michael Yapko on Hypnosis
and Depression, The American Society of Clinical Hypnosis (lists
specialists in hypnosis and their certification).
For example, some people are both de-energized and chronically
tense over extended periods of depression, particularly when
waiting for their medication to "kick in" or the right prescription
and therapeutic dosage. They also report feeling very "stuck",
unable to make headway with their cognitive therapy while their
minds continue to spin with negative thoughts. Particularly
frustrating are the thoughts that "this will never stop" and a
sense that they are not getting any help.
When hypnosis is considered as an adjunct to their treatment
several things can happen. First, if a combined relaxation/self-
hypnosis training is accomplished, the individual can experience
periods of relaxation and calming that they have not experienced
in many months or longer. This can instill a sense of greater
efficacy and control, combating the sense of helplessness and
hopelessness. In addition, some people may apply the technique
to insomnia and night time waking to aid in their sleep. Second,
the individual may experience a degree of variability, even if only
slightly, that contrasts with the ongoing drone of their depressed
mood.
Another utility of hypnosis is combining the procedure for
relaxation and focusing with the cognitive-behavioral exercise
of challenging negative thoughts. It can be very difficult to focus
and do the cognitive exercises. Hypnosis is a relaxed state of
focused attention. Utilizing this state may help the individual
develop some focus to do the cognitive work.
As can be seen from the above, hypnosis is not a treatment that
necessarily removes depression by suggestion. Rather, it can be
a tool the individual uses to strengthen their resources to cope and
to accomplish their treatment program. Many hypno-therapists
complain that it is very difficult or "impossible" to get their clients
into a "relaxed and safe inner space". The challenge can be lessened
by understanding that one should not send some people directly to
an inner experience since this may simply lead them to focus where
they already unhappily are. They may need to transition through
a number of progressive mental states to get to or create a "positive
relaxing place".
For example, before doing any hypnosis at all and especially with
younger clients, its sometimes useful to discuss the things they like to
do, see, listen to, feel, in short what sensory experiences give them
relief. For other people, it is their pets that accomplish the beginning
shift out of sameness. Then a therapist can help the client creatively
utilize their experience as a resource to build a state of mind that
varies from depression. Working first with eyes open helps too. So,
first you help the client gather their internal and external
resources. Then they build an experience. Then, having constructed
something durable and comfortable, they may open the door, go
inside that space, and perhaps even invite you along.
When I feel really stuck with a patient in training self-hypnosis I
want to know everything about their environment in terms of who
and what is stressful. Working with this who and what may be
necessary before any hypnosis training is possible. Finally if the
clinician hasn't assessed hypnotizability in some fashion, he or she
may be leading themselves and their client down the path of
frustration and disappointment. I like informal methods of
assessment ("arm-drop","eye roll", etc.) to begin with as they
may be less draining in terms of time and energy for the client
while standard scales and techniques (HIP, Harvard, etc.) may
be added.
There are some new cognitive techniques (C-BASP) for depression
coming along and I have corresponded with one of the researchers
about combining a new technique with hypnosis and visualization.
I have had preliminary anecdotal success by adding this on to
existing techniques, by self-report from clients. The point is, don't
give up either as a patient or clinician. Be creative while building on
to what works rather than discarding the foundation of
cognitive therapy and medical intervention.
Resources: Books and articles by Dr. Michael Yapko on Hypnosis
and Depression, The American Society of Clinical Hypnosis (lists
specialists in hypnosis and their certification).
Thursday, January 10, 2008
Slideways Into 2008
My metaphor for the new year occurred during a snow tubing
adventure at White Tail in Pennsylvania. The awareness that
there is no real control as you slide sideways, backwards, and
head first down the slope was freeing. Nothing to do but laugh
all the way to the bottom over and over again. And so we go
slideways into the future, the only control being how we want
to be about the direction it takes us...fighting the flow or "digging"
the snow. I am reminded that in sports and life we control
what we choose to do and how we react to what else is beyond
our control. On a tube there is no preparation, no goal, no plan,
just the ride. The more you let go, the better the ride.
Happy New Year!
Geoff Michaelson, Ph.D.
adventure at White Tail in Pennsylvania. The awareness that
there is no real control as you slide sideways, backwards, and
head first down the slope was freeing. Nothing to do but laugh
all the way to the bottom over and over again. And so we go
slideways into the future, the only control being how we want
to be about the direction it takes us...fighting the flow or "digging"
the snow. I am reminded that in sports and life we control
what we choose to do and how we react to what else is beyond
our control. On a tube there is no preparation, no goal, no plan,
just the ride. The more you let go, the better the ride.
Happy New Year!
Geoff Michaelson, Ph.D.
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