Tag Archives: Psychology

January 13, 2010 · 5:28 am

Follow-up on expressing vulnerable feelings to a loved one


Yesterday I commented on a series of studies indicating that expressing insecurities to a romantic partner might lead to perpetuating them (because of our impressions of our vulnerabilities, what we think they think of us, and our suspicions that they don’t really care). Today, I want to list the major findings of the 5 studies. See what you think of these interpretations of the data:

  • “Study 1 demonstrated that people believe expressions of regard toward interpersonally insecure and vulnerable others are relatively inauthentic.” (p. 436).
  • “Studies 2A, 2B, and 4 suggest that, when people believe they have expressed vulnerabilities to a romantic partner or friend, they believe they are viewed especially vulnerable, which in turn predicts their suspicion regarding the authenticity of the other’s expressions of positive regard and acceptance.” (ibid)
  • “Study 4 suggests that this process can operate independently of the partner’s appraisals of vulnerability and reported authenticity.” (ibid)
  • Study 5 seems to show that when subjects appraise themselves as vulnerable they doubt a new acquaintance’s expressions of pleasure (even though the new person didn’t see the subject as vulnerable.
  • Studies 3 and 4 seem to indicate that when you have doubts about your partner’s authentic expression of love, you then perceive acts of caring in a more pessimistic manner. “In particular, authenticity doubts may result in a downward estimation of the partner’s true regard and acceptance, as expressions of positive are presumed to be exaggerated and clandestine rejection can be inferred from the partner’s presumed cautious orientation.” (ibid)

SO, do you think those who express vulnerabilities then are only placated and thus receive inauthentic expressions of kindness? Have you experienced yourself devaluing objective kind acts by re-interpreting them through a lens of pessimism? “He’s only doing that because he wants me to let him have his way.” Now, that could be true, but if you find yourself regularly dismissing acts of caring then you might want to explore where your assumptions are coming from.

What should we do? We should express our insecurities and then seek to listen to our loved one with the best possible interpretation and seek to be specific and concrete in pointing out how their actions/attitudes impact us. If we are the one listening to a loved one tell us that they are not feeling secure, then we ought to express warmth, concern, etc. Put off the defensiveness and put yourself in their shoes. If you were worried, you would want another to comfort and care for you–not call you an idiot for thinking that way.

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January 12, 2010 · 5:06 am

Perpetuating vulnerable feelings?


Feel unsure of your mate’s love for you? Should you tell them that you are not feeling safe or secure in the relationship? When you tell them (accuse them of not caring?) and they profess their love for you, what will tell you that you can believe their promises? What will tell you to doubt their words?

Two Yale University psychologists (E. Lemay, Jr and M. Clark) explore this problem in 2008 in their “Walking on Eggshells: How Expressing Relationship Insecurities Perpetuates Them” (Journal of Personality & Social Psychology, v95, 420-441).

Their study is fairly long (5 studies in fact). But here are some key points.

When people feel insecure about a partner’s regard and acceptance, they often judge their own prior behavior as having communicated insecurity and emotional vulnerability to the partner. Consequently, they come to believe that they are viewed as especially insecure and vulnerable. Then, due to shared beliefs that people walk on eggshells around insecure, vulnerable others, such reflected appraisals of vulnerability elicit doubts about the authenticity of the partner’s expressions of regard and acceptance. Once authenticity is doubted, positive expressions are discounted, negative expressions are augmented, and hidden negative regard is inferred even when partners are accepting and actually hold positive regard. (p. 436)

What they are saying is that our own anxiety fuels are belief that they know we are vulnerable and are tiptoeing around us and that we doubt they love us and then we read their actions through a lens that denies the evidence of love and declares their love to be inauthentic. Which of course, we then share with them. Repeat this action and sooner or later they don’t want to be declared a liar anymore and distance from us thereby proving our deepest fears of abandonment.

In short, anticipated rejection leads to presumption that it has happened and that any activity countering that presumption is rejected and re-read through the lens of rejection. Because that is what we believe happens to weak people–they are abandoned.

So, should we keep our fears to ourself? No say the researchers. Then what should be done? The researchers say only a little on this (since it is not the focus of their research here). But, challenging cognitive distortions are at the top their list? What distortions in particular? Believing that others see you as weak as you feel; challenging the interpretations of another’s motivation. Also in their suggestions is practicing reading the commitment of the mate to the relationship by re-appraising and collecting the evidence of authentic responses from that mate.

The next time you feel the need to express your fears that your mate doesn’t really love you check to see whether your insecurity isn’t already telling you the answer you fear and rejecting evidence to the contrary. Dig a little and you may be able to find evidence that shows they love you. Then, be specific and tell them one concrete thing you would like to see changed, something that bothers you. Do it in love so as to not trigger their fears that you do not love them. Be wary of listening too much to your fears!

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December 22, 2009 · 2:57 pm

Interesting article in the American Psychologist


Just got my December issue of the American Psychologist (64:9). In it is an article but Brenda Major (and others) entitled, “Abortion and Mental Health.” These authors wrote a report in 2008 for the APA task force on Mental Health and Abortion (available at here). What I find interesting in the article is the discussion of the research on the association of mental health problems with abortion. Set aside, just for a moment, your strong feelings about the topic and consider this question: how would you go about studying the effects of abortion on women using robust measures?

You cannot do a randomized, double-blind study (you subjects get an abortion while you other subjects have your baby). Thus, you cannot fully control pre-existing or co-occurring risk factors. So, what do most researchers do? Try to indicate risk markers–correlations–that may point to possible but not proven causes. The writers of this article point out that the downside of correlation or associations is that folk tend to mistake them as causes. They give one specific example: If age is the “most important known risk factor for Alzheimer’s disease (AD)” one might assume that age causes AD. But it does not. Similarly, one can do a study that shows 100% of convicted sex offenders have their own sexual victimization and wrongly assume that sexual abuse leads to sex offending. Not so.

These authors emphasize the benefits of asking two other questions (on p. 865):

1. What is the relative risk of mental health problems associated with abortion compared to the same risks associated with having an unwanted baby (whether keeping or adopting out)?

2. What predicts individual variation in women’s psychological experiences following abortion?

The authors go on to say that the hypothesis of the researcher really impacts the kinds of research questions asked (and thus conclusions). Some research focuses on traumatic experiences, others on stress and coping, still others on the sociocultural context.

By the way, it is a long article but concludes this way (p. 886):

Mental health among women who experience an unwanted pregnancy reflects a number of factors. It reflects preexisting and co-occurring conditions in a woman’s life that place her at greater or lesser risk for poor mental health in general regardless of how she resolves her pregnancy. It reflects her appraisals of the meaning of a pregnancy and abortion and her appraisals of her ability to cope with either option.

There’s more to their final thoughts but you get the point. How you look at pregnancy, abortion, adoption is likely to have a big impact on your immediate mental health. Sadly, I suspect the research also reflects the biases of the researcher (how could it not?).

I found this article interesting because it does a great job illustrating the benefits AND drawbacks of research. Researching mental health of women with unwanted pregnancies is a good idea but will fail to address the moral and ethical questions that, in my mind, take precedence in the public debate.

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December 1, 2009 · 12:04 pm

Chronic pain and the Christian faith


Last night’s Counseling & Physiology class covered the topic of chronic pain. There are a number of syndromes and disorders that cluster around pain as the presenting problem: Chronic Fatigue, Fibromyalgia, Irritable Bowel Syndrome, Rheumatoid Arthritis, Osteoarthritis, back pain, etc. Depending on which research study you read, some 9-17% of the population struggles with some form of chronic pain.

While these various forms of pain are quite different, there are some commonalities. Chronic and diffuse pain sufferers frequently experience some form of inflammation, fatigue, sleep disruption, negative mood, and poor memory (its hard to pay attention to new information when you are weighed down by pain). We don’t really know what causes what but we do know that these symptoms form a vicious cycle. If you don’t get restorative sleep, you experience more fatigue, you are more prone to negative thought patterns, your pain levels go up, memory goes down…and thus you don’t sleep well the next night, and so on. Researchers describe this vicious cycle in terms of “allostatic load”–the deleterious effects of chronic stress hormones without restorative sleep.

Because of the diffuse nature of pain (vs. focal) and the lack of obvious objective evidence of that pain (a big red spot, a swollen limb, etc.), chronic pain sufferers and their families struggle to understand whether or not the pain is real and what they are truly capable of doing. How do you measure pain levels? It’s pretty subjective! Thus, it encourages more “I should be able to…” thinking in all parties. Those not suffering chronic pain do more damage by implying that the person is just looking for attention, is just being lazy. Those suffering pain who either deny the pain and try to do too much or refuse to engage the world and withdraw from it do damage to themselves–real physical damage.

As with all physiological problems, one’s mood, one’s perceptions, one’s focus, one’s stress levels impact severity of the problem. While chronic pain is not just in one’s head, how one responds to chronic pain may help alleviate or elevate the pain sensations. Ironically, many pain sufferers resist counseling because they fear that others will believe that their symptoms are all in their head. Those who refuse to acknowledge the psychological factors in pain sensation and management miss out on important means to cope with the pain and to lower pain perceptions.

Chronic pain sufferers must accept the need to adjust their lifestyle to accommodate more rest. They must fight to get the best restorative sleep possible. These are probably their primary practical responses–even above medical treatments (and I’m not knocking medical treatments nor saying that just getting sleep will solve the problem).

One of the biggest challenges for pain sufferers is the matter of hope and faith. When we suffer problems, we often hope they will go away. And when they do not, or only get marginally better, it is easy to slide into despair. Despair usually is the result of things not going the way we hoped or expected they would. Part of dealing with chronic pain is grieving what is lost in order to accept–even enjoy–what strength and health we do have. Without hope, we lose what self-efficacy we once had, thus not doing the basic care-taking activities within our grasp. Interestingly, one of the clearest signs of this struggle is the massive dropouts in pain management research. Frequently, dropouts number about 50% in these studies. This means that before a study gets too far along many are dropping out because they assume the new treatment isn’t going work.

Faith is not that things will go my way right now but that God is in control, cares/protects me, and is working for my ultimate redemption–even when the opposite seems to be true. Faith is acting in a manner consistent with said assumptions even while grieving over real losses. Such faith enables us to be mindful of our thoughts so that we do not practice into beliefs counter to what we have come to know as true.

The chronic pain sufferer who grieves well (asks God for relief, stays in community with others, seeks relief through human means yet has an attitude of waiting on the Lord, and yet still willing to explore and confront hidden sin in self) begins to see that in the midst of the pain, God is there and providing momentary help. Such a person need not act as if the pain were nothing but will look for and rejoice in 5% improvement, 10% more comfort, etc, rather than demanding complete healing as the determinant as to whether God is present with them in their distress.

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November 20, 2009 · 1:40 pm

Edwin Friedman on the search for solutions…


Consider Edwin Friedman’s counsel to leaders in book, A Failure of Nerve (Seabury Books, 2007)

In the search for the solution to any problem, questions are always more important than answers because the way one frames the question, or the problem,  already predetermines the range of answers one can conceive in response. (p. 37)

Seems true for counselors as well. How a counselor begins the exploration of a client’s problem narrows the field of answers as to the problem and solutions. Now, assumptions are always present–especially in questions. So, asking questions doesn’t keep the field of view open unless one is willing to ask questions not normally conceived. It is difficult to remember to ask questions that run counter to our initial hypotheses. And yet such questions are necessary if we are going to counsel actual individuals and not mere figments of our imaginations.

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November 3, 2009 · 5:38 am

Philip Cushman’s prophetic words


One of my all-time favorite books is Philip Cushman’s Constructing the Self, Constructing America: A Cultural History of Psychotherapy. In this 1995 book he details the social constructed nature of psychotherapy. My Social & Cultural Foundations class is reading a summation of this book published in article form and so I picked the book back up and read through some of my more favorite parts.Here’s some of my choice quotes from the beginning:

“When social artifacts or institutions are taken for granted it usually means that they have developed functions in the society that are so integral to the culture that they are indispensable, unacknowledged, and finally invisible.” (p. 1)

“It [psychotherapy] is thought of as a scientific practice, yet it is anything but standardized or empirical, and it has not yet developed a disciplinewide consensus about how to think about patients or what to do with them. It is thought of as a medical practice, yet it has an enormous social and political impact.” (p. 2)

“…in order to understand American psychotherapy, we must study the world into which it was born and in which it currently resides.” (p. 4)

“Origin myths describe the origins of the discipline in such a way as to demonstrate the discipline’s utility for those in positions of power. This means that mainstream historians will shy away from portraying psychology as critical of the status quo and will avoid including within their work a critical exploration of the sociopolitical frame of reference in which the discipline is embedded.” (p. 5)

“…I will argue that the current configuration of the self is the empty self. The empty self is a way of being human; it is characterized by a pervasive sense of personal emptiness and is committed to the values of self-liberation through consumption. The empty self is the perfect complement to an economy that must stave off economic stagnation by arranging for the continual purchase and consumption of surplus goods. Psychotherapy is the profession responsible for treating the unfortunate personal effects of the empty self without disrupting the economic arrangements of consumerism. Psychotherapy is permeated by the philosophy of self-contained individualism, exists within the framework of consumerism, speaks the language of self-liberation, and thereby unknowingly reproduces some of the ills it is responsible for healing.” P. 6

Now, soon after 2000, Cushman wrote about the transition from the empty self to the “multiple self.” By this he was not talking about MPD or DID. He felt that the younger generation was no longer looking to find their true self in therapy but to maintain a fragmented self in a chaotic world. In this sense, “who am I at church, work, school, friends, dating, etc. and how can I keep all my pieces from crashing down altogether.”

But, it is interesting to read his view of psychotherapy as supporting the consumeristic economy (even encouraging it). I wonder how our current economic woes will impact the world of therapy….

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November 2, 2009 · 11:40 am

Technoethics?


At September’s AACC conference I attended a presentation entitled, “Technoethics” by Jana Vanderslice, a psychologist from Texas. She got me thinking about the use of e-mail and other Internet-based technologies with counselees. Here are some of the issues:

1. E-mail. Do you have a policy about your use of e-mail with counselees? Do you inform them about the limits or possible problems that might be encountered? Problems such as security and confidentiality, whether or not you will read them “in time”, what becomes of them (printed out and kept in a file?), whether or not you provide brief counseling through e-mail and possible charges, etc. Dr. Vanderslice suggests having a start to the email that says, “Confidential! This is not meant to take the place of in person consultation…”

2. If you do e-mail counseling, do you (a) know who you are emailing? What data do you collect from the person you provide email counseling to? And (b), do you think about how your email may sound if it is printed off and/or forwarded to others. You should assume that your electronic communications may be passed on. Further, if you have regular e-mail contact, how will you deal with the nature of always being at the beck and call of clientele?

3. Your Social networking accts. Do you use twitter? Do you have a Facebook or MySpace account or the like? Do you “friend” your clients? Do you have anything personal on the web you’d rather your clients didn’t see? This becomes a form of self-disclosure. There may be things revealed about yourself on-line that you would never reveal to a client. Remember, if the client is in the same Facebook network, they can likely see more of you than you might realize.

4. Google searches. Similarly, it might be worth your while to search yourself and see what is out there. Did you know that there are “rate my counselor” type sites out there? Many of these exist to help you find healthcare providers in your area, but include ratings by current or former clients. Do you know what others are saying about you?

5. IT and other providers. Who has access to your accounts and computer? Does your IT dept (if you are in a larger organization) know to honor HIPAA regulations? If you use a vendor (e.g., Geek Squad), they need to sign an agreement to maintain the privacy of the clientele data on your email or database. Can you encrypt email and/or WORD documents?

Can you think of other technoethics issues?

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October 26, 2009 · 9:13 am

PTSD and surgery mortality rates


Today I begin “Counseling & Physiology”, a crash course (6 weeks!) for my students to explore the mind/body connections and how counselors pay attention to the body even if not their primary focus.

Last week I saw this news item on my Medscape.com feed: “Veterans with PTSD twice as likely to die after surgery”

Here are some of the highlights from a research study done at the San Francisco VA and UC San Francisco:

  1. 10 year retrospective study of 1792 vets (ending in 2008). 7.8% had established dx of PTSD. On average vets with PTSD were 7 years younger than those without the diagnosis (you would think then, younger = higher survival rates). Surgeries studied were elective surgeries.
  2. 25% increase in mortality 1 year post surgery for vets with PTSD, even if surgery happens years after getting out of the service
  3. Mortality rates for these vets were higher than those with Diabetes
  4. PTSD is an independent risk factor for mortality
  5. DX of PTSD was associated with increased cardiac issues (may point to why the mortality rates are higher

Sobering research if you ask me. Let us not become lazy in our thinking. Emotional problems such as severe depression and anxiety (which PTSD tends to bring both together) have a substantial impact on the entire person, affecting every part of the person from cells to spirit. Neither let us believe that if the cells are involved in such a disorder that there is nothing that counselors can do. Clients can learn to manage and even defeat some of the symptoms of PTSD by taking control of their thought life.

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October 23, 2009 · 1:51 pm

The practice of unlicensed counseling


The practice of counseling, therapy, psychotherapy and other related terms is restricted to those with proper licensing in most, if not all, US states. Makes sense on most levels, right? You wouldn’t want to go to an unlicensed doctor for your appendectomy. In opposition to Holiday Inn’s ads, you wouldn’t want just anybody doing professional work on you. License control is supposed to protect the public from harm. Bad docs and bad therapists should lose their license and not be allowed to practice.

But with counseling and therapy, it gets a bit sticky. Lots of different professions do similar activities. Unlike surgeons, you have people from widely divergent schools of thought and training doing very similar things. LCSWs, LSWs, LMFTs, Psychologists, Psychiatrists, LPCs all do talk therapy. They all diagnose and intervene per their view of what is wrong and what needs to change (thoughts, behaviors. feelings, etc.).

And it gets stickier. Pastors, clergy, and religiously trained individuals do many of these as well. While they may not give DSM or ICD9 diagnoses and bill insurance companies, they do talk therapy with people who are depressed, anxious, angry, on the verge of divorce–just like all of those licensed people above.  In my world, there are pastoral counselors, biblical counselors, pastors who counsel, christian counselors, etc. Most of these in PA are not licensed by any body. (In PA we don’t have a pastoral counselor license as some states do.)

In an effort to tighten controls, there is a state effort underfoot (HB 1250) to tighten who can practice as a counselor. There were already controls but now the new bill would disallow someone like myself to hire or supervise an unlicensed (but in my opinion competent) person UNLESS they were actively in the process of becoming licensed.

Why does this matter?

1. There are many competent people doing counseling related work that are not licensed (nor could they be since their training is of a religious or pastoral nature). Should the state control these individuals? Right now they haven’t been actively going after these folk. The law will continue to remain vague: Here’s the restriction for LPC practice:

Only individuals who have received licenses as licensed professional counselors under this act may style themselves as licensed professional counselors and use the letters “L.P.C.” in connection with their names. It shall be unlawful for an individual to style oneself as a licensed professional counselor, advertise or offer to engage in the practice of professional counselor or use any words or symbols indicating or tending to indicate that the individual is a licensed professional counselor without holding a license in good standing under this act. [underline indicates new change in this paragraph]

Who decides what “engage in the practice of…or use any words…” constitutes? Obviously, one cannot intentionally lie but does the term therapy indicate a license?

2. There are many who provide pastoral care who are not ordained clergy. They have graduated from seminary-based programs that are not professional counseling programs. Yes, the current standard makes clear that it does not seek to limit the work of those acting under the legal auspices of a religious institution (i.e., are ordained by the church). But, should the state regulate those who provide biblical counsel but are not ordained? As long as these individuals make clear (informed consent) what it is they do and what they do not do, shouldn’t they be able to make a living? Research indicates that lay people can have tremendous success in helping those with depression and anxiety.

I’m all for protecting the public. But while licenses limit who gets to perform certain duties, it does not eliminate unethical or harmful practice. Further, much of psychotherapy is art as well as science. Artists can learn their trade in a variety of locations. What we need to do is to make sure the public can clearly identify the kind of counseling (and limits of) each counselor does. Second, those who provide biblical counseling ought to have some authoritative body. It would be great if they were recognized and “licensed” by denominations or organizations (e.g. the AACC who is trying to do this).

But I would hate to see the many seasoned, unlicensed counselors lose their ability to ply their trade.

That raises a question of analogy. Can anyone make a legal living cutting hair for a fee without a license?

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October 22, 2009 · 5:00 am

Remembering Little Albert


The latest issue of American Psychologist has a very interesting story about the search for John Watson’s baby Albert. Remember from your Psych 101 class that John Watson, a behaviorist at Johns Hopkins in the 1920s, attempted to condition the infant to be afraid of white rats by pairing scary sounds with the presentation of the rat. Most every history of psychology tells the story how his condition fear generalized to other furry objects.

For a couple of generations the story ended there. Myths held that the mother took the child away out of her anger; that Watson later deconditioned him. Neither are true. But these researchers decided to spend a great deal of time and energy seeing if they could discover who he was. With Watson burning his own notes before his death, they didn’t have much to go on.

I won’t relay all the details here but suffice it to say they likely discovered who Albert was (Douglas Merritte) and who his mother was (Arvilla, a wet nurse who lived/worked at the university as a wet nurse after becoming pregnant out-of-wedlock for the second time).

Sadly, the boy died before he turned seven (unclear but maybe due to meningitis). So, we haven’t any knowledge of the impact of Watson’s research on him.

What I find amazing is that it was considered ethical to seek and reveal this information in today’s American Psychologist. We are called to provide the highest standards in clinical and research settings, which include anonymity. Why was it okay to reveal this information now when the person in question isn’t able to determine whether he would want this information released. Maybe existing relatives helping with the search gave permission.

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