anne cutler psychoanalyst

Perspective

2009-07-01T11:38:00.005-04:00

I recently spent a weekend at the beach for the first time this summer. As I sat on the beach, I reexperienced how calming it is to watch the waves break on the sand and listen to the sound of the surf. Anxieties seem to drop away with each crashing wave. Later I was thinking that one of the benefits of being at the seashore is that it gives you perspective. Being so close to the enormity of the ocean can make individual problems seem smaller, while the rhythm of the waves relaxes one’s breathing for further physical relaxation.

Perspective is a crucial element to a sense of well-being.

Perspective is a crucial element to a sense of well-being. It allows us to discern between big problems that require attention and smaller issues that don’t deserve the angst they sometimes initiate. Growing up, it’s almost impossible not to internalize distorted perceptions of ourselves and the world around us. In psychotherapy, part of the work is to recognize these distortions and put them in perspective. The greater self-knowledge that results allows for greater happiness and less stress.

I have also found, in working with couples, that the ability to look at things from the other’s perspective is one of the keys to better communication. It’s the underpinning of empathy. Without perspective, we often make the wrong assumptions about another’s intentions, and this can lead to confusion and conflict.

So spend some time at the beach this summer if you get the chance. It’s a good place to start.

Overreacting

2009-05-20T16:51:00.004-04:00

There is no such thing as an overreaction. I know that may sound odd to most of you reading this, since you can probably think of many instances when you or someone around you has “overreacted” to something or taken something the wrong way. Actually, you’re simply (or complexly) reacting to something else instead of what seems to be going on on the surface.

Take an example of a husband and wife in couples therapy. They’re recounting an argument to the psychotherapist that occurred earlier in the week.

There is no such thing as an overreaction. I know that may sound odd to most of you reading this, since you can probably think of many instances when you or someone around you has “overreacted” to something or taken something the wrong way. Actually, you’re simply (or complexly) reacting to something else instead of what seems to be going on on the surface.

Take an example of a husband and wife in couples therapy. They’re recounting an argument to the psychotherapist that occurred earlier in the week. The wife’s birthday was coming up and they were out with some friends. She overheard her husband speaking to a couple of their friends about all the plans he was making for her birthday party. She leaned over and said to her husband, with anger, “We’re going to have to talk about this party later.” He felt hurt by her tone and angry that she wasn’t feeling spontaneous and happy about the party, especially since he was doing it for her. He felt she had overreacted.

As the couples counselor dug deeper below the surface with them, the wife revealed that when she was growing up, her mother had always planned elaborate birthday parties for her without any regard for the daughter’s wishes. The parties turned into big events for the mother to show off her hostess abilities, but the daughter always had a miserable time, feeling completely left out. So when she heard her husband planning her birthday party, it felt like a retraumatization of her early birthday experiences. Her feelings of anger toward her husband were layered up with memories of hurt and anger towards her mother.

These kinds of unconscious reactions are very common, and they often lead to misunderstandings and escalating conflicts. But the more you understand your own unconscious conflicts and issues, the better you can separate out what is an appropriate reaction to what’s going on in the moment, and which of the feelings getting stirred up are actually residues of past conflicts. The psychoanalytic form of psychotherapy concentrates on understanding the individual’s underlying conflicts and helping to resolve them so that all the old feelings aren’t brought to bear on current situations. It’s one of the keys to greater harmony.

Not a Dress Rehearsal...

2009-04-28T16:39:00.002-04:00

A smart woman said to me years ago, when I was stuck in ambivalence, “this is not a dress rehearsal.” My life was being lived in a state of indecision, as if waiting for the opening night curtain to rise. At the root of this indecision for me, as is common for many people, was a deep sense of ambivalence.

Ambivalence is not about not knowing what you want.

A smart woman said to me years ago, when I was stuck in ambivalence, “this is not a dress rehearsal.” My life was being lived in a state of indecision, as if waiting for the opening night curtain to rise. At the root of this indecision for me, as is common for many people, was a deep sense of ambivalence.

Ambivalence is not about not knowing what you want. It’s really about wanting two opposite things at the same time; or having two opposing feelings simultaneously. Hence the feeling of being stuck. If you move toward one desire, you’re moving away from the opposite desire.

Another aspect of ambivalence, at the feeling level, is the experience of feeling both love and hate for the same person. While sometimes this is clear on the surface, often one or the other feeling is repressed (kept out of consciousness). This can lead to behavior that seems unexplainable. For example, hurting someone you apparently feel only love for. When feelings stay hidden, they remain unresolved.

Psychotherapy can help you work through ambivalence, as it did for me. It is not always easy, and it can take time, but the result is rewarding: a much clearer sense of who you are and what you want. Then you can get past the dress rehearsal and take the center stage of your life.

The First Session

2009-04-20T16:32:00.003-04:00

New patients are often unsure what to expect in the first session, how to behave, what to say. There can be anxiety about starting a new process and opening up to someone you’re meeting for the first time.

The first session is an opportunity for both the therapist and the patient to get a sense of each other and whether they can work well together.

New patients are often unsure what to expect in the first session, how to behave, what to say. There can be anxiety about starting a new process and opening up to someone you’re meeting for the first time.

The first session is an opportunity for both the therapist and the patient to get a sense of each other and whether they can work well together. As the patient, you want to see how comfortable you feel in the presence of the therapist. You are not expected to trust the therapist completely from the beginning, but you should be able to have a sense of him or her as someone you could trust over time. The psychotherapist is trying to get an overall sense of a new patient in the first session – what crisis or other issues they’re dealing with currently, what their life is like, how they view themselves, and perhaps some background about their childhood and recent past.

It’s ok to ask questions of the therapist. What is her background and training? What is his style of working? What types of patients does she work with? These types of questions will give you a better sense of the therapist’s perspective and experience. It can be a relief to unburden yourself of the things you’ve been dealing with on your own, and you want to have a sense that the therapist understands and can work with you to help you make the changes you want in your life.

Corporations as Dysfunctional Families

2009-03-23T12:48:00.002-04:00

Stress in the workplace is not just due to staff cuts, tight deadlines, and limited resources. There is also a subtler, pervasive factor contributing to employees’ stress. That is the underlying dynamic of the corporation and the individuals that make it up. I think of corporations as big dysfunctional families. The CEO is the admired and feared parent. Coworkers are siblings, complete with rivalry.

Stress in the workplace is not just due to staff cuts, tight deadlines, and limited resources. There is also a subtler, pervasive factor contributing to employees’ stress. That is the underlying dynamic of the corporation and the individuals that make it up. I think of corporations as big dysfunctional families. The CEO is the admired and feared parent. Coworkers are siblings, complete with rivalry.

In his book, The Psychodynamics of Work and Organizations (1993, Guilford Press), William Czander states: “Because the organization is a hierarchical system, it closely resembles the family structure, and the competitive nature of work requires that one continuously move up or ahead and achieve the top position. Psychodynamically, all employees want to be the favored child of the idealized leader, and all want to take the leader’s place. Jealousy of the leader’s power, perks, and position often precipitates an array of affects, most of which are prohibited and not expressed.”

Because these feelings cannot be expressed, they often come out in other ways. For example, one member of a team undermines another’s efforts, even though both team members would be best served by working together cooperatively to achieve their goals. Gossip and rumors are other common ways that employees compete and undermine each other. As in families, the CEO/parent often doesn’t see everything that’s going on amongst the employees. Favoritism exists, and can lead to further jealousy and bitterness.

Conversely, almost all human beings seek connection with others and fear loneliness and abandonment. But sometimes these underlying fears and desires lead to behaviors which actually push others away. Sometimes we actually invite the thing we fear most.

Sometimes corporations need psychotherapy as much as individuals do.

If you have work stories you’d like to share, I’ll respond with my thoughts on some of the underlying dynamics.

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Separating Feelings from Actions

2009-03-09T08:58:00.002-04:00

How often do you hear people say “you shouldn’t feel like that…” Maybe you even say it to yourself. What these kinds of statements imply is that you can and should control your feelings on a regular basis. However, it is enormously difficult to carry out. And it may not even be wise to deny or repress your feelings. They don’t go away, they just get pushed down only to come up in some other way, such as somatic symptoms, depression, anxiety, or sleeplessness.

How often do you hear people say “you shouldn’t feel like that…” Maybe you even say it to yourself. What these kinds of statements imply is that you can and should control your feelings on a regular basis. However, it is enormously difficult to carry out. And it may not even be wise to deny or repress your feelings. They don’t go away, they just get pushed down only to come up in some other way, such as somatic symptoms, depression, anxiety, or sleeplessness.

A common misconception underlying the belief that feelings are to be controlled is the idea that feelings and actions are somehow inseparable. In fact, the more you think of them as completely separate, the freer you are to feel your feelings as they arise. Then you can decide how or if you want to act on them. It’s a liberating concept because you no longer have to expend a lot of psychic energy keeping your feelings beneath the surface. And, by choosing separately how to act on those feelings, you can reduce relationship conflicts as well.

Anger is a good example. Imagine feeling really angry at your spouse because he or she has forgotten something that’s important to you. That is a natural feeling. However, if you step back before creating a fight, you may realize that your spouse has been particularly stressed at work lately and worried about losing his or her job given the economic climate. In those circumstances, it can be easier to forget even important family events. With that in mind you can choose to have a more constructive conversation with your spouse, letting him know that you’re disappointed he forgot the event, but you also understand the extra stress he’s under at the moment. That will raise the issue without putting him on the defensive.

Managing Relationship Conflicts

2009-02-22T13:21:00.008-05:00

One of the main concerns I hear from patients is how to handle stress and conflicts in relationships. Why is it that sometimes it’s hardest to get along with the people with whom you’re most interested in having harmony? We all have ways of dealing with stress in relationships, and to complicate matters further, these styles can sometimes conflict in ways that exacerbate the problem.

One of the main concerns I hear from patients is how to handle stress and conflicts in relationships. Why is it that sometimes it’s hardest to get along with the people with whom you’re most interested in having harmony? We all have ways of dealing with stress in relationships, and to complicate matters further, these styles can sometimes conflict in ways that exacerbate the problem.

Some common conflict styles include:
o Avoidance. This can involve not bringing up problems at all until resentment has grown too strong, and then exploding in a way that doesn’t invite communication.
o Need to be right. Without realizing it, conflicts get reduced to the idea that someone is right and someone is wrong. Then all the energy goes into proving that you’re right and the other person is wrong, which leaves no grounds for effective communication or compromise.
o Overgeneralizing. If you’re often starting sentences with “you always…” or “you never…”, you’re probably incorrect and putting the other person on the defensive, often a communication killer. This often includes bringing up past conflicts, which can confuse the current issue under discussion.
o Not listening. How many times have you been in a conversation where you find yourself not listening to what the other person is saying because you’re busy planning what you’re going to say next? This can effectively derail communication, turning it instead into a kind of sequential monologue, with both people talking and nobody listening.

It’s important to understand your own style of communication and dealing with conflict as well as that of the person you’re in relationship with. One of the key elements to dealing effectively with conflict is to practice the art of non-defensiveness. This involves listening with an open mind to what the other person is saying and understanding the other person’s point of view.

As a psychotherapist I work with individuals and couples to help improve conflict resolution skills. Contact me at 917-684-6515 or by email at annecutler.psychoanalyst@gmail.com.

What your dreams are telling you

2009-02-09T16:02:00.003-05:00

Most psychotherapists love to work with dreams. As Freud said, “dreams are the royal road to the unconscious.” Even if you’re not convinced about Freud, the fact remains that while we’re sleeping we have much greater access to our brains. We can explore our unconscious conflicts, recall distant memories, and create wonderful metaphorical images to explain our inner conflicts. The tricky part is to figure out what your sleeping brain was telling you once you’re awake.

Most psychotherapists love to work with dreams. As Freud said, “dreams are the royal road to the unconscious.” Even if you’re not convinced about Freud, the fact remains that while we’re sleeping we have much greater access to our brains. We can explore our unconscious conflicts, recall distant memories, and create wonderful metaphorical images to explain our inner conflicts. The tricky part is to figure out what your sleeping brain was telling you once you’re awake.

That’s where dream interpretation techniques come in. In general, dreams are triggered by recent events – significant happenings, thoughts, conversations – that occurred in the day or days before the dream. Then the unconscious links your thoughts and feelings about these events to other thoughts and feelings from your past. Dreams let us know what are anxieties are, what our major inner conflicts and relationship conflicts are about, and so much more.

Anyone can access the meaning of their dreams. A psychotherapist can help because of her training in dream interpretation as well her experience with lots of dreams. I trained for years with a psychoanalyst named Montague Ullman who devoted the last 30 years of his career to developing a group method of dream interpretation. The process involves a group of dreamers meeting once a week or so. In each meeting, one member volunteers a dream and the group then works together to help the dreamer understand his dream. There are a number of steps the group works through to bring out the full meaning of the dream. It is highly effective and almost magical to those involved. It deepens self-knowledge and fosters a true sense of community.

I’ll give more specifics about the method in a future post.

If you’d like to join a dream group in New York City, email me at annecutler.psychoanalyst@gmail.com or call 917.684.6515.

Hope

2009-01-29T09:40:00.003-05:00

I was in Washington DC among the crowd of nearly 2 million people present to witness the swearing in of our new president, Barack Obama. It was a bitterly cold day, and yet people came to the Mall that day before the sun came up to wait on long lines for the privilege of being part of this moment in history. There was a feeling of excitement and happiness and optimism in the cold air.

I was in Washington DC among the crowd of nearly 2 million people present to witness the swearing in of our new president, Barack Obama. It was a bitterly cold day, and yet people came to the Mall that day before the sun came up to wait on long lines for the privilege of being part of this moment in history. There was a feeling of excitement and happiness and optimism in the cold air.

As I listened to Obama’s inaugural address, I started thinking about his campaign message of hope in the face of all the difficulties we’re facing in this country right now. Financial instability, war, lack of health insurance, lack of trust in government brought about by the George W. years… all conspire to make us feel down. And yet, all 2 million of us were sitting there in the freezing cold feeling hopeful.

Hopelessness is one of the components of depression. When someone is feeling depressed, she often can’t think of anything to feel hopeful about. This can contribute to the pervasive feeling of paralysis in depression. But finding even one thing to feel hopeful about can start to turn the tide of depression. Therapy can provide that sense of hope, that change is possible, and that someone can help you.

Why New Year's Resolutions Fail

2009-01-22T20:13:00.002-05:00

I had lunch with a friend soon after the new year, and she told me with chagrin that by January 3rd she’d already broken the new year’s resolution she set for herself. Although she may have broken her resolution unusually quickly, she’s not alone. The majority of people who make resolutions don’t keep them.

I had lunch with a friend soon after the new year, and she told me with chagrin that by January 3rd she’d already broken the new year’s resolution she set for herself. Although she may have broken her resolution unusually quickly, she’s not alone. The majority of people who make resolutions don’t keep them.

Research has shown that after one month 36% of resolutions have already been broken, and after 6 months, 54% have been broken. This cycle of resolving to change and then not being able to can lead to lower self-esteem and feelings of depression. You started the new year out full of resolve and feeling optimistic. Then within weeks or months you’ve reverted to the behaviors you were trying to change. Now you add the self-recrimination of having failed at what you promised yourself to do. Optimism can be replaced by pessimism and a sense of frustration.

Change is difficult. And certain kinds of change are more difficult than others. Among the most common new year’s resolutions people make are: lose weight, exercise to get in shape, quit smoking, stop drinking, get out of debt, spend more time with family and friends. Each of these resolutions involves significant change in entrenched habits and ways of life. And each issue involves a complex set of underlying issues to be resolved if change is to be maintained.

As a psychotherapist, I have worked with many patients over the years who enter therapy wanting desperately to change some aspect or aspects of their lives. People want to be happier, they want to feel less stressed. They want to get out of a bad relationship. They want to find and build a good relationship. But change, even good change, involves some discomfort. The part of the self that wants to avoid that discomfort fights against change.

So what’s to be done? In psychotherapy, people get support for understanding why they do what they do, and then in creating change in the desired direction. Getting support is a key ingredient to succeeding in keeping your resolutions. Secondly, there’s an underlying assumption that the magic of entering a new year will in and of itself power the change. But really, January 2nd is only 2 days after December 31st. The main thing that the change of years does is to strengthen intent. But without a specific plan for change, intent won’t be enough.

So, go ahead, make a resolution. But don’t forget to make a plan and get support!

Coping with Financial Uncertainty

2009-01-12T12:10:00.006-05:00

Financial uncertainty has become a major cause of stress in the US and around the world. Every day, the news blasts more reports of doom and gloom. If you haven’t personally lost your job or savings, you probably know somebody who has. So no one is immune from the stress and anxiety of financial insecurity in these times.
How do you keep from being overcome by these fears?
Here are some ways you can manage the stress...

Financial uncertainty has become a major cause of stress in the US and around the world. Every day, the news blasts more reports of doom and gloom. If you haven’t personally lost your job or savings, you probably know somebody who has. So no one is immune from the stress and anxiety of financial insecurity in these times.

How do you keep from being overcome by these fears?

Here are some ways you can manage the stress so that you can continue to enjoy life and make good decisions for moving forward:
¸ Think long term. When you’re feeling particularly anxious, all your thoughts and emotions tend to focus in the current moment in a negative way. Remind yourself to think over the long term. Life is full of ups and downs, and so is the economy. In fact, there are predictable economic cycles, so you can be relatively certain that what’s down now will eventually go back up.
¸ Breathe. It’s that simple. Anxiety affects your body so that you feel physical symptoms such as shortness of breath, headaches, stomachaches, etc. These physical symptoms in turn can increase your sense of stress. But if you do things to relax your body – deep breathing, exercise, meditation – your state of mind will improve too.
¸ Take action. If you’re worried about losing your job, investigate ways you can make yourself more valuable at work. If you need to find a job, spend time researching your field to find out the best direction to take. Make a schedule for yourself so that you’re doing something positive in this direction every day. Inaction simply adds to the overall anxiety.
¸ Don’t isolate. Tap into whatever network of friends, family, and colleagues you have. In the current economy, you are not alone in feeling the stress. Talking with others who are going through the same thing is enormously helpful in reducing feelings of isolation and improving your mood. And, it can lead to concrete shared ideas of how to find a job or invest your savings.
¸ Take time to do the things you enjoy. When you’re overwhelmed by a stressful situation, it’s easy to forget to have some fun. But diversion from anxiety can restore perspective and lessen the stress overall, giving you energy to focus on useful solutions. Sometimes laughter is the best medicine!

Please add comments with your ideas for reducing stress in tough financial times.

I can help. Contact me at: 917.684.6515 or by email at annecutler.psychoanalyst@gmail.com.

The Beauty of Not Knowing

2009-01-04T13:57:00.002-05:00

To counteract the anxiety of not knowing, we often invent reasons for events based on whatever small amount of evidence is available. But these reasons are often distortions of reality since much of the situation remains hidden. And what’s worse, they often involve self-recrimination. For example, a person who felt unloved by her father while growing up may explain this as follows: “he doesn’t love me because I’m a bad person and unlovable.” These rationales often occur unconsciously, so that one is not even aware they are being made.

To counteract the anxiety of not knowing, we often invent reasons for events based on whatever small amount of evidence is available. But these reasons are often distortions of reality since much of the situation remains hidden. And what’s worse, they often involve self-recrimination. For example, a person who felt unloved by her father while growing up may explain this as follows: “he doesn’t love me because I’m a bad person and unlovable.” These rationales often occur unconsciously, so that one is not even aware they are being made.

These rationales lead to a mistaken sense of control. “The problem is within me, therefore I have the power to fix it.” Then, as the psyche goes about trying to fix something that may never have been a problem in the first place, further problems occur. The reasoning backfires, often leading to lowered self-esteem, depression, etc.

But, essentially, control is an illusion.

I had a patient whose parents had a nasty divorce when she was a young teenager. The father never communicated why he left, and my patient and her mother’s lives changed dramatically for the worse after the divorce. She was plagued with the unexpectedness of his leaving, feeling she had no warning. Later, as an adult, this patient struggled in her relationships with men. She would fear that a man was going to leave her, even (especially?) if there were no signs that this was going to happen. She would become needy and upset at the end of every date. Unconsciously, she kept believing, “I’m not good enough for him to stay.”

Finding a Therapist Who is Right for You

2008-12-31T20:16:00.003-05:00

Especially if you’re thinking about entering therapy for the first time, it can be confusing and difficult to figure out how to find the right therapist for you. For the lay person, the field of psychotherapy can be difficult to navigate. Therapists arrive at their practices from a fairly diverse set of backgrounds, training, and orientations.

I’d like to provide an overview of the basics that may help you to effectively choose the best therapist for you with a minimum of confusion.

Especially if you’re thinking about entering therapy for the first time, it can be confusing and difficult to figure out how to find the right therapist for you. For the lay person, the field of psychotherapy can be difficult to navigate. Therapists arrive at their practices from a fairly diverse set of backgrounds, training, and orientations.

I’d like to provide an overview of the basics that may help you to effectively choose the best therapist for you with a minimum of confusion.

Selection considerations include the therapist’s:
• Gender
• Theoretical orientation
• Education
• Style

And, there are:
• Practical considerations
• The “fit”
• Shopping around

The Therapist

• Male vs. Female
If you have a distinctly easier time relating to a man or a woman, you may want to select accordingly. That will help you to feel more at ease from the first session. Effective psychotherapy requires openness on the part of the patient, and the easier this is to achieve, the better. However, finding a really good therapist is always more important than the therapist’s gender.

• Theoretical orientation
o Psychoanalytic
• Psychoanalysis is founded in Freud’s theories. Since Freud laid the groundwork, the field has been expanded by following theorists.
• In general, psychoanalysis is the most in-depth form of psychotherapy, with patients often in treatment 2, 3, or 4 times per week. However, psychoanalysis is also an orientation that can be practiced at lesser frequency, often once a week.
• Psychoanalysis treats the whole person, not just symptoms on the surface. It focuses on making unconscious issues and conflicts conscious.
o Cognitive/behavioral
• The underlying theory of cognitive therapies is that problems are caused by distorted thinking. Therapy focuses on changing the way the patient thinks. It is the most structured and instructional form of therapy.
• Most frequently used in treating phobias and obsessive behavior.
o Relational
• Interactions between persons are the basic medium in which the psychological work takes place for relational therapists (i.e., between the therapist and the patient).
• The mode of work is more level, less authoritative, than other forms of psychotherapy.
• Integration of the self is one of the goals of relational therapy.
o Self psychological
• A theory within psychoanalysis originated by Kohut.
• The use of empathy and mirroring are crucial therapeutic tools for a Self Psychologist.
• Most commonly associated with treating patients with narcissistic personality disorders.
o Object relations
• Form of psychoanalytic theory originated in Britain
• In this theory, an internal model of relationships is built up inside the self, which determines the way the person thinks and feels and perceives the world.
• The therapist works with the patient to change the inner constellation of parts of the self.
o Ego psychology
• A development within mainstream psychoanalysis
• Emphasizes the development of the ego (from Freud’s id, ego, and superego)
• Approach focuses on conflicts, the demonstration of resistances, and a strengthening of the ego for optimal ego functioning
o Eclectic

• Education
o MSW (Master of Social Work)
• This is 2-year graduate program focusing on psychotherapy and social services.
o Psychoanalyst (Certified)
• Training completed at a psychoanalytic institute, usually a minimum of 5 years. Training includes years of supervised practice seeing patients. This is the only degree that requires students to complete their own psychoanalysis as patients as part of their training.
o Psychologist (Masters)
• A 2-year masters degree with a variety of different focuses within the field of psychology. May or may not include education in psychotherapy.
o PhD
• Doctorate level training in the field of psychology. Usually takes a minimum of 5 years to complete.
o PsyD
• Almost as much training as a PhD, but with less emphasis on the scientific aspects of the field (research, etc.). Usually includes clinical training.
o Psychiatrist
• This is a medical degree. A psychiatrist has graduated from medical school (MD), and has gone on to complete a psychiatric residency program. A psychiatrist may or may not have any training in psychotherapy. This is the only degree that allows one to prescribe medication. Many other types of psychotherapists have working alliances with a psychiatrist in the event that a patient needs medication.

• Practical Considerations
o Fee structure
o Location
o Desired frequency
o Medication
o Flexibility of scheduling

• The “fit”
o The fit between a psychotherapist and a patient is not quantifiable or overt. Different factors contribute to a good fit, such as the therapist’s style of working, personality, and manner. As a patient, you will know if there is a good fit with a therapist if you feel at ease speaking openly with the therapist.

• Shopping around
o It’s ok to meet with several therapists before you decide on one who’s best for you. You may want to meet different types of therapists to determine which theoretical approach is most comfortable. It can also help to get referrals from people you know who are, or have been, in therapy themselves. Once you find a therapist you want to work with, it’s not necessary to keep shopping just for the sake of it. You might as well get started.