Hope

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.

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Why New Year's Resolutions Fail

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!

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Coping with Financial Uncertainty

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.

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The Beauty of Not Knowing

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.”

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Finding a Therapist Who is Right for You

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.

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