I look inside myself and see my heart is black
I see my red door and must have it painted black
Maybe then I'll fade away and not have to face the facts
It's not easy facin' up when your whole world is black
The Rolling Stones
The Holiday Blues
The holiday season is typically a joyous time. We are often surrounded by loved ones exchanging gifts and good cheer. However, the holiday season can also be a stressful time. Shopping for gifts or sending out cards can be time-consuming and a financial strain. Many people travel to be with families, which can be tiring. Those who travel far might even suffer from jet lag. Being with one’s extended family can be emotionally draining. Dysfunctional family dynamics that have been dormant all year can rear their ugly head. Our expectations don’t always match up with the idyllic representations we see in the movies or on tv. New Years can bring up feelings of remorse and failure. To some the tinsel and bright colorful lights are nothing more than a reminder of the darkness and cold of winter that looms just below the ornaments.
During the holiday season many feel isolated, alone or unhappy with their current relationships. They might hate their jobs or even be unemployed. They might be physically ill or are close to someone who is sick or even dying. As we get older, the holidays can become an annual reminder of the loved ones we have lost over the years. We are flooded with childhood memories, some good and some bad. Many of the loved ones we grew up with are no longer with us.
When we gather with family and friends, we often over eat, drink too much, skip exercise routines, and don’t get enough sleep. It is common to feel exhausted and a bit grumpy around holidays. Moments of depression are not uncommon. It is easy to see how you can suffer from the holiday blues.
For many getting through the holidays can be a relief. Once you get back into your daily routines, much of the holiday malaise tends to pass. You are aware that the days will get longer, there will be more daylight, temperatures will warm up, and spring will soon be in the air — and you have 365 days until your next family gathering. You begin to exercise again, eat healthy and are glad to be back to work and your daily routines. But this is not the case for everyone. Depression can drag on beyond the holidays. Some people experience bouts of depression that can last the entire winter season, and in some instances even longer.
Dr. Martin Klein is a clinical psychologist who specializes in the treatment of depression. He has offices in Westport and Branford CT.
Seasonal Affective Disorder (SAD) is a type of depression that is related to the changes in the season. Symptoms typically start out mild in the fall and gradually become more severe as the winter approaches. This syndrome is often referred to as the "winter blues” because it is triggered by the lack of day light and the cold weather. Like other forms of depression, people who have SAD can be overwhelmed with feelings of guilt, anxiety and despair. They can feel like the energy in their body has been zapped resulting in sluggishness, poor concentration and little motivation to do activities that they once found to be pleasurable. Due to intrusive negative thoughts, they can easily become agitated. This high degree of irritability can make it hard to fall asleep and stay asleep, resulting in exhaustion and mood swings. One's appetite is often affected and accompanied by either weight gain or loss. Many people who have SAD suffer from low self-esteem.
Some of the factors that seem to play a role in the onset of SAD is a change in circadian rhythms. The research suggests the reduction in sunlight disrupts the body's internal clock and throws off one's sense of well-being. Not having enough sunlight can also cause of drop in serotonin, a neurotransmitter, that when lowered results in mood changes associated with depression and anxiety. The change in seasons can also disrupt the body's level of melatonin. Melatonin plays an important role in sleep patterns, affect and energy level.
There are several treatment options for individuals who suffer from Seasonal Affective Disorder. It is important to discuss your symptoms with your primary care physician (PCP) to rule out the possibility of other medical conditions that can cause mood changes. If your PCP does diagnose you with SAD, he will most likely refer you to a clinical psychologist for psychotherapy to learn strategies to identify and change negative thoughts and behaviors as well as learn relaxation techniques to reduce stress, bodily tension, and elevate one's mood.
Light Therapy, also called phototherapy is often utilized to treat SAD. Utilizing a special light box, a person sits in front of this special bright light for an hour each morning. The light therapy mimics the natural light that occurs in the spring and summer months and affects a change in the brain's chemicals linked to moods. Light therapy typically begins working within a few weeks and there are few negative side affects.
Some people benefit from medications. Wellbutrin is an anti-depressant that is often used to treat severe cases of SAD. The medication can be taken during the SAD season, from late fall until the end of winter each year. Exercise, meditation and stress management tools can also be helpful to reduce SAD symptoms.
Dr. Martin Klein is a clinical psychologist who specializes in Seasonal Affective Disorder. He has offices in Westport and Branford CT.
Everything that irritates us about others can lead us to an understanding of ourselves.
Couples therapy is more complex than individual psychotherapy. In individual therapy you are working with one person. In couples therapy you are dealing with a minimum of two. Not only are there twice as many people in the room, but each individual brings his or her own set of psychological issues to the relationship. These psychological issues are not static, but rather are dynamic and intertwine between the couple in a myriad of complex configurations and interpersonal entanglements.
Relationships can take on an ominous life of its own. When left unmanaged, it can throw couples into a whirlwind of interpersonal conflict and distress. Many couples become overcome by the negative patterns of their relationship. They feel beaten down and hopeless — victimized by how the dynamics of the relationship brings out the worst in each other. It is difficult to grasp how two individuals who at one point in time were in love now feel only contempt toward each other. How attraction can transform into repulsion so quickly is beyond all that seems rational.
What complicates couples therapy even more is how each person in the relationships carries within him or herself a vast array of influential voices that have been incorporated into their own sense of self. These voices shapes the ways each partner interacts with the other. Voices from the past, present and even future can be heard within the couple’s narrative — learned beliefs, views, even politics of parents, grandparents, siblings, children, previous relationships, colleagues or friends. In some ways couples counseling is more like group therapy than individual counseling.
To be successful, the psychologist must listen, comprehend, and map out all that is being said within, outside and between the two partners. It is the psychologist’s job to start the initial couples counseling sessions with a comprehensive psychosocial assessment. This is necessary in order to learn all that is being said and not said by each participant, who is being influenced by who, and how all these different voices interact and affect the dynamics of the relationship.
Couples counseling can sometimes feel like a tennis match. Couples arguing back and forth, volleying for their point of view. A therapist, however, is not a referee. It is not the job of the psychologist to determine who is right or wrong or resolve a dispute by compromise. Conflict resolution is the technique used in mediation where an arbiter assists the couple to negotiate the terms of a settlement. A settlement is something that is acceptable when you are getting a divorce, not when you are planning to stay together. To settle and sacrifice your needs for the sake of the relationship can only lead to further resentment, conflict and contempt. It is counterproductive. To stick with the tennis analogy, couples counseling does not lead to “Love” just because the participants both agree to being “at fault.”
Taking sides in couples counseling is a big mistake. What is important in couples counseling is for the psychologist to assist both partners to develop the ego strength to see outside their own personal assumptions and begin to understand the perspective of the other and how it relates to the dynamics of the relationship. A seasoned therapist knows the focus in working with a couple must be on insight and transformation, not on who is right or wrong.
I help couples pinpoint and understand the sources of their conflicts. I will work with you to achieve a better understanding of the external influences and family dynamics that play a role in shaping your relationship and cause dysfunctional interactions. I will assist you in developing new strategies to solidify your relationship and regain trust and intimacy. The work will include learning how to openly communicate, problem solve and develop new productive ways to discuss, understand and accept individual differences.
The goal of couples therapy is to learn to see your significant other in a new light, based upon insight and knowledge and not the blind subconscious forces we sometimes mistake for attraction and love.
Dr. Martin Klein is a clinical psychologist who practices in Westport and Branford CT. He specializes in couples therapy and marital counseling.
It Was Meant To Be
People often repeat proverbs as explanations as to why certain events have occurred in their lives. One saying I commonly hear is: "it was meant to be." People use this expression to account for both positive and negative events in their lives. For example, "It was meant to be that I met the man of my dreams" or "the promotion at work that I did not get was not meant to be."
This saying implies that what has happened in a person's life occurred because of an external omnipotent force. These expression are stated in past tense, and is never said prior to an event as a premonition.
It Happened For A Reason
The proverb implies a sense of destiny -- the belief one's actions are predetermined and must have happened for a reason. In fact, some people actually say "it must have happened for a reason" rather than "it was meant to be" -- but both expressions have similar connotations.
In a predetermined world, one is no longer responsible for his or her decisions. One might think she is making a choice, but in actuality she is doing what is dictated by destiny. To use an an analogy, in a world where destiny rules, one's experience of having free will is like the child's experience of being the captain of the ship on a carnival ride where the toy steering wheel has no real control of the boat that in reality travels on a fixed circular track. In other words, free will and choice are illusory.
The Abandon Of Free Will
Why would someone want to accept a worldview that undermines their right to self determination? Isn't personal freedom what we all strive for? From an early age are we not taught the goal of life is to achieve as much freedom as possible, be it financially, socially, at work or in one's relationships? Why would a person want their freedom taken away or diminished by some sort of authoritarian force or being? Is it possible that personal freedom is not all that it is cracked up to be?
The Anxiety Of Choice
Some people have a hard time making decisions. Decisions are not always easy, be it what college to go to, who to marry, where to live, how to invest, should I have kids, take this job, divorce or retire? While you often hear personal freedom is a wonderful privilege, when faced with actual choices, individuals often become psychologically paralyzed. Fear of making the wrong decision can lead to overwhelming anxiety and despair. Once the choice has been made, many individuals often doubt their decision and experience the dread associated with regret. This regret sometimes manifests itself in an obsessive like rumination: "should have" -- "could have" --"what if." Other times, it is defended against by denying the the personal responsibility for the decision. It was not my fault, or I could not have choose otherwise because it was beyond by control -- "it was meant to be."
Paradoxically, to some individuals freedom can be experience as a limitation. To choose "A" means you did not choose "B". Decisions can be perceived as an act of eliminating options. Contrary to the popular saying, for these individuals, every time a door opens another door is closed. A closed door symbolizes one's finitude. Alexander Graham Bell said it so nicely: "When one door closes, another opens; but we often look so long and so regretfully upon the closed door that we do not see the one which has opened for us."
Should Have Could Have
Personal freedom can cause anxiety on many different levels. First, there is the fear of making the wrong decision. This anxiety manifests in obsessive thoughts, thinking over and over again about the pros and cons of each decision. Ironically, while it may feel like not choosing keeps open possibilities, in reality no decision is itself a choice, one that is nonproductive or forward-moving. Second, there is the anxiety associated with regret. This anxiety manifests in ruminative thoughts, the "should have" -- "could have."
Coping Mechanisms and Regret
Both types of anxiety are very painful and can result in despair. Many individuals develop coping mechanisms to avoid these intense negative feelings. For example, some might develop compulsions. -- repetitive rituals as a means of trying to gain a sense of control over fear of the unknown. Others might avoid the decision altogether -- perhaps alcohol or drug abuse as a means of not dealing with the question at hand. Several might deny there is even a choice -- if life is ruled by destiny -- "it was meant to be " you are not responsible for decisions, thus cannot have regrets.
From experience we all know that these coping mechanisms -- be it obsessions, compulsions, avoidance or denial -- have limited abilities to defend against these fears and anxieties associated with the responsibility and pressure of self determination.
Claustrophobia, Panic Attacks And The Fear of Death
There is one more level of anxiety worth mentioning that is intertwined with both the fear to decide and the regret of past decisions. This anxiety is much deeper and more cumbersome than the anxieties discussed above. For the fear of limitation when pushed to its root origin brings one to the fear of one's finitude. Perhaps the claustrophobia or panic associated with a closed door is intrinsically the fear of one's mortality. The existential psychologist refer to this ultimate cause of angst as "death anxiety." But the fairy tale of "happily ever after" is perhaps a topic for another blog.
Dr. Martin Klein is a clinical psychologist who specializes in the treatment of anxiety. He has offices in Westport and Branford CT.
Copyright November 2016, Martin Klein, Ph.D.
And you may find yourself
Living in a shotgun shack
And you may find yourself
In another part of the world
And you may find yourself
Behind the wheel of a large automobile
And you may find yourself in a beautiful house
With a beautiful wife
And you may ask yourself,
well...How did I get here?
From an early age we are taught to follow the rules of society very seriously. We are thrown into a predetermined set of familial, and more broadly, cultural norms that drive and define us. For most of our waken time, we act and do what we are told without question. We follow in our parent's foot steps and when we astray we are redirected back to the norm by modeling and conditioning.
As children we learn about ethics and morals. We learn to internalize what is right and what is wrong and how we should act, think and behave in different situations. Even before we are born, we have a name, a demarcation that already has significance and affects who we will become. We fear making a mistake; be it getting a "D" in school, not getting into the right college, choosing the right spouse, finding the right profession, raising your kids properly or saving enough in your 401k.
We live our lives propelled forward -- looking backwards only to remember where we came from, who we are, and the the ideals that guide us to who we become. Fredrick Nietzsche called it the "Herd," Martin Heidegger called it the "They," Sigmund Freud called it the "Super Ego," and Jacque Lacan called it the "the Symbolic." While these thinkers might not agree on all aspects of their philosophical presuppositions, their basic premise share a similar significance.
We are born into a historical world, with a language, ideology and common sensibility. Like in a familiar game or sport, we learn the rules so well, we are able to play our assigned roles so naturally, without even a moment of hesitation. Be it the language we speak, the activities we do, the popular styles or fashion we follow, how we communicate, feel or related to others. This human "belongingness" to a collective symbolic order is best illustrated in today's obsession with social media. In today's world, the toddler, before she can master walking, knows how to surf the World Wide Web. We live in a society where we communicate by text, are always "connected" and are absorbed in 24/7 media and news. Ask any parent about the panic that occurs when you try to take a child's I Phone away. The 'Internet Of Things" has become the the iconic symbol of our generation's alienation from our own subjectivity -- a constant connectivity to avoid self-reflection. This avoidance to be with one's own self has reached epidemic proportions in our current society; as manifested in the abundance of obsessions, compulsions and addictions to drugs, social media, video games and internet pornography.
For many of us, we are so absorbed living our lives we have no time to think about or question the very nature of our existence. It is only when we are jolted by a specific event or perhaps a developmental crisis, we find ourselves thrown into self reflection and ridden with existential doubt and anxiety. For many this existential crisis manifests in the form of psychological symptoms, be it panic attacks, insomnia, obsessions or compulsions, feelings of helplessness, a sense of directionless, lack of pleasure or molase. For many it is arises in the form of a mid-life crisis" or confronted by an illness or older age.
In my practice, I often here people say: it felt as if one day I awoken out of a deep sleep and found myself entangled into a strange life, surrounded by people I don't know and working a meaningless job I don't like. How did I get here? is a question many people ask when we meet for the first time in my office. Why did we turn out way we did? What were the underlining reasons that caused us to be who we are? How did our lives end up the way it did? How did things turn out so different from one's expectations?
Be it the 75 year old man who does not recognize his own reflection in the mirror. Where did the time go? When he looked in the mirror, the image looked more like his father than he. How about the couple who met in high school and fell in love at first sight. They were soulmates, best friends and always had each other's back. Now they find themselves married twenty years with two kids and they can barely look at each other without a conflict. A man who dreamt of fame an fortunate as a child, now counts the days to retirement and his government pension. How could a man with such promise end up working such a personally meaningless job? How does a child of the sixties, who fought for freedom and equality, find herself working for a hedge fund helping the top one percent become even wealthier? Or, the man faced with illness, question the purpose of his very existence.
How did we get here? is the question that arises when the self takes a step back and reflects upon its own historical relevance. What is the purpose of my life? It is also the question that unhingers the deeper existential questions of self-identity, free will, meaninglessness and personal finitude.
There is such a contradiction to the human condition. We take ourselves very seriously. Who we are, how we want to be perceived, the importance and consequence of our actions, what we look like, what we achieved, our physical health, our relationships, who we want to become. Yet, when we sit back and reflect upon the greater existential questions, our sense of self-importance can shrink to utter confusion and meaninglessness. Are we not all "bipolar" -- faced with one's own finitude, we race to achieve what we were meant to be, yet why bother, if in the grand scheme of thing, what we do does not matter.
This is the human dilemma. Faced with a life crisis, getting older and an awareness of one's finitude, cracks begin to form in the foundation of one's everyday identity, purpose and significance. Panic sets in unleashing powerful waves of existential doubt and anxiety. Reflecting upon one's personal history, like a literary critic analyzing a narrative, the individual begins the process of self discovery and understanding the thematic motives upon which their lives and self identity were constructed.
Personal freedom can be both a blessing and a curse. While you are free to choose your own destiny, this freedom comes with a price, an awareness of the ultimate groundlesssness of your existence. To face death, is both freeing in terms of the anxiety associated with stress of everyday decisions and concerns, yet existentially wounding and anxiety provoking when confronted with one's temporality and ultimate lack of permanency and significance.
Perhaps the question "How did we get here?" naturally leads us to the question "How do we get out of here? I will let Bob Dylan have the final words.
"There must be some way out of here" said the joker to the thief
"There's too much confusion", I can't get no relief
Businessmen, they drink my wine, plowmen dig my earth
None of them along the line know what any of it is worth.
"No reason to get excited", the thief he kindly spoke
"There are many here among us who feel that life is but a joke
But you and I, we've been through that, and this is not our fate
So let us not talk falsely now, the hour is getting late".
Copyright, Feb. 2017, Martin Klein, Ph.D
Alcohol is legal and socially acceptable. It plays an important role in our culture and daily lives. To make a toast on a special occasion or engage with your associates at a happy hour is considered to be normal and even proper etiquette. While low dosages of alcohol might reduce social inhibitions or improve cardiac health, it has long been known that excessive drinking is detrimental to most of the organs in your body and in fact can be deadly if done to excess.
Over the long-term, heavy alcohol consumption can cause severe illness such as liver and brain damage and increase risk of cancer. A recent study concluded that drinking as little as 10-14 glasses of wine or beer a week can reduce one's life expectancy by several years. While alcohol may not be seen by society as a deadly drug, in our country over 15 million people are reported to have some sort of alcohol use disorder, and over 88,000 people die from alcoholism on an annual basis. Alcohol is a highly addictive substance. In fact, trying to detox off of alcohol without medical assistant can have dire physiological consequences. It is no wonder that alcoholism is viewed as a chronic and sometimes fatal disease.
However, alcoholism has not always been considered to be a disease. Prior to the twentieth century, a person's inability to "hold their liquor" was seen more as a personal weakness. Alcoholics were identified as "drunks," with flawed character and low morals. It was not until the 1930s that the medical community began to define alcoholism as a disease and Alcoholics Anonymous (AA) was founded and embraced the disease model as a core principle. The disease model allowed the medical profession to begin to treat addicts as victims of their illness rather than derelicts who should be punished for their sins.
The disease model has its merits -- it offered alcoholics the opportunity for recovery rather than social scorn. However, it also had an intrinsic flaw -- it did not address the underlying psychological issues that caused the substance abuse in the first place.
Many people who abuse alcohol suffer from some sort of underlying anxiety disorder. In an attempt to self-medicate their underlying psychological issues, the alcoholic develops an addiction. The alcoholic now has dual presenting problems -- 1. anxiety and 2. alcohol dependence. It is my clinical view that to achieve sustained sobriety, the alcohol abuse and the underlying anxiety dysfunctions must be concurrently treated. In fact, between 20 to 50 percent of people do relapse right after the completion of disease model treatment program and nearly 90 percent of people relapse within 4 years of completing an alcohol rehabilitation program.
Being human is not a easy feat. We don't have control over many variables in our lives and we must all face possibilities that tragedies can happen at anytime, including one's own mortality. For most of us, however, we adapt to our existential condition. We learn how to put things out of our heads so we can function in the world and limit our fears. Anxiety is a normal part of life and in many instances it arises for good reason. For example, if a lion is chasing you in the jungle, anxiety and fear are not only appropriate, they are essential to one's survival instinct.
Alcoholics tend to be individuals that did not grow-up in ideal family settings. They did not develop a basic sense of security or trust and thus never felt safe with others or even natural in their own skin.
They tend to be overwhelmed by irrational anxieties and uncontrollable fears even in situations that don't justify these feelings. Their high degree of anxieties can manifest in different ways. Some individuals suffer from general anxiety; constant worrisome thoughts and unnecessary fears about routine events and everyday activities. Others have social anxieties; fear of being scrutinized by others, humiliated or embarrassed in public. Many are plagued by obsessions or compulsions; paralyzed by the "should've could've," find it difficult to make decisions, stop ruminations or unwanted behaviors. Many cannot slow down their thought processes and suffer from an inability to relax or insomnia. Others have phobias; public speaking, going in an elevator or meeting a stranger can result in a feeling of panic, chest pain, tightness in the throat and shortness of breath. A history of trauma or past abusive can result in the avoidance of intimacy, low self-esteem, intrusive thoughts and self-destructive behaviors.
Alcoholics can have have one or more of the types of anxiety disorders described above. To achieve sobriety and avoid relapse, a person has to do more than stop drinking, they have to learn better coping mechanisms to handle their underlining anxieties that are at the root of their substance abuse problem.
AA meetings can play a significant role in helping the alcoholic address their anxieties. More than just focusing on alcohol as a disease, there is a significant psycho-social component to the AA group meetings that address the alcoholic's anxieties head on. AA group meetings can be viewed as a form of exposure therapy; whereby the alcoholic faces its irrational fears and learns more adoptive interpersonal modalities of functioning. AA offers a type of re-parenting experience; a safe environment of unconditional support that promotes basic trust and a sense of social well being. Attending meetings and sharing with others in an open and honest manner is self empowering; it reinforces that one is okay for who they are. By surrendering to a high power, the alcoholic comes to terms with the reality that many existential fears are not in their control. By bonding with a sponsor, honesty and intimacy is achieved perhaps for the first time. By taking one step at a time, the person stops ruminating about future and past decisions. By having to attend groups and speak in front of others, irrational interpersonal and social fears are called into question.
However, for many AA meetings are not the right mileu to address their psychological issues. They need more individualistic and intensive psychotherapy to work though their childhood and family issues and learn more adaptive ways to improve self-esteem communication, interpersonal relationships and abilities to handle existential issues as they arise. Existential psychotherapy can help you learn how to differentiate between appropriate anxieties, the fear one feels when a lion is chasing you in the jungle, and irrational anxieties, the fears of low self-esteem, being around others or being a failure.
Dr. Martin Klein, Ph.D. is a clinical psychologist who practices in Westport CT. He specializes in alcoholism, addictions and anxiety disorders. He is trained in existential psychoanalysis and psychotherapy.
Dr. Martin Klein, Ph.D. psychologist specializes in the treatment of anxiety utilizing a combination of hypnosis, mindfulness techniques and psychotherapy. He practices in Westport, CT.
It’s not that easy being green;
Having to spend each day the color of the leaves.
When I think it could be nicer being red, or yellow or gold-
or something much more colorful like that.
It's not easy being green.
It seems you blend in with so many other ordinary things.
And people tend to pass you over 'cause you're not standing out
like flashy sparkles in the water- or stars in the sky.
Life can be hard. We are born into the world so helpless and dependent on others. As we get older we are faced with many challenges and unknowns. Learning to walk is no easy feat. The act of separation is painful. The first day away from your parents is traumatic and anxiety provoking. School is a challenge and requires more and more work as we advance. When school does finally end, we are faced with the anxiety of finding a good job and preparing to grind through the hoops of advancement. While there are many wonderful things about having a family, child rearing is much more difficult than anyone can imagine. Raising a family is beyond a full-time responsibility. The required sacrifice of one's freedom for the good of the family at times can be exhausting and not so personally rewarding.
Yet we continue to tightly grasp onto our dreams. Many of the ideals that motivate us we digested even before we knew how to speak. We learn from our parents, teachers, and the many forms of social media who we should be, think, and become. We are told we can be outstanding. We want to "be all we can be." We believe we can become our idols if we dress or talk like them or buy their products. Even the child believes the commercials that the toy inside the box is the real thing, or that they can become the action figure or build a fighter jet just like perfect representation on the box top. We enter the socialization process and strive to be a good person, be responsible, have a good job, support our families and the community.
When you are young time seems to go so slow. A ten year old dreams of being a teenager, a teenager dream of being a college student, a college student dreams of being an adult. However, as we get older, our sense of temporality seems to change -- time seems to quickly speed up.
With a blink of an eye, you find yourself middle aged. When you look in the mirror you don't recognize yourself. You now look more like your own parent than your internal image of yourself. Your body is beginning to slow down and the wear and tear of aging results in aches and pains. For the first time, you are faced with the limitations of both your aging body and ability to live out your dreams and childhood aspirations.
Like Wile E. Coyote, from the Road Runner cartoon, you realize, perhaps for the first time, you are hanging onto a fragile branch that in time will crack and fall into the abyss.
You start to question the very premise of your existence. The metaphysical questions of the great philosophers no longer seem abstract and irrelevant. Who am I? What is my purpose? Can I ever feel whole or complete? Does my life actually matter? Am I a coherent self or a loose collection of fragment streams of thoughts and ideas? If I am going to die, does anything I try to accomplish count for anything in the larger scheme of things? Shakespeare's quote "to be or not to be that is the question" shakes your existential core.
To face one's own death can be frightening. Much of what we do in our lives is about losing ourselves in the everyday busyness — to avoid, deny and repress our own limitation. One of my clients coined the term "ego cowardice" to describe this failure to face reality and continue living a life based upon false hopes, oneiric ideals and deceptions.”
To face one's finitude takes courage. It might even feel a bit like bungee jumping without the cord. But the truth is that the cord was cut a long time ago.
Perhaps Rose, in the movie Moonstruck, said it best when she finds out her middle aged husband is cheating on her with a younger woman: "I just want you to know Cosmo, no matter what you do, you're gonna die, just like everybody else."
To accept one's existence might only be liberating for a moment. But in life -- a moment in time is all we have. Why not make the most of it.
Dr. Martin Klein is a clinical psychologist who specializes in insight oriented existential psychotherapy. He works with people dealing with issues related to life transitions, identity, intimacy, relationships, careers, spirituality, grief, aging, illness, loneliness and meaningfulness. He has offices in Westport and Branford CT
From an early age we learn to be silent. Embedded deep in our collective thoughts are proverbial beliefs such as “Children should be seen and not heard” and ‘If you have nothing good to say, then say nothing at all.” This “looking away” attitude of society has resulted in generations of adults who suffer the pain of silence -- the pain associated with being a victim of childhood abuse.
How can a child, who must be dependent upon adults for nurturance and guidance, accept the terrible reality that his or her parental figures are non-trustworthy, out of control and capable of harmful abuse? How can such a child, whose basic trust and sense of self was violated, learn to trust another individual or allow for an intimate and bonding relationship?
As a means of survival, victims of childhood abuse learn, early on in life, coping strategies to defend against thoughts and feelings to painful and frightening to put into words.
While these defense mechanisms serve important functions at the time of the abuse, as the child psychologically develops they tend to hinder adaptation to adulthood. The traits and behaviors that were at one time beneficial in terms of helping the child survive an abusive situation become maladaptive when applied to more appropriate relationships. Healthy relationships rely upon basic trust and intimacy – two characteristics survivors of abuse tend to lack.
The adult survivor relives the past in the present as if the environment they currently occupy is as dangerous, unpredictable and uncontrollable as their childhood realities. As a result, many survivors tend to be non-trusting, guarded, avoidant of intimacy and hyper vigilant.
The three coping mechanisms most widely used by adult survivors to defend against painful and intruding thoughts and feelings are repressions, denial and dissociation.
Many adults who have been abused as children are unaware of their own victimizations. They are unable to remember, at least on a cognitive level, their past history of abuse. By repressing these traumatic memories, the individual tempts to go on with life as if the abuse had never happened. “What I don’t know can’t hurt them” is the faulty premise upon which this defense mechanism rests.
Repression, however, can only go so far. The more the individual attempts to push these negative thoughts and feelings out of mind, the more they can return in the form of flashbacks, nightmares and even psychosomatic symptoms.
For example, repressed anger may result in tension headaches, fear of abandonment can manifest as gastro-intestinal problems, and feelings of guilt can appear as back or should trouble, not to mention the array of sexual, dysfunctions, eating disorders, addictions or characterological traits that can signify some form of unresolved issue related to the abuse.
Victims tend to distort the facts surrounding the abuse. They deny their victimizations. They believe they desired, deserved, or willingly participated in the abuse. Many abusers threatened their victims into secrecy, leaving them to carry these concealed burdens well into adulthood.
Certain victims blame themselves for the abuse as a means of gaining mastery over the abusive situation. “If I am responsible for the abuse, then I am also capable of controlling and possibly preventing the abuse.”
Other victims blame themselves for the abuse because they confuse their age appropriate need for affections with abuse they received. “I am to blame because I wanted my father to come into my bedroom and cuddle.” Victims, who blame themselves for the abuse, tend to suffer from excessive guilt, depression, low self-esteem and self-defeating thoughts and behaviors, including suicidal thoughts and gestures.
Dissociation in another coping strategy abuse victims use to defend against painful thoughts and feelings. When adult survivors are confronted with situations or events that symbolically remind them of the childhood abuse, they defend against these intruding recollections by either temporarily losing touch with reality or numbing their bodies so they don’t experience the pain associated with the abuse.
Like a circuit breaker, dissociation shuts down a person’s cognitive and emotional processes in order to prevent an overload of painful stimuli. Dissociation, however, is only a temporary solution; it does not resolve the underlying issues that are triggering the problem. The moment the individual is confronted with internal or external stimuli that bring forth painful recollections, the maladaptive mechanisms arise and prevent the person once again from performing everyday functions.
It is difficult for an abuse victim to seek professional psychological help. They are caught in a vicious circle of maladaptive defenses. To break the silence, develop trust and intimacy with a therapist, and begin to work through one’s pain is a frightening, but much needed process.
Dr. Klein is a clinical psychologist who practices in Westport CT. He specializes in the treatment of trauma, Post Traumatic Stress Disorders (PTSD) and adults survivors of emotional, physical and sexual childhood abuse.
For the adult survivor of childhood abuse, what is most frightening about the therapeutic process is its demand for verbal communication and intimacy. Many victims are unaware of their past history of abuse or find it too difficult to speak openly about their painful memories, especially to a therapist.
Victims of abuse are conflicted about how they should relate to a therapist. They desire their therapist’s understanding and care, but fear if they let down their defenses they might become vulnerable once again to possible abuse.
Childhood abuse rarely appears as the presenting problem. To diagnose a victim of abuse, the therapist must learn to read between the lines of what the person is saying or even not saying. It is within the silence that victims express their suffering and need for help. The abuse victim communicates less with speech, and more with the symbolic language of the body.
There they sit facing the therapist, scared, frightened, hyper vigilant, numb, looking away from the therapist’s eyes in order to avoid what they perceive as their therapists’ piercing and critical gaze.
As a perceived parental figure, therapists can easily become screens for the victim’s projections. The individual may experience the therapist as if he or she is an abuser and the therapeutic session an abusive situation. If this occurs, the conflicts and struggles the adult had as a child may be acted out within the realm of the therapeutic relationship.
It is understandable why even a seasoned therapist might be disturbed by the victim’s inappropriate and situationally dystonic behaviors and actions. To cope with their own level of anxiety, some therapists might choose to relate to the patient in a defensive manner.
The most common form of defense used by therapists to create distance between themselves and the acting out patient is the diagnostic procedure. By labeling a person with a diagnosis, the patient as subject is transformed into an object that can then be defined, manipulated and controlled.
Because of their hyper vigilance, victims are sensitive to how others perceive them. If they feel the therapist is relating to them as an object rather than as a fellow subject, their acting out tendencies will escalate.
The feeling of being objectified by the therapist will serve as a catalyst for the victim to re-experience and reenact the past abusive situation within the present therapeutic relationship. In other words, the defensive therapist will be perceived by the victim as being manipulative and controlling and as a result will react in a defense fashion against what they perceive to be a threat.
The goal of treatment is not for the therapist to diagnose the victim, but rather for the victim to begin to learn how to identify and understand their patterns of thoughts, emotions and behaviors. By organizing their experiences into language, their victim will develop the psychological distance and personal integrity required to gain a sense of mastery and control.
Over and against the victim’s negative projections, the therapist must relate to the victim with unconditional compassion and support. For it only by developing a safe and highly structured milieu that the victim will be able to let down his or her defenses and begin to work through the issues related to the abuse.
It is understandable why the victim’s defense mechanisms might be interpreted by both the therapist and patient as maladaptive character traits. No one would dispute the negative effects these defense mechanisms have in terms of sabotaging and resisting the therapeutic process. However, to continue to view the victim’s defense mechanisms as a form of “resistance” will have a negative effect upon treatment. To critically confront the defenses can make the victim feel as defective and helpless as he or she felt at the time of the abuse.
By recontexualizing these defenses mechanisms, from within the horizon of a developmental/ historical perspective, the victim will begin to realize the important role these personality traits played in terms of their survival. Defense mechanisms are, in fact, coping strategies that, in the past, helped the victim adapt to a maladaptive environment.
By reinterpreting these defense mechanisms as coping strategies, the patient will begin to develop more positive self-image and begin to fell more integrated and in control. In time, they will realize that these maladaptive defenses mechanisms are no longer appropriate or needed.
In addition to basic trust, self doubt is a problem that also plagues victims of childhood abuse. The victim does not trust his or her own thoughts and perceptions – especially past memories associated with the abuse. In fact, many victims are unsure if their memories are fantasy or reality.
To help the victim overcome self-doubt, it is important for the therapist to validate his or her memories. What matters is not the historical facticity of the memories, but rather what psychological significance these memories have in terms of the person’s current experience.
To accomplish this goal, the therapist, must keep in mind that the victim’s recollections of the past are based upon a child’s perspective – a viewpoint that is very different from how we as adults perceive ourselves, others and the world. For example, children tend to perceive adults as being bigger than life and also do not have a proper understanding of sexuality, aggression, or even a clear demarcation of self and other. From this vantage point, it is understandable why the victim’s memories might have a limited or distorted child-like quality to their narrative.
Working through the defenses, learning to trust oneself and the therapist, reconnecting thoughts with feelings, and beginning to integrate the past with the present is both a frightening and exciting process.
What is most frightening about the process is that it requires the subject to face the unknown, What is most rewarding about the process is that if offers the subject the freedom for personal expansion and growth.
Dr. Klein is a clinical psychologist who practices in Westport CT. He specializes in the treatment of trauma, Post Traumatic Stress Disorders (PTSD) and adults survivors of emotional, physical and sexual childhood abuse.
Dr. Martin Klein, Ph.D. is a clinical psychologist who practices in Westport and Branford CT. He works with children, adults and couples.