Don't Blame your Parents

The recent death of Alice Miller, an influential European psychoanalyst, revives a question that has nagged people for decades, whether or not they’ve been in therapy: To what extent are our parents responsible for our own psychological problems?

Dr. Miller, in her book The Drama of the Gifted Child, spotlighted the effects of childhood abuse and trauma on people’s emotional development. The headline version of her work is this: Blame your parents for your psychological problems. It’s a pretty simple, powerful idea, and one that has taken root as a stereotype of what happens in psychotherapy: An adult patient and his or her therapist sit around talking about how the patient’s parents are at fault for the psychological problems the patient is facing.

But this isn’t true. The lesson that I and most other psychotherapists have drawn from Dr. Miller and others is that adults’ psychological problems can indeed be rooted in childhood trauma. If a patient comes in wanting to address self-defeating behaviors, one step of the therapy process is to understand where and how these behavior patterns developed. Some of that may be traced to a patient’s parents or to other circumstances of one’s early life. But exploring how something started isn’t the same as blaming. And what gets explored in psychotherapy isn’t just what other people did, but also how the patient reacted to that, understood it at the time, and interprets it now. In other words, other people’s actions are only one part of the puzzle.

Furthermore, re-examining long-ago events isn’t the point of psychotherapy; it’s just a step. The ultimate goal, if you’re in therapy, is to change your life now. Reflecting on how you understand and interpret your past can help you better see why you’re engaging in counterproductive behavior in the present. Do you find yourself fighting with your coworkers or bosses over and over again? Do you keep having the same unsatisfying and destructive relationships with romantic partners? If so, that’s not your parents’ fault. What it may be instead is your treating people today as if you were the same person you were when you were a child. The responsibility is on you to take your awareness of what drives your behavior and use that to change.

Therapy and the Internet

Here’s one more arena in which Google has changed our lives: the process of psychotherapy.

How the internet can complicate the patient-therapist relationship is the subject of an interesting story by Dana Scarton that ran in The Washington Post this week. Scarton writes about the growing amount of information that patients can find about their therapist online -- and that therapists can find about their patients.

Googling your patient or therapist, or checking out the other’s Facebook page, if he/she has one, raises all sorts of issues relevant to the therapeutic relationship. The most significant, I think, is that the internet enables both the patient and therapist to learn all sorts of things about each other’s lives that they haven’t learned directly from the other.

I think it’s a bad idea for therapists to google their clients, and I don’t do it myself. I think it’s essential that my understanding of my clients be based on what they disclose during a therapy session. What patients tell me -- or don’t tell me -- about their lives, when they tell me, and how they tell me are all, in and of themselves, important things for us to talk about while helping them work out their problems. Researching a patient’s life online would put me in some awkward situations: If I don’t tell the patient what I’ve done, I end up with information about him or her that I know but can’t talk about. And if I do tell the patient what I’ve done, the patient may interpret my outside research as a sign that I don’t believe what he or she is telling me in person. Either way, my research would destroy the trust and honesty that are necessary for a productive therapist-client relationship.

I know that many people seeking therapy start by researching therapists online (I have my own website, after all). I also know that searching online for one’s friends and acquaintances is an inevitable part of modern-day life, and it’s a hard habit to break. If you’re a person googling your therapist while in treatment, I would suggest that you bring this up with your therapist. Searching online in this context is usually a reflection of a patient’s curiosity about the therapist and the therapist’s life. These questions and feelings can be extremely helpful when discussed in the course of therapy. What does a patient want to know about the therapist that he isn’t learning in therapy? Why does he want to know this? How does he think this knowledge will help him? Discussing these questions in therapy, and trying to answer them, can often give patients insight into their own problems and their relationships with people in their lives other than the therapist.

As a psychologist with a private practice, I think it’s important that I have a presence online; the challenge for me is to not be too online. But aside from my website and initial emails with potential clients, I try to keep my professional communications with clients on the phone or in person.

Attacking the Overweight

Harriet Brown writes so articulately about the stigma and prejudice experienced by people who are overweight, it’s hard to say anything other than link to it. She highlights how well accepted it is to disparage the overweight, despite the increasing evidence that weight loss and regulation is not simply a matter of self-control and discipline. Unfortunately, doctors can be as guilty of this as anyone, routinely attributing health problems to weight without looking further. When people feel that disdain from their doctor, they are less likely to get consistent medical care or comply with their recommendations. For some reason, weight and fat remains one of the few areas where people feel free to disparage others. Surely, there must be ways to address issues of health and weight without also demeaning those who wrestle with it.

How Not to Talk About your Child's Weight

This week, Michelle Obama, trying to promote efforts to combat obesity, described taking her kids to the pediatrician and being told that they were overweight. She also mentioned that President Obama had referred to one of their daughters as “chubby.” These remarks caused consternation among eating disorders professionals, because of their apparent overemphasis on weight and dieting, rather than on healthy eating and health in general. Too often, when people talk about the obesity epidemic, it sounds like an attack on the overweight.

There are better ways to promote healthful eating than to call a youngster “chubby.” Those who treat eating disorders strive to help their patients move away from dieting and strict rules about good and bad foods. They aim to help their patients be less rigidly focused on a number and a weight and instead aim for healthy behaviors. One of the challenges in treating people with eating disorders is when the culture at large supports exactly the same attitudes that get in the way of fighting an eating disorder. In this link, Laura Collins, the executive director of FEAST (Families Empowered and Supporting Treatment of Eating Disorders), writes about how some of the First Lady’s comments sound in the eating disorders world. In a later post, she also mentions speaking to a member of the First Lady’s staff and explaining these issues. It will be interesting to see if this will have any effect on the way Michelle Obama talks about her daughters’ eating habits in the future.

Making your New Year’s Resolutions Stick

It’s a new year, which means that people are already making (and possibly breaking) their New Year’s resolutions. A useful article on Time.com takes advice from addiction experts on how to make your resolutions stick. What are the main points?

-Be honest with yourself about what you’re doing. If you’re trying to moderate your drinking and every time you plan to have 2 drinks, you end up having 5, then this should signal to you that your drinking may be more problematic than you’re acknowledging.

-Start out by trying to temporarily go cold turkey. For example, if your ultimate goal is to drink less, it might be easier to stop completely for a designated period of time rather than trying to taper off.

-Think before you act. Expect to get urges or cravings for whatever you’re trying to change. When you feel an urge, try to delay acting on it immediately. Try to reflect on the craving and think about the trigger. This may enable you to resist it better. The more you practice resisting or delaying giving in to cravings, the easier it will become.

-Give yourself a break. Be positive in your approach. Rewarding yourself for making a small change is far more effective than punishing yourself for not being able to do it. In fact, learning to tolerate imperfection in yourself may be the most useful change of all.

-Try to surround yourself with people who are doing what you want to be doing. It’s hard to stop smoking when you are only around smokers or to drink less when you mainly hang out in bars. It can be tough to change friends or to change the way you socialize, but it will make it easier for you to achieve your goals.

A last point (and this part is from me, not Time.com) is that change can be very hard. We all know what is good for us--eating right, exercising regularly, and not smoking, for example. Yet it can be very difficult to give up something that we know is not in our best interests. Be honest with yourself about what payoff you get from this habit you are trying to break. If you can’t acknowledge what you like about it--what it does for you, or the loss you will feel if you do give it up--it will be more challenging to achieve the change you want.

New Research About Handling Stress

Two recent articles discussing studies of animals in stressful situations shed light on some valuable lessons about the role of stress in people’s lives.

In today’s New York Times Magazine, Gretchen Reynolds writes about an experiment in which two groups of rats ended up reacting differently to the same unpleasant situation. One group of rats exercised regularly for several weeks; the other group didn’t exercise at all. When both types of rats were exposed to stress -- specifically, forced to swim in cold water -- the brains of the exercising rats weren’t affected as negatively as those of the active rats. A related study indicated that, after an injection with chemicals designed to increase their stress level, active rats were less anxious than the idle ones. The studies support the idea that the physical stress of exercise helps the brain better handle emotional stress. But the payoff isn’t immediate. For rats, when it comes to seeing the benefits of exercise, the magic number is apparently between three and six weeks.

Meanwhile, in The Atlantic, David Dobbs writes about the insights of Stephen Suomi, a prominent researcher who has studied the emotional development of rhesus monkeys. Suomi has shown that when monkeys who are genetically handicapped in their ability to process a chemical in their brain known as serotonin -- a risk factor for anxiety and depression -- are raised as babies in poor environments, they grow up to process serotonin less efficiently as adults and are more likely to end up anxious and depressed. But when these genetically-handicapped monkeys are raised in ideal environments, they don’t just grow up to process serotonin efficiently; they do it more efficiently than those monkeys without the initial deficit. Monkeys who thrive despite this genetic weakness may in fact be more likely to prosper than your average monkey.

What does this mean for humans? Suomi’s research with monkeys is relevant to the study of what are sometimes known as “orchid children” -- children who possess gene variants that increase their susceptibility to problems such as depression, anxiety, and attention-deficit hyperactivity disorder. Given a stressful or abusive childhood, these kids are more likely to suffer negative consequences (versus “dandelion kids” who can pretty much thrive anywhere). But the article suggests that if these orchid children are raised in a more favorable environment, then these genetic variants can contribute to enhanced functioning. In short, what has usually been seen only as a liability can, under the right circumstances, be a strength.

As for the stressed-out rat experiments, it adds to a growing body of research indicating that exercise helps not only our physical health, but our mental health as well. As is the case with the rats in these studies, these stress-reducing benefits aren’t immediate. But there’s one important difference between people and the lab rats: Unlike the rats, no scientists are forcing us to exercise. People, unlike rats, need their own motivation. To reap enrichment from an exercise routine, they have to overcome inertia and push themselves to do something they might find unpleasant initially. But if they can stay the course until they start enjoying the returns, it’s worth it.

Positive Psychology Has Its Limits

Last week, I read the book Bright-Sided: How the Relentless Promotion of Positive Thinking has Undermined America, by Barbara Ehrenreich. What got me interested was hearing a radio interview in which the author, who was diagnosed with breast cancer several years ago, talked about her reaction to the breast cancer culture she encountered during her treatment. Cancer was a gift, people would say. It’s the best thing that ever happened to me.

Ehrenreich wasn’t soothed by the cheeriness that people had in reaction to their cancer, and that they expected from her. Rather, this relentless focus on maintaining a positive attitude felt stifling to her. And when she expressed anger about her diagnosis, about the effects of chemotherapy, and about the frustrations of dealing with her insurance company, people responded by suggesting that she was too angry. Run, don’t walk, someone told her, to some counseling.

Ehrenreich points out that certain assertions that are often accepted as truth -- such that a positive attitude lessens your chances of getting cancer and improves your chances of surviving it -- are actually simplifications of the relevant research. While stress can weaken your immune system, that doesn’t mean that if you’re stressed, you’re more likely to get cancer. Similarly, while therapy and support groups may be good for people's emotional health, therapy, or support groups won't extend their lives. The problem, Ehrenreich points out, is that sometimes this research trickles down in such a way that people end up blaming themselves unnecessarily for their illness or for their inability to prevent its spread.

Another part of the book addresses the spread of positive psychology, a relatively new area of psychology that focuses on the study of positive emotions, happiness, and resilience. In her view, this research, along with some other New Age ideas, is being misused to foster the belief that what happens to us is our fault. For example, rather than focus on systemic issues (such as income inequality or a crumbling economy) as reasons why you lost your job, these disciplines focus on attributing what happens to you on internal, individual characteristics, and essentially blame the victim for what happens to him or her.

It’s an interesting argument that relates to the tension in people's lives between denial of reality on the one hand and debilitating, excessive pessimism on the other. If you have breast cancer, being told that your anger and sadness about the cancer is going to make it worse would most likely fill you with both rage and guilt. At the same time, if all you can think about is what is out of your control, it will be difficult to work to change anything about your situation. Sometimes, it’s important not to minimize the bad, or sad things that happen to us, or that we feel. You can recognize them and acknowledge them in a way that enables you to move forward.