Intensive Short Term Dynamic Psychotherapy Training

Having been introduced to the benefits of ISTDP by a psychiatrist that I work with, I have now embarked upon an intensive 3 year training program in Halifax with Dr. Joel Town (red sweater) and Dr. Allan Abbass (front left).  Without any doubt, this is the most thorough and meaningful training of my career and although very challenging in many ways, I know it will help me to become better at what I do.

ISTDP involves addressing core feelings that have often been pushed away by a host of automatic defensive methods either consciously or unconsciously to lower anxiety.  Helping people identify, experience and express these emotions and re-learn to use them as a guide for more adaptive living can yield enormous benefits.

Training involves doing it yourself which is challenging but fulfilling. In this model, therapist and client work as a team by having meaningful discussions and addressing anxiety and therapeutic relationship issues that may arise in session- to practice key skills for everyday living.

 

Working through anxiety

3 a.m…Try to sleep but there is no way.  I keep thinking about my presentation today. Stomach upset, churning.  Get up and read some more. Have a coffee.  I’ll never have time to get ready, there is so much to know, things everybody else in class or in the audience knows and I don’t! They’ll know I’m just faking it. I’ll stutter and mumble and look like a fool…Read some more and have another coffee, sun is rising…

Living with anxiety is hard.  The problem is that it becomes a self-fulfilling prophesy.  This is due to the fact that not believing in ourselves actually decreases our ability to focus and be at our best. Anxiety actually eats away at our self-esteem insidiously and incrementally.  One of the worst things for people to face is public speaking.  I remember dreading school assignments where we had to face the class.  At one point in high school, I had probably talked in front of my class without taking a breath for 2 minutes when I suddenly had to take a huge-hyperventilation type inhalation & exhalation-much to the delight of my classmates who ribbed me about it for years to come.  After that, public speaking in college and university was something I equally feared and avoided as much as I could.   Over time, due to my work, I was forced to practice speaking in front of large audiences, so I was forced to overcome my fears.

In my work as a therapist, I have often had to offer guidance and support to people with anxiety.  Sometimes anxiety comes from people having experienced negative situations. Other times, anxiety can be as a result of things that haven’t happened but that people fear.  As a cognitive behavioral therapist, my approach remains similar in both of these instances.  Through personal experience and over my career, I have come to believe that we must first learn to calm ourselves down physiologically.  The heart communicates to the brain-our breath is critical.  Slow down your breathing and calm your mind to think more effectively.   Second, confront negative automatic thoughts that are fueling your fears.  These “thinking errors” make you feel a certain way, which in turn influence your actions. Turning this cycle around takes time and the discipline to intentionally practice new ways that have been ingrained in us from years and years of being fear driven. Unfortunately, we have also learned to avoid facing our fears or what we don’t like doing, and this avoidance has actually given us some relief. So over time, we have tricked ourselves into thinking that avoidance works. Just don’t make that call or answer the phone. Don’t tell him or her how you really feel or what you really think.  Get somebody else to drive you or just make an excuse not to go. The problem with this strategy is that it only lasts for short periods of time and you have to keep doing it. The good news is that it doesn’t always have to be this way.

Anxiety is treated through exposure.  Gradually, people are encouraged to learn how to control their breathing to better use their minds.  Afterwards, a process of gradual exposure to the feared situation is introduced in order to slowly but surely help people see that they are able to do the thing they didn’t think they could. In therapy, you learn that perfect doesn’t exist and that you are in fact no worse, or better, than anyone else.  Just human with normal imperfections but also great gifts and strengths that you may have never known or may have forgotten about sometime along the way.  In closing, I would say that the best thing to do to fight and overcome anxiety  (not run from it), is to learn as much as you can and then practice acting outside of your comfort zone to increase your self-esteem and your self-confidence.

The Science behind Sex Addiction

I have always been very devoted to doing things well. So it was with some reservation (and even trepidation) that I decided to obtain formal training to become a Certified Sex Addiction Therapist (CSAT) a few years ago.  Reservation because I knew that the overriding view within the mental health field remains that there is no such thing as “sex addiction”.  It does not exist because it is not in the Diagnostic and Statistical Manual of mental health disorders (DSM 5) due to a lack of research.  Video gaming on the other hand, made it in last edition.   As I was already using some of Dr. Patrick Carnes’ materials to help those referred to me to the best of my ability, I decided to go ahead with learning more as helping my clients will always come first.  Since completing my CSAT training through the International Institute for Trauma and Addiction Professionals, I am very glad to say that I am much more knowledgeable about this issue and how to be helpful.  Despite this, I often experience skepticism and criticism from medically trained  professionals that remains quite insulting and disheartening, especially considering the number of people who present with serious consequences of their sexually compulsive behavior.  I am very glad to say that many of my clients who have committed to changing their lives through the task based model developed by Dr. Carnes, report that they have managed to develop healthier coping skills and have learned not to use sex as a drug.  These individuals have found a new sense of pride and integrity.  They have stopped acting-out sexually in unhealthy and unproductive ways and have learned to form meaningful and intimate relationships.  There is clearly a need for more research in this field to dispel the myths and establish a solid base of evidence.  This important research is starting to occur.  Please read this article for more.

WHY ARE 12 STEP MEETINGS SO IMPORTANT IN THE RECOVERY PROCESS?

No matter the level of crisis and upheaval in their lives, rarely do people want to attend 12 step meetings (e.g. Alcoholics Anonymous, Narcotics Anonymous, SexAddicts Anonymous) when they first come to me for help. I believe that this is because most of us have been raised to believe that unless you can fix a problem yourself, you are basically weak and incompetent.

Paradoxically, in my 27 years of clinical work, I have never seen anyone manage to stop their addictive behavior for any significant amount of time without the help of others. Those who attempt to “go it alone” inevitably relapse and have to live with more shame. This is referred to as “white knuckling it” or first order change, which is only superficial and short term. Their addiction counts on them being ashamed and alone.

People often say they are too busy/shy/proud to attend meetings, but sometimes, and especially after difficulties arise, they /make it a priority/overcome their shyness/swallow their pride and get to a meeting. Once they do attend several times with an open mind (and heart), changes start to occur at a deeper, personal level. This is termed “second order change” and is much more lasting if worked through and allowed to develop through a lot of hard work. It’s as if isolation and shame’s stranglehold is broken, and the addiction is weakened. People see that others care. About them. No matter what.

This realization can be powerful.

It is very different and uncomfortable for most addicts who have learned to be independent to a fault. When running addiction aftercare groups, it is remarkable how often groups are formed by self-described “lone wolves”. Most group participants start off by telling me that s/he wants to control their problematic alcohol/drug/behaviour on their own, and never thought they would be listening to others, or talking to others about their struggles. And it is equally remarkable how many people don’t want to stop attending 12-step groups once they realize that receiving and giving peer support actually makes them stronger.

A healthy amount of interdependence must be learned and accepted by those who move past addiction. Sometimes I need you and sometimes you need me.

Gradually, over time, unhealthy bonds are broken with the drug or behaviour of choice and replaced by healthy ones with real people. It’s a process that is reminiscent of the parable of the onion in Dostoyevsky’s “The Brothers Karamazov”, in which people are pulled out of hell by trust, altruism and selflessness, but pulled back by giving in to irrational fear, and caring only about one’s own interests.

An unfortunate barrier for many people is that 12 step meetings are “cultish” and all about religion-which is understandably a concern-especially when you are not of any particular faith. It is important to remember that although there may be reference to God and some elements of prayer at 12 step meetings, participation in this is voluntary, and as described in chapter 4 of the Big Book of Alcoholics Anonymous on Agnostics, it is about finding your own perception of a Higher Power due to the fact that believing you have all the answers just doesn’t work and must be relinquished in order to learn to live in consultation with others, and build a network of support.

It’s OK to be yourself and you don’t have to do anything you don’t want to do at 12 step meetings. Being respectful but assertive with your boundaries is critical if you don’t feel comfortable, or if someone is trying to impose something on you at a meeting. This is good practice for life. Simply bowing one’s head in respect and saying nothing or going for a walk break during a meeting is perfectly acceptable. Saying “I pass” or “I am just here to listen” are common phrases for those who are just trying out meetings and will be understood and respected at a healthy meeting.

So, if you are caught up in some type of addiction, start by doing the obvious: stop listening only to yourself. Get to a meeting where others can share the load with you. The support you will receive there is different than that provided by a professional. 12-step meetings are free and happen mostly every day. Participants have been where you are. Some have learned ways of getting out of addiction’s grasp by learning about themselves and changing how they think and act. You can learn too!