When my baby was recently diagnosed with an infantile hemangioma (vascular birthmark), I found myself doing exactly what I tell my clients not to do when they have anxiety about a health issue.  I started “googling” uncontrollably.  I spent weeks looking at horrific google images of hemangiomas and reading about brain disorders that rarely are associated with hemangiomas.  After weeks of incessantly and obsessively googling, I was convinced that I knew more than
my pediatrician.  Rationally, I knew that googling was magnifying my anxiety, yet, I could not stop myself.

What I discovered online both hurt me and helped me.  I convinced myself that his birthmark would permanently disfigure his face and that his cerebellum was damaged.  This realization led to total panic, loss of appetite, and sleepless nights.   Fortunately, my “google diagnosis” turned out to be wrong and I had
unnecessarily and prematurely spent weeks worrying endlessly.

My “google diagnosis” and elevated anxiety did eventually lead me to seek expert advice from hemangioma specialists and away from the virtual world of terror.  Seeking such consultation was not an option my pediatrician presented for my son, and, it turned out such consultation was necessary to determine an appropriate course of treatment.

If your guts tells you that your primary care physician may not have all the answers, please trust your instinct and do your own research.  However, if you decide to research your concerns online, do so knowing that what you find can easily be misinterpreted and seek a second opinion from a specialist.

If you have a lot of health anxiety, I recommend staying off google entirely if you can control your impulses.  If not, here are some tips on how to googlemedical concerns responsibly:

• Information published on the internet is not regulated. Please check the source and the date of the information you find.
• Remember that blogs are often based on anecdote rather than the scientific method.
• Ask medical professionals to recommend credible web sites.
• Use the internet to educate yourself and gather more information but do not to self-diagnose.

“I Know What’s Gonna Happen Next”

Schema Therapy

The Powerful Influence of Our Mental Maps

1. WHAT IS SCHEMA THERAPY?

This article is largely based on the practice theories developed by Jeffrey E. Young, PhD in his book “Schema Therapy”. Our internal schematic is a pattern or an organizing framework which we personalize for ourselves over a lifetime. It is the lense through which we see ourselves and the world and thereby make sense of things “out there” as well as “in here”

Schemas are used as a “short cut” in which we make assumptions about a particular circumstance based on only limited information. Of course, this is a vital skill in negotiating the world and we do it many times a day, making determinations based on someone’s tone of voice or choice of words. But when we have developed a negative or destructive schema, there are many innocuous events or “triggers” which precipitate a set of assumptions about negative or harmful things which are about to happen or worse which cause a cascade of internal negative and self-defeating dialouge.

Schema Therapy is heavily influenced by Cognitive Behavioral theories (CBT) and can be effective over time with deeply entrenched and maladaptive or destructive thought patterns. Unlike traditional CBT which focuses primarily on breaking the cycle of maladaptive thoughts and actions, the Schema model also is focused on the initial etiology of the development which typically is most profoundly evident in childhood. In this way, Schema Therapy (ST) also shares roots with traditional psychoanalytic theory.

2. HOW DOES SCHEMA THERAPY WORK?

Because it is often used to treat longstanding conditions of problematic thought and behavioral patterns, ST typically takes a while to be effective. Two to three years of treatment is most often necessary to see significant change and improvement and rarely is the therapy less than one year. This is intuitive. It took a long time to build up the entrenched mental schematic and it will take time (though far less time) to change them to a more healthy one.

There are two primary approaches which the effective ST therapist will take with the patient. First is Empathic Confrontation. In this, the therapist acknowledges the reasonableness of the existing schema. He recognizes, appreciates and accepts the legitimacy of the development and enduring quality of the patients perspective. However, at the same time, this is gently but consistently challenged and questioned. The goal is to demonstrate that alternatives exist. That the way in which the patient sees themselves and the world is in fact not an objective truth, but a choice. And it is a choice that was reasonable at the time it was selected, but is no longer useful. In fact, it is destructive and must be changed. The fact that it “feels true” is only because it has gone unchallenged for so long.

The second approach is termed “corrective emotional experience through limited re-parenting experience”. In short, this describes an experience the patient has in which the therapist is parentified in a healthy and limited way, thereby allowing the patient to have an approximation of a different parent/child relationship than the one they in fact experienced. This creates an opportunity for the patient to directly and indirectly seek and to an extent have some of the caregiving needs that they failed to attain in childhood. While the above scenario may sound complex or contrived, it should be experienced as neither, but rather as a natural by product of a healthy therapeutic rapport between therapist and patient.

3. UNIVERSAL CORE EMOTIONAL NEEDS

ST presumes that we all have these core emotional needs. They include a need for safety, stability, nurturance, acceptance, autonomy, competence, self-identity, the ability to express oneself, play, and a world with realistic limits which encourages self-control. It is the goal of Schema Therapy to provide the patient with these experiences in an adequate and creative way so as to compensate for deficits in childhood and adulthood. For the therapist to be effective in this form of treatment, he must not only be well versed in the process and skilled, he must also have a genuine care for the patient, he must be flexible, creative and he must be comfortable being openly warm and caring to the patient.

For further information and training please visit the International Society of Schema Therapy
www.isst-online.com

Jamie, age 45, is by all measures a talented and hard-working person. He has earned multiple graduate degrees and amassed much professional expertise. Yet Jamie finds himself unemployed, with no immediate job-prospects. He is surprised to find himself in this position in mid-life, and has been experiencing feelings of anxiety and depression. He says:

“I’ve been feeling frustrated, wondering what it is that I can do, hating that I feel like I have to watch money more closely than I ever have before and not knowing how I’m going to pay bills or support my family. I’m intelligent and I’ve done things that are supposed to lead to success. And yet, here I am, not certain of what the future is going to bring. If I’ve worked hard and don’t have very much to show for it, it’s hard to say that I’m going to get up and feel that I can do it all again. When you get rejection from your efforts—and when that happens enough—it’s hard to get past.”

The current recession has brought unemployment concerns to the forefront of many people’s lives. As of July 2011, the Bureau of Labor Statistics reports that the unemployment rate in the United States is 9.1%. While the rate in Massachusetts comes in slightly lower at 7.6%, it is clear that unemployment is a visible and painful problem for many people. This concern is felt not only by the unemployed, but also by those who are worried about losing the jobs they have or finding a full-time job for the first time.

The John J. Heldrich Center for Workforce Development at Rutgers University conducted a survey of 1,200 unemployed American workers. Results indicated that a strong majority of those still jobless experienced daily stress and feelings of depression and helplessness. Many of those surveyed also reported having difficulties with personal relationships and sleep problems. The findings underscore the very real mental health implications of ongoing unemployment.

Experts have suggested ways that to cope with unemployment anxiety. Ideas include:

*Acknowledgment of Adversity

Recognize being in a difficult situation. Unemployment is not likely to be a problem that is easily resolved, and has a lot to do with factors beyond individual control. It is important to demonstrate self-compassion during this period of personal adversity.

*Avoiding Isolation

It is also helpful to remember that there are many, many, other people facing the same situation right now. Networking with other individuals looking for work and seeking out support of friends and family can help individuals cope with unemployment concerns.

*Keeping Active

Seeking out opportunities to engage in activity, including exercise, intellectual stimulation, and service opportunities can aide in maintaining physical and mental health and can help take the focus off of being unemployed.

*Re-Framing the Problem

While periods of unemployment can be challenging and uncertain, they can also be used to reevaluate professional goals, engage in new training, and think creatively about new directions.

*Remaining Committed

Retaining a commitment to seek work opportunities and acting on that commitment by continuing to apply for posted jobs, attending job fairs, and seeking out support from local resources can help promote hopefulness during unemployment.

There are additionally many local resources which aim to help those who are looking for employment network with each other and to access helpful information. Some of these include:

Boston Area Networking Group (BANG)
http://finance.groups.yahoo.com/group/bostonbusinessprofessionals/

Boston Women’s Network
http://www.bostonwomensnetwork.org/

Financial Executives Networking Group
http://www.thefeng.org/

Massachusetts Career Centers
http://www.mass.gov/?pageID=elwdhomepage&L=1&L0=Home&sid=Elwd

New England Networking
http://finance.groups.yahoo.com/group/NewEnglandNetworking/

Operation A.B.L.E (Ability Based on Long Experience)http://www.operationable.net/job_listings.html?fi=Sales+and+Marketing

(More comprehensive list can be found at http://www.job-hunt.org)

While the above coping strategies are useful, receiving more extensive support through psychotherapy may be helpful in cases where anxiety over unemployment issues is constant, manifested in physical symptoms (e.g., sleeplessness, muscle tension), and/or interfering with relationships and daily functioning.

Navigating unemployment anxiety is not easy and there will continue to be many people like Jamie, who struggle to cope with an unexpected turn of events in their professional lives. While solutions will not happen overnight, there is support available. If you feel the need to talk to someone about unemployment anxiety and/or professional transitions, please contact us at info@bostoneveningtherapy.com or call 617-738-1480.

References:

Bureau of Labor Statistics
http://www.bls.gov/eag/eag.us.htm AND http://www.bls.gov/lau/home.htm

John J. Heldrich Center for Workforce Development , Rutgers, The State University of New Jersey (2009)

“The Anguish of Unemployment”

http://www.heldrich.rutgers.edu/sites/default/files/content/Heldrich_Work_Trends_Anguish_Unemployment.pdf

Leahy, R. L. (2009) Unemployment Anxiety, The Behavior Therapist, Vol 32(3), Mar, 2009. pp. 49, 51.

Leahy, R. L. (2009) Facing Unemployment: Ten Steps to Handling Your Unemployment Anxiety http://www.psychologytoday.com/blog/anxiety-files/200902/facing-unemployment-ten-steps-handling-your-unemployment-anxiety

Rampell, C. (May 19, 2011) Many With New College Degree Find the Job Market Humbling

http://www.nytimes.com/2011/05/19/business/economy/19grads.html

Other Sources:

http://www.job-hunt.org

http://moodletter.com/Unemployment.html

Author:  Sara Lafkas of Boston Evening Therapy Associates, Brookline, MA

Social Anxiety Disorder is the third most common psychiatric illness, and depending on the definition one uses- the incidence is believed to be anywhere from 5 to 13 percent of the population in the United States suffer from it in their lifetime.

Social Anxiety manifests in various ways some of which can be fairly innocuous. Everyone is nervous about social interactions from time to time, the difference with what would be understood as a Social Anxiety Disorder, is that it is experienced in a pervasive way which has a negative and sometimes harmful effect on an individual’s life. This type of condition may cause someone to pre-maturely leave social situations or avoid them altogether. It may lead to social isolation, poor work performance and troubled marital relationships. In most of these cases, people report having anxious thoughts such as: “People will notice how nervous I look,” “ I will say the wrong thing,” or “Everyone will think I am out of place and a loser,” which only adds to the anxiety level.

Taking the step to seek counseling is often a big decision and in itself can induce anxiety. At BETA, we will work with you at your pace and engage with you with skill, empathy and effectiveness. We will together and collaboratively seek to minimize anxiety and gradually replace it with confidence, hope and a sense of potential.

Common somatic complaints include:

• Pounding or racing heart beat
• Dry mouth
• Shaking
• Shortness of breath
•  Feeling dizzy

Fairly innocuous social actions may feel impossible. The thought of speaking to a group, socializing with strangers, or proposing a toast, can be absolutely terrifying to imagine. You may experience a racing heart, dizziness, sweating, or other anxiety symptoms. Often, if you do force yourself to socialize, you may feel miserable before, during, and after the event and replay the events in your mind. Typically, the problem isn’t limited to social events, but may affect your life at work and at school.

Getting Help for Anxiety:

There are a number of treatments for anxiety. Certain types of psychotherapy can help treat and manage social anxiety disorder. An effective therapist may use cognitive behavioral therapy, or CBT, the most widely researched intervention. CBT seeks to correct established patterns of negative thinking and the behaviors they cause by helping people face their social fears directly. Our therapists are highly trained in this and other treatment modalities.

We want to help. Very often good therapeutic interventions can therapy can address many of these issues and result in a notable improvement in comfort, confidence, performance, relationships and quality of life.  To arrange a session with one of our therapists, please contact us at info@bostoneveningtherapy or call us at 617-738-1480.

An Introduction to Internal Family Systems Therapy

To learn more about Dr. Schwartz’s model of therapy, I attended a conference where he was presenting. I had the opportunity to hear him lecture as well as interview him about the theory, practice, and thought processes that helped him to create Internal Family Systems Therapy.

In addition to a summary of key concepts that I took from his lecture and writings, this article also includes audio clips from my interview with him.

Dr. Schwartz theorizes that the mind is not a unitary entity, but is instead a system that contains multiple parts that work together for the greater good of the whole being. In addition to these multiple parts, we also have a Self that has the capacity to lead the system.

After a person experiences a traumatic event, disharmony can develop among parts. In his book, “Internal Family Systems Therapy”, Dr. Schwartz writes, “A developing system will also be constrained if it accumulates burdens along the way. This happens when the system is traumatized (thrown out of balance) before it has fully developed. Trauma also has the effect of freezing or fixating members of the system at the point in time of the trauma. These frozen members are not only no longer available to help, but their extreme emotions further constrain the system and force other members into hyperprotective roles” (p. 21).

Dr. Schwartz believes that it can be valuable to get to know, understand, and show respect towards these protective parts before the therapist and client begin to explore the injured parts that they protect. Once they have done this, the client's protective parts will show enough trust to step back and allow the client to see those parts that have been exiled. The client and therapist can then begin to nurture and console these injured parts who remain frozen in past trauma. Additionally, they help the client's parts to once again place trust and confidence in the Self, who innately has the capacity to lead and care for the system.

Dr. Schwartz practices what he preaches. Despite following him through crowds of people as we talked, he remained soft-spoken, cool, and managed to exude a palpable calmness.

I started our interview by asking him to speak about what other therapeutic models, or systems of belief, had contributed to his creation of the Internal Family Systems model of therapy. Click here to hear the interview with Dr Richard Schwartz about his influences

I proceeded to ask Dr. Schwartz to speak in more detail about how he helps his clients, and himself, to stay in touch with the Self when they experience internal and external stressors. Click here to hear the interview with Dr Richard Schwartz about staying with the Self

Still amazed by Dr. Schwartz’s ability to appear so grounded and present in the moment, I asked him to speak more about how to help therapists to hold onto their sense of Self in session. Click here to hear the interview with Dr Richard Schwartz about therapist and self

One of the applications of his approach that I found most interesting, was how it could be incorporated into couples and family therapy. I asked Dr. Schwartz to speak about how this is accomplished. Click here to hear the interview with Dr Richard Schwartz and family therapy

Dr. Schwartz also spoke about how to help family members address anger they might hold towards each other, by helping them to check in with their parts and access their Selves. Click here to hear the interview with Dr Richard Schwartz and family therapy part two

Dr. Schwartz and I ended our interview with him describing to me how therapy and trauma work is like a bulb of garlic. Click here to hear the interview with Dr Richard Schwartz about trauma and the garlic metaphor

I would like to thank Dr. Richard Schwartz for taking the time to be interviewed for this piece.

The author of this interview, Katie Novick, LICSW, is a clinician with Boston Evening Therapy Associates in Brookline, Massachusetts.

After the conference on Saturday, I was sitting down by the Fort Point Channel, thinking about everything I had learned over the last three days. There was a heavy, moist, fog that had settled over the city. It left massive buildings truncated-their top halves completely obscured. As I looked out on this scene, I realized that the clock tower-usually a landmark seen from many points in the city-had disappeared. I was struck by the power of this fog to alter my perception of reality.

As human beings we are amazingly resilient. When faced with potentially traumatic or upsetting experiences our minds and our bodies go into action to protect ourselves from the environment. Our defenses roll in, like the fog, to protect us.

In this process, sometimes things become hidden. Like the clock tower, time becomes obscured. The past often finds its way into the present, while our fears for the future have a way of visiting us prematurely. And some of those things that make us most special, most unique, must also be hidden away because we don’t trust our environment or ourselves to keep them safe.

As therapists and as clients, it can be important to understand, and value, the protective purpose this fog has served rather than to simply hope for sun. Similarly, we must remember that underneath that protective surface, lies a whole and precious self.

In the coming months, I will interview therapists who are doing innovative work in the field of trauma and share with you what I learn.

My first piece will be from my interview with Dr. Richard Schwartz, who is the creator of the Internal Family Systems Model of therapy. He speaks eloquently about the protective powers of our different parts, and the whole and unscathed selves that we each possess.

Author post by Brookline Massachusetts Therapist Katie Novick, LICSW

The bear cub, the one with the splayed foot didn’t know how long she had been walking. But she knew she was lost. The rich sweet smells of Huckleberry and Pine were faint and far on the horizon but diffuse and so hard to locate exactly.

The deep green scent of Oak, Spruce, Evergreen and a dozen kind of wild grass might have been intriguing to her, even intoxicating in their beauty, but not now. Now all elements of those feelings were being pushed mercilessly and completely out of the way by the animal which had affixed itself to her back….Fear.

“Where am I?” How did I do it all wrong?” Momma will be so mad, I’m so stupid, all the others did it right. My lame foot and my lame mind have failed me. And I am alone. And what if I am always so? What if I die here, here in these unfamiliar woods surrounded by creatures I do not know and who do not know me. Am I even a bear? I have not even done the bear things that bears do. Maybe I am being punished, but for what I do not know.

The bear did not try to think these thoughts, they just came and since they just came, they felt natural and they felt true. “But I did not have to come here to this place to think this way. I have felt alone for a long time. Alone in a group of bears I know and love and who love me. I have felt alone because I have always felt unworthy of anything else.

I am tired. I am tired. Tired of fear and the constant rustlings of my mind and the voice that tells me unendingly of what is not possible and what is to be feared and worst of all, what is to be ashamed of. The bear looked at his deformed foot, the locus of his shame. The burning hot center of his unfitness. “Could I chew it off? Could I be free of it forever. Would I be a hero for destroying the thing which causes so much embarrassment and humiliation? Would the others see me differently, love and accept me for my courage? Perhaps they would?”

The bear considered his foot, observed the skewed contours and hard angles. He saw how narrow the wrist was and how thin the bones were. He had fed well before getting lost and his strength was up…….”I could do it. I could gnaw through this and be done with it forever” He sat very still and waited……and listened…….for what? Encouragement? A sign? But…. there was nothing. Nothing but the gentle creek passing in a quiet rush just below him, and the chatter of the squirrels and chipmunks. The sun had broken out over him above the trees and he opened his chest to its warmth. “This feels good” he thought. This sun, this creek, these squirrels and chipmunks and……me. I feel good here. And he began to think that he hadn’t really wandered off the path too far, and that probably his mother was looking for him and that her smell was so much stronger than his. She could smell out anything. And that hadn’t this same thing happened to another cub just recently? Yes. It had indeed. And it was ok. And the bear knew it was all going to be ok.

Several of BETA staff recently attended an intensive conference in Boston to learn the latest techniques on meditation, visualization and peak performance practices for every day life. My colleague, Wayne Kessler and I interviewed Dr. Dan Brown, the conference speaker, on topics such as the role of the psychotherapist in the spiritual and personal development of clients, concepts such as languishing and flourishing, peak performance, and to learn tips for happiness from Dr. Brown.

For those of you not familiar with Dan Brown, he is one of the most highly respected educators in the field, and has been teaching health and mental health professionals for many years. He is the Associate Clinical Professor of Psychology at the Harvard Medical School, and has been on the faculty of Harvard Medical School for 24 years. Dan is the author of 14 books including Transformations of Consciousness (with Ken Wilbur & Jack Engler), and a new book on Mahamudra. Pointing Out the Great Way: The Mahamudra Tradition of Tibetan Meditation-Stages (Wisdom Publications), and two books on public dialogues with H.H. The Dalai Lama.

Our interviews with Dr. Brown resulted in 6 quick videos on our Youtube video channelthat we are sure you will find insightful.

In this video focusing on tips for happiness, Dan makes it clear that actively stepping out into the world of others in a meaningful way can have a profoundly positive impact on our sense of well being. Dr. Brown notes that happiness derived from relationships is “most frequently reported as the best forms of happiness, that includes intimacy, friendship, but also includes community service and compassion giving to others in various ways.” While most of us know in a general way that helping others is a “good thing to do” it is not often as clear that exhaustive studies have shown consistently that it tends to have a powerfully positive emotional and psychic effect on the person doing the helping.

Few therapists have such a mastery of either Eastern or Western therapeutic and personal growth practices as Dan Brown, PhD, let alone both.

Boston Evening Therapy Associates (BETA) therapists recently attended an intensive conference in the technique of meditation and visualization and the attainment of peak performance in every day life. Our clinic Director, Aaron Gilbert interviewed Dr. Brown on topics such as the goal of psychotherapy, spiritual and personal development, role of the psychotherapist, concepts such as languishing and flourishing, peak performance, and tips for happiness. From these interviews, we created 6 quick videos on our Youtube video channel that we are sure you will find insightful. Please let us know which one you like the best!

Feel free to click on the video to be directed to the corresponding Youtube page.

Is the Goal of Psychotherapy the Absence of Psychopathology or Optimal Mental Health?

Should Systems of Well Being Be Focused on Spiritual and Personal Development?

Is the Role of the Psychotherapist to Help People Elaborate Their Larger Purpose in Life?

What are the Concepts of Languishing and Flourishing? Achieving Happiness in Life

How Can One Find Flow and Peak Performance in Life with a Boring Job?

Tips for Happiness;What Can One Do To Be Happy in This Emotional Life?