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What Type of Person Never Admits to Needing Therapy?

It is a truism in psychotherapy that those who actually should be attending therapy are the ones who rarely find their way into treatment.

In “Pack Leader Psychology” I categorized personalities into three types: Dominators, Submissives and Avoiders. Dominators are the types most likely to need therapy yet also least likely to seek treatment. However, the behavior of Dominators is also the most likely to send others into therapy.

Scratch the surface of anyone in therapy for common problems such as depression or anxiety or ADHD and you’ll usually find a Submissive or Avoider whose life has been made difficult by a Dominator.

This shows up in predictable ways such as:

  • a child with an intrusive, opinionated “helicopter parent” who develops behavioral problems or school attention problems due to the parent’s anxiety and over-control
  • a spouse who has been controlled, threatened or even abused by a partner and who is experiencing nervousness, anxiety and insomnia
  • a family member frustrated with a sibling who is attention-seeking, dramatic, and can never be wrong about anything
  • a spouse who believes she has to submit to her husband who argues about everything and cannot back down in a fight

Submissives and Avoiders come to therapy to find ways to cope with the Dominators in their lives. While I can certainly help these patients, especially by helping them be more assertive, my effectiveness is limited because the person who really needs therapy is not in the room.

I actually would love to require that everyone come to therapy WITH the person who is the source of their problems. That would really help the process along! All psychology is about human relationships, after all.

But getting Dominators to show up in therapy or stay in therapy for the long haul is the trick. Because of their strong reluctance to admit any faults, Dominators have great difficulty admitting that they might need therapy or might need to address any personal deficits.

Dominators can’t admit fault because they experience high levels of shame and, as a result, have great difficulty being accountable for their behavior. Challenge them on a mistake and they will lash out at others rather than take the blame.

Of course, if the Dominator were in therapy we could dig deeper and look at their insecure attachments to parents in their childhood to explain this self-protective behavior, but…

This leaves Submissives and Avoiders to seek help to address their own emotional problems that often developed as a result of the Dominator’s behavior. If the Dominator is “always right and never wrong” this sows chaos in the lives of those around them.

While Dominators are reluctant to accept blame, Submissives tend to be very self-blaming. These people-pleasers have learned to default to thoughts of self-criticism. Even if they have been treated terribly by a Dominator, perhaps abused physically or emotionally, Submissives may dismiss feelings of resentment or anger because they “shouldn’t feel that way.” The disconnect between the obvious reality of the Dominator’s inappropriate behavior and dismissal of the Submissive’s true emotions leads to confusion and a loss of authenticity or sense of self. Anyone would be anxious or depressed in that situation!

If you know someone who lacks accountability, does not like to be proven wrong, can’t apologize and hates criticism, you probably know a Dominator.

When I gently point out some behavior patterns in their lives, patients often come to the obvious conclusion themselves, saying: “Sounds like my wife/dad/sister is the one who should be in therapy.” Yep!

Was it depression or antidepressants that caused Andreas Lubitz to crash the Germanwings plane?

Was it depression or antidepressants that caused Andreas Lubitz to crash the Germanwings plane?

Antidepressant medications were found in Lubitz’s apartment, although there is no evidence he was taking them. Rather than blaming the depression, some writers are wondering if we shouldn’t blame the anti-depressants.

On the website Mad In America, David Healy, MD, argues in a blog “Winging it: Antidepressants and Plane Crashes that antidepressants double the risk of suicide. “They do so by causing psychosis, or by producing an agitation laced with suicidal or homicidal thoughts, or by producing an almost lobotomized state in which people will do things they would ordinarily never do, or by increasing blood alcohol levels if the person has had a drink.”

Remember that medical science does not know how antidepressants work or even if they do actually change brain chemistry in helpful ways. We do know that serotonin levels are not linked to depression, yet this neurotransmitter is what selective serotonin re-uptake inhibitors (SSRIs) and serotonin-norepinepherine re-uptake inhibitors (SNRIs) are purported to alter.

What is most frightening to me about psychoactive drugs is this phrase from Healy’s post: “Once treated with a drug, a pilot is never the same again.” Many people do not realize that once most psychoactive drugs are ingested they permanently alter brain chemistry and functioning. Do we want pilots who are on or have been on these drugs? Or if they have been on the drugs, shouldn’t the FAA/NTSB be closely monitoring them?

Also on Mad In America, Julie Wood reports that at least 47 planes have crashed while the pilots were on antidepressants.

She provides extensive evidence of many other plane crashes that were or were likely to be suicides and shows a link between these crashes and psychoactive medication use.

Wood concludes:

  • Suicides involving aircraft are almost certainly under-reported;
  • The potential contribution of antidepressant medications to crashes is not being properly considered in crash investigations, and the FAA/NTSB are either unaware of, or are disregarding many side effects reflected in black box warnings;
  • Among the relevant side-effects that the FAA seems not to take into account are suicidal ideation and violent thoughts.
  • Commercial pilots are taking more antidepressant drugs, and lying about it more often, than the FAA acknowledges.

Big Pharma and physicians continue to pretend that psychoactive drugs are harmless “cures.”

Actually, they are far from harmless and they cure nothing.

Relationship Problems? Shame Is To Blame

I was conducting a therapy session for relationship problems with a married couple, their second, and the wife continually escalated to anger when any topic came up. Even when the husband kindly suggested they put their toddlers to bed before 10 pm so the couple could have some time together, the wife felt criticized and “attacked.” She failed to recognize his suggestion was an attempt to connect with her and was not solely a criticism. The root of their relationship problems was that her discomfort with feelings of shame led her to attack with anger.

In discussing this topic I’ll use the terms “Dominator” and “Submissive” that I describe in my book “Pack Leader Psychology.”

Dominators react to feelings of shame or low self-worth by attempting to control or dominate others so that they can manage, redirect or prevent shame-laden messages from affecting them. They have great difficulty admitting fault, apologizing, or being wrong. Dominators attack others with anger when they feel shame.

Submissives handle shame by attacking themselves with internal messages of shame: “See, you really are a loser. You need to change.”

Here is another example of how the feeling of shame plays out in relationships.

Janae, the Dominator wife, forgot to pick up the dry cleaning on the way home. David, the Submissive husband, asked if she picked up the dry cleaning. Rather than feeling the shame of her mistake and admitting her fault, she goes to great lengths to manage her pain. She makes excuses: “I had to work late” or “I didn’t think they weren’t going to be ready today.” Or she blames him: “You were supposed to text me to remind me.” Or she lashes out at him for an unrelated past mistake: “Well, you forgot to pick up the milk yesterday.” or “You should have taken them in last week.” These angry responses are “reactive emotions,” with shame as the “core emotion.”

To Janae, the feeling of shame is so intolerable that she must defend herself from experiencing it at all costs, even if it means damaging her relationship with her husband.

Shame plays out in minor ways like this or in major relationship problems, such as domestic violence. Dominators who go to the extreme of physical or emotional abuse cannot tolerate any sense of being criticized or rejected. The perception that their partner is withdrawing love in any way, no matter how minuscule, triggers their fearful reaction. So they become aggressively confrontational, to the point that they are then legitimately criticized and their partner does withdraw her love.

Sadly, Dominators then get exactly what they are working to avoid: The feelings of shame they dislike are now piled on even more deeply and intensely.

In my session with the couple, the wife eventually began crying, was resentful and stopped engaging in session. I could see she knew she had over-reacted, but she could not admit that. Even though I recognize the roots of shame underlying her behavior, it is difficult not to dislike a Dominator when she behaves in this way. I have to remind myself that those who need the most love often behave in ways that often drive love away. Finding compassion for these hurt people is essential, but can be a challenge for those in relationship with them who often trigger to anger themselves in response.

The other side of this relationship equation is the Submissive partner, who also is mishandling feelings of shame. He may take on more than his fair share of blame for the argument. He may learn to avoid directing shaming messages at his spouse because he fears her aggressive reaction. He wants to keep peace and will do anything to avoid causing a fight.

I also believe that because Submissives dislike the feeling of shame themselves, they avoid placing blame or shame on their partner. It’s as if Submissives know the pain of shame and want to protect their partners from it. This well-intentioned behavior, however, leads to a lack of assertiveness that enables the Dominator to continue to act out and avoid feelings of shame.

An attack-and-withdraw pattern then ensues in the relationship, leading to a painful and disabling feeling of disconnection.

If both partners could learn to manage feelings of shame in a healthy, self-compassionate and self-accepting manner, they would experience much less turmoil in the relationship. The Dominator would feel less urge to lash out at the Submissive. The Submissive would feel able to fairly criticize the Dominator and would not submit unthinkingly to the Dominator’s wrath. Both could be open and vulnerable about their feelings of shame with each other, which would lead to emotional intimacy, a closer bond and a deeper connection.

Shame is the root cause of most relationship problems and many other behavioral problems. It is sad that today so many people seem to have great difficulty handling this feeling in an emotionally healthy manner.

Childhood Stress is Linked to Accelerated Aging

It has long been known that childhood trauma, such as abuse or death of a parent, can lead to psychological and behavioral problems. But this new study also shows that childhood trauma is linked to accelerated aging.

As reported in PsyBlog: “The results showed that both mental health problems and childhood adversity were associated with shortening of telomeres — caps on each strand of DNA which affect how the cells age.”

While I have not read the entire study, previous studies have shown that trauma does not have to be significant for it to affect a child. Trauma does not have to mean sexual abuse or being beaten. To a child, merely the lack of warmth of an accepting, loving parent is enough to be considered traumatic.

This makes complete sense is we understand attachment theory and look at the effect of chronic stress on the body and mind. Children have a biological need for safety and warmth. A child exposed to frightening situations early in life, such as domestic violence, crime or abuse,  becomes primed to remain chronically in “fight-or-flight” mode. The body’s arousal system is then perpetually “on guard,” which is exhausting mentally and physically.

Many people with “mental disorders” have problems with both fatigue and hyper-arousal. The body is not designed to remain in alert mode; it is designed to flee or fight, then immediately relax in the safety of our tribe.

Children with early trauma often have rarely experienced the safe haven of caring, nurturing parents or environments. If their trust has been betrayed through emotional or physical neglect or abuse, they may lack secure attachment to caregivers, which means they may also never know how to relax into the comfort of a caring relationship.

Studies like this confirm what makes common sense: The lack of a feeling of safety in childhood is linked to poor outcomes in both mental and physical health. Quite simply, feeling accepted, protected and loved are key components of childrearing. The rise in mental illness and now of accelerated aging and physical illness can be directly traced to a lack of warmth in parents and caregivers or a disruption in their care.

This makes it all the more clear that parenting education and early childhood interventions can have tremendous impacts on the mental and physical health of millions of people.

 

Are Gadgets Killing Self-Awareness?

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I heard a snippet of an interview on NPR tonight with a man who believes that the extensive use of gadgets is leading to a lack of creativity. He thinks that creativity requires quiet time to think and that the constant distraction by electronic media may lead to fewer moments of inspiration.

Of course, many commentators have noted that kids growing up today, with their faces interacting with screens and not with other people, will likely lack interpersonal skills and fail to develop essential emotional connections with others. It is shocking to me to watch a line full of people at a coffee shop who cannot spend 60 seconds waiting for their latte without letting go of their phone. God forbid they actually make small talk with the person in front of them.

image0093968Studies have shown that just having a short conversation with others can help a person feel connected and can improve mood. Even prosaic comments about the weather or the long line can make us feel we are part of a shared experience, and can affirm our sense of belonging, even if it is just to the tribe that waits in long lines at coffee shops on snowy days. We are not so different, you and me.

But if we never share vents about the snow storm or pleasantries about the excellent espresso, how do we remind ourselves that we are similar? How do we feel attached and experience the universality of experience that is human existence? Without reminders of our human alikeness, we may start to believe we are different. And different equals alone. And alone can equal depressed or anxious or insecure based on thoughts of self-judgment and shame.

But the big problem that I would like to address with this over-focus on cell phones is that it may lead to a lack of self-awareness or mindfulness.

Being able to observe and gain control over thoughts and feelings is mindfulness. In mindfulness, we learn that just because we feel an emotion or have a thought does not mean we have to react to it or believe it.

However, it seems that repeatedly and automatically reaching for a gadget in response to a ping will teach us the opposite: I am a automaton to this device and to my emotionally needy search for social affirmation through it.

As with creativity, self-awareness needs stillness. To be mindful, we cannot have a mind full of distraction. Inner peace is not learned by being constantly distracted and pulled out of our centeredness and into our gadgets, especially if those gadgets bring messages of social drama, social rejection, and social shaming. If every 30 seconds an email pings up or a social media “like” pops up with its red number, when are we going to have time to just “be?” To merely be quiet in mind, perhaps also in body. To allow our thoughts to settle, our fears to recede, and our inherent peaceful calm to surface.

Seated, silent meditation can be a wonderful tool to gain mindfulness and stillness. But I am a big fan of integrating mindfulness and self-awareness into micro-moments during one’s day.

If after you meditate the remaining 23 hours plus of your day is spent in impulsive, thought-less reactivity to a machine, that seems as if it may undo what value the seated meditation brought to you. Contemplatives know that ideally we bring self-awareness and calm to our entire lives.

One of the tests of emotional maturity and emotional intelligence is the ability to be alone. Alone with our selves and our thoughts. That means alone without the interference of a gadget to distract us from that aloneness.

Put down the device. Connect with others, connect with your creativity, connect with yourself, connect with your self.