All posts by Rune Moelbak

I am Rune Moelbak, Ph.D.: A clinical psychologist in Houston, Texas. I write articles on therapy, psychology, and cultural-philosophical critique, and publish my ideas in national and international journals. I am the owner of Better Therapy: A therapy practice for people who are looking for a more in-depth therapy experience.
picture of therapy couch

Psychotherapy: Does Therapy Work?

Many people who are considering therapy for their psychological difficulties, may wonder how effective talking about their problems is really going to be… So let’s examine the question: Does therapy work?

What’s Wrong with Talk Therapy?

The concern about whether or not therapy works, might not be assuaged by reading a recent Time Magazine opinion piece, that questions the legitimacy of longer term talk therapy. In the piece, entitled “The Trouble with Talk Therapy”,  neuroscience journalist and author, Maia Szalvitz, argues that most therapists have no clue about the latest and most effective treatments for common psychological problems. Instead they want to “go deep” to uncover unconscious feelings and motivations, which she says, has not been found to be effective in treating problems like Obsessive Compulsive Disorder, Depression, Anxiety, and Post Traumatic Stress.

The problem, she says, is not that effective treatments don’t exist for these problems, but that therapists either don’t know of them, or choose not to make use of them.  She cites Alan Kazdin, who is the former president of the American Psychological Association, for saying that “Most of the treatments used in clinical practice have not been evaluated in research.  Also, many of the treatments that have been well established are not being used.”

As a result, Szalavitz claims, she has a hard time knowing where to refer herself or her friends for effective treatment, for as she concludes, talk therapy has an “evidence” problem…

What’s Wrong with Szalavitz’s and Kazdin’s Argument? 

Psychological distress cannot be separated from who you are as a person:

Szalavitz and Kazdin are asking the right questions, but on the basis of a wrong understanding. Their assumption is that psychological problems are “disorders”, and that “disorders” can be treated like one treats a medical illness. Hence there should be one best treatment for depression, one best treatment for OCD, one best treatment for anxiety, and so forth.

The problem with that understanding is that it is based on ignoring the subjective meaning and function of our psychological distress. What makes a problem psychological is precisely that it involves the life of the person. This means that I can be depressed for different reasons than you and that your obsessions and compulsions can serve a different function in your life than they do in mine. OCD and depression are therefore not phenomena that exist in some objective reality where they can be treated using some standard method that gets applied the same way to each person. Instead they are surface manifestations of underlying psychological conflicts and issues that are highly particular to each individual. If we want to get to the root of the problem, we must therefore make these particular conflicts and issues the real focus of the therapy.

Psychological issues are intertwined, not separate from each other:

Szalavitz and Kazdin also make another mistaken assumption. They believe that problems like anxiety, depression, obsessions, and compulsions exist independently from each other, making it the case that one can focus treatment on a single problem and select the best treatment technique for each problem.

In actuality, however, most people who come to therapy have a variety of psychological issues that cut across identifiable “disorders”. They bring their life to the therapy, not an illness. Any therapist is likely to agree that the longer one works with a client in therapy, the harder it becomes to provide a diagnosis. As the complexity of our understanding of our clients increase, so does the inadequacy of any particular label or diagnosis. People are first and foremost people and as they expand their own understanding of the interconnections between their symptoms and themselves, the need to localize and separate their problems from who they are as people tends to disappear. As the now deceased Dutch psychologist, J.H. Van den Berg, has pointed out, people come as wholes, not as fragments, and one cannot focus on a single area of a person’s life without implicating all the others. One cannot lift the corner of a carpet, without lifting the whole carpet…  

Psychotherapy focuses on subjective truth, not objective knowledge: 

A third mistake Szalavitz and Kazdin make is that they fail to appreciate that there are two different truths and realities in life. Science deals with objective truth and objective reality. It deals with “facts” based on unbiased observations and treats these facts as universal truths rather than contextual truths.

Psychotherapy, however, deals with subjective truth and subjective reality. Subjective truth and subjective reality are not a lesser truth or lesser reality. In fact, our subjective experience is often what is most instrumental in motivating our behaviors.

To illustrate the difference, let me provide an example: If a male client can’t grieve the death of a close friend, this is not because he is objectively incapable of grieving or crying, but may be because he subjectively believes that “real men don’t cry”. This subjective reality, which he may or may not be aware of at the start of the therapy, can explain his lack of ability to grieve. It also provides “evidence” for why he may objectively present as depressed. Natural grief that is being suppressed may turn into a heaviness that cannot be released and may lead to a lack of contact with vital emotions that manifests  as symptoms of depression.

In therapy, however, the client may not initially be aware of this subjective belief, nor would the therapist know of it simply by looking at the client’s objective symptoms. The secret to understanding the client’s depression thus lies in a subjective truth that must be discovered, not in an objective knowledge that can be said to be universally applicable each time somebody shows up as depressed.

Why Psychotherapy Cannot be Standardized… 

What Szalavitz and Kazdin don’t understand is that therapy is not factory work and is not about providing prefabricated treatments of objective problems. It is about understanding the unique subjective causes that motivate and explain surface level symptoms that may look the same, but have widely discrepant reasons for being. This means treating the “person”, not the “disorder”, for the person explains the disorder and not the other way around.

So Back to Our Original Question: Does Therapy Work?

I believe the answer is yes, but it works in a very different way than a coffee maker works to make coffee or an oven toaster works to make toast. It helps people discover their own subjective truths, and not simply to change a behavior. Following Szalavitz’s and Kazdin’s advise is to apply a logic that may very well work in the realm of machines and objective cause and effect, but is very ill suited for the likes of us

About me: I am Rune Moelbak, Ph.D.,  a psychodynamic therapist in Houston, Texas. If you are interested in learning more about how a psychodynamic approach can help you get to the root of your problems, click here.

image of people having an affair

Extra-Marital Affairs: Why Do People Cheat?

Infidelity and Cheating is Widespread:

Statistics show that between 35-50% of all women or men in a relationship have had an affair. With such widespread occurrence of infidelity, affairs cannot only be attributed to some act of deviance or amorality, but must be looked at as a normal fact of life.

This begs the question “why do so many people cheat?” And, “What are the challenges to staying faithful and monogamous in a relationship?”

Is There Something Wrong with Cheating?

Over the years psychologists and sociologists have advanced many viewpoints on this matter. The current stance of many couples therapists seems almost naively moralistic and judgmental, focusing mostly on the “victim’s” right to feel angry and the perpetrator’s need to atone. They implicitly turn cheating into a simple selfish act, a violation of social norms, and a sign of immaturity.

And yet, aren’t we all fascinated by the forbidden? Doesn’t the forbidden actually enhance our eroticism? Have we not all been tempted by the lure of what might exist on the other side of the fence?

If we dig deeper into our unconscious we will find that most people, whether they admit to it or not, have been tempted to cheat, have fantasized about somebody else than their spouse, and have found secret emotional fulfillment with others without wanting their spouses to know.

Judging Our Desires Can Lead to Cheating

Oftentimes what propels a person into an affair is ironically their lack of ability to talk to their spouse about their deepest darkest fantasies. The prohibition against having an affair is thus often what makes it happen. The affair becomes the actual outlet, for what cannot be talked about within the existing relationship. What gets denied, goes underground, only to become expressed through actions and impulses in another setting.

A chronic problem in intimate relationships is the inability to openly admit to and share fantasies and urges that are not considered “right” or “proper”, and that one does not feel a decent human being “should” have. Because there is then no room for it within the relationship, there is also no room for a part of the person. This part is then forced to exist in secret and to be siphoned off to a parallel reality, whether it be internet porn, a secret lover, or a clandestine emotional encounter. People’s fears of confessing and being a 100% themselves within a relationship thus leads to a pressing need for more than one relationship to contain all parts of oneself.

In some relationships, this fact of life is openly embraced. Hence we have communities of swingers, people who agree to have open relationships, or people who agree to have threesomes. Some report that this greatly spices up their life and reduces the need for their partner to secretly cheat, but others suggest it comes with its own dangers, and leads to unmanageable jealousy that tends to ultimately break people apart.

Why Do People Have Affairs?

People who have been cheated on and have felt the betrayal of an extra-marital affair, may end up blaming themselves, thinking that they were deficient in some way. Oftentimes, however, partners who cheat are struggling with their own issues (like all of us), which make it difficult for them to get all their needs met with one partner, no matter who that partner is.

A common problem encountered by men is the “Madonna – Whore” complex, by which tender feelings originally felt toward a person’s mother, cannot be reconciled with a person’s “dirty” sexual desires. In this case, a person will thus have a need to relate to their spouse as a good friend and revered mother, and live out their sexual fantasies with a “lover” whose only function is to serve as a sexual outlet for these unaccepted desires. It is for example not uncommon for someone to not be able to have great sex with a person they respect, and to have great sex with someone whom they don’t really respect much as a person.

Another common situation is for a person to recreate a relationship with their spouse that makes them feel trapped, stifled, and in need of an escape. A person may for example unknowingly contribute to a relationship where they feel lonely and unloved, and find themselves in need of getting those needs met elsewhere. It is thus not uncommon to find that the person feeling lonely has withdrawn themselves and stopped sharing the personal thoughts and feelings that would have made them feel more loved and intimate. At the end of the day, we therefore sometimes unconsciously create the very types of relationships, which we then find insufferable. A true test of this is whether or not the next relationship tends to end in the same situation, making break-ups and infidelity a sort of coping mechanism that substitutes for dealing with one’s own barriers to establishing a fulfilling intimate partnership with someone.

A Common Factor that Leads to Infidelity:

The list of why we cheat is long and often involves complicated personal and interpersonal dynamics. But one thing seems to be true across the board: Cheating seems to happen when a part of the person cannot be expressed within the confines of a single relationship. There are many reasons why this cannot happen, but the root cause is often the lack of ability to create, and tolerate, intimacy, and the inability to be completely oneself within one’s existing relationship…

About Me: I am Rune Moelbak, Ph.D., a psychologist in Houston, Texas. I use a non-shaming and non-blaming approach to working with individuals who feel guilty about having an affair, and couples who are struggling with issues of infidelity. Click on this link to read more about my approach to couples therapy…

heart symbolizing intimacy

5 Ways to Improve Intimacy in Your Marriage

Do you sometimes feel you have very little in common with your partner or spouse? Do you often feel lonely in your relationship or marriage? Do you silently ask yourself if you and your partner are slowly growing apart?

If so, you are not alone. Many couples struggle to maintain intimacy and stay emotionally connected over time. The good news is, connection and intimacy in your marriage or relationship is something you can build. Here are five ways to improve intimacy in your marriage or relationship:

1. Empathize – Don’t Problem-Solve:

When your partner opens up to you about a concern they are having at work or elsewhere, don’t try to solve their problem. Instead, try to connect with their feelings. Show that you understand what your partner must be going through, how difficult it must be to be in their shoes. Encourage your partner to tell you more about what bothers them; show interest. Have your partner tell you enough about their feelings, opinions, and thoughts so that if your friend asked you to tell them why your partner is upset, you would be able to give them an accurate summary. Sometimes, all we want from each other is someone who will hear us out without being judgmental, without siding with “the enemy”, and without giving us advise based on their own perspective. Feeling understood rather than evaluated, can greatly increase our sense of intimacy and connection with our partner.

2. Create Rituals of Connection:

Do you really know what is going on with your partner at work? Do you know what worries are on their mind? Instead of leaving these kinds of questions unanswered, why not build in a ritual of sitting down for dinner or for late evening tea, to check in about each other’s day? Turn off the TV and cell phone and make this your daily together-time. Maybe set aside 15 minutes for each person to share about their day. When focus is on your partner, make it all about them, and don’t redirect the conversation to yourself. The goal is not to bring up concerns about each other, but to discuss all the external stressors and successes that are going on at work or with other people. The goal is to strengthen the conviction that you have an ally in each other and are facing the world together. This sense of togetherness and support is one of the best ways to improve intimacy in your marriage over time.

3. Share Your Spontaneous Reactions:

Famous couples researcher, John Gottman, discovered that healthy couples share many more of their spontaneous reactions with each other than couples who are disconnected. Couples who complain that they just don’t have anything to talk to each other about anymore, forget that connection is not always about depth of conversation. Get in the habit of sharing your reactions to even mundane things. Did you like your cup of coffee this morning? Share it. Did you laugh at a Facebook post? Let your partner know. These little invitations to connect are important to the health and intimacy of your relationship. In relationships where partners feel disconnected, Gottman found that not only are these little “bids for connection” few and far between, they are also often met with lack of interest from the partner. If your partner makes a bid for connection, be sure not to turn them down or ignore them. If you routinely do, they will soon stop sharing and your level of intimacy will slowly wither away.

4. Invite Deeper Conversations:

Sometimes when couples get into the doldrum of things, they may interact with each other in routine-like ways that can become  deadening or boring and can decrease the sense of intimacy. Couples may start to feel like they are out of things to talk about or that they already know their partners position on different topics. In such cases, it usually pays to ask more philosophical or personal questions, to get at your partner’s deeper underlying thoughts and feelings. Your partner likes to travel: Why is this so important to them? How might this relate to their background or childhood history in some way? It’s important to your partner to be on time: Why do they attach importance to punctuality? Where does that value stem from? What feelings do they have about this issue? Learn to become interested in the deeper motivations, desires, and values of your partner. It is one of the best ways to improve intimacy in your marriage and have more meaningful conversations with your partner.

5. Get Away from the Everyday:

Sometimes what couples really need to rediscover their connection and improve their intimacy is to create new experiences and memories together. It often pays to plan a trip or take time away from the everyday routine. If you always go for dinner and a movie on Fridays, shake it up a little. Try something new. Stay overnight at a hotel in a different city. Take turns planning an outing, by looking up events in the local newspaper. Agree to be open-minded about your partner’s suggestions and try out an event your partner is interested in without judging or dragging your feet. A relationship is a living thing, and new experiences can help give new life to your shared existence and improve intimacy in your marriage.

About me: I am Rune Moelbak, Ph.D. a couples therapist in Houston, Texas. I help couples reconnect and improve intimacy in their relationship or marriage. Read more about my approach to couples therapy.

man facing countless choices

Low Self-Esteem and the Flight from Self

Many people in our society live lives that are not fully their own. They try to become their ideal self – an image of who they SHOULD be – rather than to be who they truly are.

Although there is nothing wrong with striving to be better at something, sometimes these strivings secretly function as judgments on ourselves. We want to be better, not as a function of our natural striving for self-actualization, but to make up for our low self-esteem and a lack of ability to accept ourselves for who we are…

The student who always MUST have straight A-s on their report card may for example have an ideal self that dictates that they always be the best at what they do. If they fall short of this unrealistic standard, they may harshly criticize themselves for falling short and being a “loser”.

Underneath our high standards of self-worth, we may thus often find a harsh critical voice that condemns us as chronically deficient.

We may, in other words, be stuck in a chronic cycle of unrealistic expectations that lead to inevitable failure and periods of low self-esteem.

We may have set up what psychoanalyst Karen Horney calls a “Pride System”, where we are either chasing a self that we want to be (our ideal self), or angry with ourselves for not being who we want to be (our actual self).

The Pride System:

Pride denotes a falsely inflated virtue that has sprung up to take the place of a perceived vulnerability. I may, for example, pride myself of being all-loving and selfless in order to make up for a sensitivity I have to being accused of not being a good or morally virtuous person. At the core of my prideful pursuit of my all-loving ideal, thus lies a wound or bruise to my self-esteem that it is intended to cover or make up for.

I know that my values or virtues are really part of my pride system, rather than a sign of healthy self-esteem, if I need relentless confirmation of their veracity from the external world. For example, if I am only worthwhile if I get an A, or lovable if others praise me for my selflessness. Another sign that my pursuits are prideful is that I pursue them compulsively and inflexibly, and that my failure to be a particular kind of self produces a crisis in my self-worth and self-esteem.

What Karen Horney rightly points out is that neither the ideal self nor the self I am when I fall short of my ideals, should be confused with my true self. Both the ideal and the failure to embody one’s ideal are two side of the same failed project. In setting up my impossible ideal, I also set up my flawed self. Both go to together like night and day.

The unfortunate thing is that many people live their entire lives within their pride system and never get in touch with who they really are.

Ideals as Defenses Against Low Self-Esteem:

Most of the time, unrealistic ideals emerge early on in life as a form of protection against low self-esteem. They are frequently attempts to ward off feelings of vulnerability, anxiety, or shame.

Karen Horney  talks about a “fundamental anxiety” people can experience when growing up. Fundamental anxiety is an anxiety about being who I am. It is the experience that something about me is flawed or unacceptable.

It may be, for example, that I depended on others but felt let down, or that it was unsafe to assert my needs and express anger in my family. The result of such experiences may have been that I learned to disavow my dependency needs or my healthy assertiveness, and instead decided to dedicate my life to never needing anyone or never expressing dissension.

The ideal self therefore emerges as an alternative self I can strive to be, which would be more acceptable, more admired, and will rise above the frailties and insufficiencies of my more vulnerable self.

The Ideal Selves in American Beauty:

The movie American Beauty is an excellent illustration of the extent to which we will go to flee from fundamental anxiety in an attempt to make up for low self-esteem. While very humorous, the movie is also a tragic commentary on the ways people will bend themselves to obtain praise from others, paying the price of becoming alienated from themselves in return.

Caroline:

… We meet Caroline, the self-contemptuous mother who spends her life making up for her childhood shame of being poor by adopting a workaholic lifestyle and having periodic break-downs when she falls short of meeting her ambitious goals…

Frank:

… We meet Colonel Frank Fitts, a father who spends his life pursuing military structure and discipline to ward off acknowledgement of the impulse to give in to his homosexual desires and the shame he feels about having them…

Angela:

… And we meet Angela, a flamboyant attention-seeking teenager who brags about her sexual experiences to cover up her fundamental shame of feeling boring and uninteresting…

All of these characters illustrate the price many people pay for unacknowledged low self-esteem that is relentlessly hidden underneath the pursuits of a different, better ME.

The Strategies We Use to Ward Off Low Self-Esteem:

In her excellent books on fundamental anxiety and the pride system, Our Inner Conflicts, and Neurosis and Human Growth, Karen Horney describes the various ways in which our energy and growth get diverted from our real self toward our ideal self.

Karen Horney: Our Inner Conflicts

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Karen Horney: Neurosis and Human Growth

Click on image to read about book

 

 

 

 

 

 

 

In Our Inner Conflicts, she identifies several typical strategies people use to make up for their low self-esteem and secret self-contempt.

In the strategy of moving away, a person disavows any dependency needs or needs for love, to pursue an ideal of independence, self-reliance, and freedom from commitments.

In the strategy of moving towards, a person disavows any self-focus, any assertiveness of one’s needs, and any expression of dissension in order to preserve a self-mage of an all-loving, self-sacrificing, good natured human being.

In the strategy of moving against, life becomes about winning, being better than, and always being on top, but the price one pays is the inability to collaborate, to learn from others, and to be vulnerable.

Each strategy becomes pathological only in so far as it becomes rigid and unbendable. For example: I may end up in an emotionally abusive relationship with a controlling partner and not be able to stand up for myself because I have made a virtue out of always putting others first or being “self-less”, or I may become a world-traveller who idealizes my freedom from constraints, but really live a life to protect myself from my inability to be intimate and close with others.

The challenge for many people who, like the characters in American Beauty, find themselves the victims of impossible ideals, is to come to terms with the initial wounds that made them abandon themselves on the altar of their ideals.

People must realize that their ideal self is a protective device to overcome an underlying shame, anxiety, or vulnerability. They must realize they will never redeem themselves by trying to become different from their real self, but must get to the root of their underlying low self-esteem and learn to accept and embrace who they truly are.

They must embark on the process of finding compassion for themselves, so they can allow themselves to be human again, rather than aspire to live the life of a God.

About me: I am Rune Moelbak, Ph.D., a psychologist in Houston, Texas who has helped hundreds of people regain their authentic self and feel more at peace with themselves. Visit my website to learn more about my my approach to anxiety and low self-esteem. 

Picture of 5 post-it notes

5 Common Things People Say to Avoid Seeing a Therapist

The vast majority of people who are contemplating seeing a therapist will be marred by doubts and reservations that may ultimately get in the way of following through. Some of these concerns may be quite rational and practical, but others are typically roadblocks we put in our own way because we are afraid…

Resistances to Therapy:

Therapists have long referred to these rationalizations in defense of our fears as “resistances”. Resistance is an expected part of every therapeutic journey. What Freud determined quite early on is that people want change from a distressing situation, but are also deeply afraid of change and of the process that is going to get them there. A part of each person therefore actively – albeit often unknowingly -resists the process of therapy. These resistances often start before the person has even walked in the door and may prevent them from ever picking up the phone and scheduling that first appointment…

Here are five of the most common resistances people have to seeing a therapist and some reasons why they might be rationalizations that cover up underlying fears: 

1. I Should Be Able to Solve My Own Problems…

This resistance to seeing a therapist is quite common. Many people have learned that the hallmark of skillful and confident people is that they are able to manage life without relying on anybody else. They think they must be weak or inadequate if they have to see a therapist; that this means that they are not competent or skillful like everybody else, or that they can’t cope with life.

Fact is that underneath an overly self-reliant attitude are often deep-seated fears about depending on others. Many people develop the attitude that they must manage life on their own, because they are afraid that others would ultimately not be there for them in their hour of need. Reaching out to others and admitting that you need them can sometimes activate the feeling of becoming a child again who cannot fend for him or herself and who is utterly at other people’s mercy. Although we all have deep seated wishes to return to a state of being taken care of again, such wishes have often had to be squelched as part of growing up, and we may now judge ourselves as “childish” or “immature” for having them. And yet when we fall in love and develop strong relationships with others, we are confronted with the fact that these needs never went away. The ability to endure the vulnerability of depending on others is thus a necessary skill to have in order to form strong bonds and feel intimate with others.

It is now easy to see why some people may not allow themselves to even contemplate therapy. They don’t feel comfortable getting in touch with the child within and enduring the risk of rejection and let-down that comes with having to depend on others.

 2. Therapy is Too Expensive – I Can’t Afford It…

Finances are often used as a prime reason why therapy is not an option for a person. Sometimes embarking on therapy would truly be a bad financial decision, especially if you are struggling to meet your many financial obligations. At other times, however, concerns about finances may serve as a convenient way to appease certain underlying fears about the therapeutic endeavor itself. It is for example not uncommon to find that people will go on expensive vacations or remodel their kitchen, but not feel they can spare the expense to see a therapist.

Many times a concerns with financial means to pay for therapy conceals a variety of underlying concerns. These can include: guilt feelings about making yourself a priority, minimizing and deprioritizing your mental health, or resentments about the idea of having to pay for someone to listen. Many people are okay spending money on others, but feel uncomfortable with making themselves a priority. Therapy for them is the ultimate self-indulgence and may feel like a selfish need. Others, who feel quite okay spending money on material possessions like a new car, a new kitchen, or expensive jewelry, may not feel that spiritual things like their own mental health is of equal value. Finally, whether people admit to it or not, there is often some anger or resentments that people experience for having to depart with a treasured belonging (money) in order to get somebody to care or to listen. Rather than examine the variety of these concerns, it is often easier to chalk them up to the statement that therapy is simply too expensive.

 3. Seeing a Therapist Means I’m Crazy…

Many people find it difficult to square the idea of going to therapy with their need to feel normal. We have a very powerful social instinct that wants nothing more than to blend in with everybody else. We are afraid to stand out from the crowd in any negative way and we convince ourselves that therapy means that something about us is wrong or defective; that we have stepped outside of the acceptable limits of our society.

This resistance to the idea of therapy and what it must mean about ME or my self-concept is based on the illusion that “normal” people don’t need therapy. Fact is that every human being develops certain bruises to their self-esteem, experiences certain personal limitations in their interactions with others, and don’t know how to cope at various points in their life. Psychoanalyst, Nancy McWilliams, quips in her famous textbook to therapists, that the question to ask oneself is not: Am I nuts? But: How nuts am I? And nuts in what way?

People who go through life adhering to an illusion of normalcy can only do so by pushing their struggles to the side and pretending that everything is fine. Over the long term this actually produces more psychological distress than dealing with your issues head-on. Ironically, trying hard to be normal can be crazy-making, and allowing yourself to confront your irrationalities and “craziness” can make you feel normal again. Dismissing therapy as something that is only for “crazy” people is thus a way to express discomfort with who you are, and not acknowledging that it is human to suffer.

 4. It is Weird to Air My Dirty Laundry to a Stranger…

It is not uncommon for people to convince themselves that talking to a therapist will feel too awkward or uncomfortable. They might say to themselves that it is unnatural to talk to a professional about your problems, and that a therapist really offers nothing that a friend or family member couldn’t offer. In addition, they say, it is not comfortable to share their deepest darkest secrets with someone they hardly know and who doesn’t reciprocate by sharing something about their own personal life.

These resistances to embarking on a therapeutic journey serve as  deterrents to having to face one’s fears of opening up and becoming fully known to someone. One naturally feels quite “naked” and exposed when one is asked to divulge thoughts and feelings to someone who is not responding in kind. However, discomfort about opening up to a therapist is often about confronting one’s own shame about admitting to the full scope of one’s human emotions, thoughts, needs, and wishes.

The same qualities about the therapist that are often cited as deterrents to opening up, are also the qualities that ultimately allow people to go deeper into their issues and be more honest than they can be with a friend:

  • Because the therapist does not divulge much about their own personal problems, the client is free to focus exclusively on their own issues without having to be concerned about taking care of someone else.
  • Because the therapist is not part of the client’s life, a client can feel safe to genuinely express themselves without fear of repercussion for their everyday relationships.
  • Because the therapist is not a friend or family member, and has no self-interest in the client choosing particular actions over others, a client can discuss concerns without feeling an implicit pull to make particular decisions.

At the end of the day, the therapeutic set-up, while initially a foreign concept, actually ends up making it easier rather than harder for a person to share their thoughts and feelings freely.

 5. It Will Be Awkward if I Don’t Like My Therapist

Some people may hold themselves back from scheduling an appointment because they don’t want to get themselves into a situation they can’t get out of. They may be concerned that a therapist won’t be right for them and that it’s going to be uncomfortable to tell their therapist that they would prefer not to come back.

These kinds of fears of getting stuck in a bad situation often hide over discomfort with assertiveness and ultimately with anger and aggression. Some people feel that they would hurt their therapist’s feelings if they truly expressed their mind and feel like their only choice is to go along with whatever their therapist is telling them so as to not incur their therapist’s wrath. This of course leads to fears of being swallowed up in the relationship and losing one’s autonomy and independence.

It may be of great comfort to such people to know that therapists receive training in how to manage a client’s negative reactions, and that working through negative reactions is part and parcel of good therapy. Therapy is about creating space for clients to be themselves fully, which means creating space for negative as well as positive emotions. No therapy can ever be completely successful if a person has not been able to express and work through their anger, disappointment, fears, and frustrations as they pertain to their therapist as well as significant others. It is quite liberating to have the experience that one’s therapist can withstand one’s fury without retaliating or rescinding their support.

About me: I am Rune Moelbak, Ph.D., a psychologist in Houston Texas. I help people confront their fears and live more genuine lives. If you have fears and concerns about therapy that I have not addressed in this article, please feel free to send me an e-mail with your questions. For more information about the process of individual therapy click here.  

What's your story?

The Power of Story-Telling

On my recent trip to Nicaragua, I learned at least two things: 1. That when looked at from a Venezuelan/ Nicaraguan socialist perspective, the US is a country of police brutality and moral decay, and that, 2. Spirit Airlines are not stingy with their amenities, they are just engaging in “frill control”. Funny how reality changes when you tell a story differently…

A Cultural Lesson on the Power of Story-Telling:

Nicaragua is currently a country that receives a lot of financial aid from the Venezuelan government, due to their mutual sympathies toward a kind of socialism practiced by the now deceased political leader, Hugo Chavez. For that reason, you can find posters that pay homage to the former Venezuelan in places all over Nicaragua. You can also, I discovered, watch unadulterated TV transmitted straight from Venezuela.

When I would settle in at night after a long day of sightseeing in the tropical heat, I would turn on the TV in my air-conditioned hotel room, and would find myself fascinated by one particular Venezuelan station and the entirely different world-view presented there.

The US was on this channel depicted as quite morally depraved. The evening’s news included a segment on police brutality against civilians in various places in the US, presented as if it were breaking news.

The news was followed by a theme show featuring all the wonderful socialist initiatives of the Venezuelan government: First you saw how many modernized apartments were being built through the decree of the government, and then coverage followed of other government initiatives: workers would now be able to pay fair prices on everyday goods due to government intervention, the environment was now being saved through nation-wide programs to plant trees…. The initiatives were seemingly never-ending…

Every segment introduced one hopeful initiative after another, and the clips were always of people doing things together – collectively – making political decisions about what kind of society and destiny they wanted. This was a society that valued people and community over and above raw capitalism, and it reminded me a little bit of the Obama campaign’s “Yes, we can!”, which had that same kind of optimist spirit, before it lost its fizzle.

After watching this Venezuelan station for just 30 minutes I was left with an indelible impression of optimism, although a part of me of course knew that this was quite a different spin on reality than the one I had typically been presented with. From a North American perspective, Chavez was always depicted as somewhat of a selfish dictator, and socialism, of course, always depicted as bad.

However, crossing cultural boundaries, not just geographically, but mentally, is quite eye-opening. It made me think of the power of stories as a mediator of the reality we experience, the emotions we feel, and the actions that become conceivable. It also made me think of the tendency of stories to hide their story-like nature behind a presentation of facts.

The Venezuelan news station was not consciously telling stories, but merely reporting facts, and many of the stories we tell in the US media, to ourselves, and to others, have that same pretension to transcend their story like nature.

The Story of Psychological Disorders

The idea of the unadulterated fact is, however, itself the product of a story: the story of the enlightenment or of science. According to this story, we can access reality purely as it is in itself outside of the logic of a certain story line and pre-understanding. And yet, as hermeneutic philosopher Hans Georg Gadamer has pointed out, even science takes place within a prior understanding of the world. There is never such a thing as approaching the world without making certain pre-judgments or assumptions about it.

A research study about the effectiveness of a certain therapy for Bipolar Disorder for example, may seem like it is only reporting facts (looking at quantifiable variables and measurements of probability), but it is assuming an illness model of psychological distress which is not itself part of what is studied. An illness model, of course, is a story about why people suffer that attributes the suffering to a disease process or cause underneath the actual life of the person, and is by no means the only possible story.

The medical or biological view of psychological distress has a particular strong-hold in our current North American and European zeitgeist. People are always wondering: Do I have ADHD? Am I Borderline? Do I have a psychological disorder? …As if assigning a label and naming one’s suffering as a generic underlying “thing”, solves the problem, and alleviates the discomfort of figuring out why I suffer in some more human or existential sense.

And yet, these “entities” which we like to label ourselves with are themselves largely the product of stories. What appears to be science and is presented in an officially sanctioned diagnostic manual (DSM) as if it were, is really the product of a political process of debating different research studies, naming conventions, and inclusion criteria. Psychological Disorders are voted into existence. The other side of a disorder is all the contentious opinions that had to be tabled in order for the construct to appear as an independently existing noun.

Therapy as Story-Telling

Rather than try to fit people into categories of a medical story, therapy offers a space where alternative stories can be told. Therapy as a “talking cure” is really about telling your own unique story. A person is helped to unearth memories, feelings, and experiences that sometimes pose challenges to existing stories, and require the reorganization of one’s understanding of oneself and of the world. The medical narrative is here often a hindrance that disallows people from pondering the idea that symptoms exist for a reason, that feelings contain useful messages, and that our bodies express that which we cannot yet say.

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And so it is that a trip to Nicaragua made me wiser about the power of the stories we tell and about the need to examine the stories we live as our own personal and cultural truths.

The Venezuelan government has their story…

Spirit Airlines has theirs…

What’s your story?

About me: I am a psychologist in Houston, Texas who likes to think outside the box and is committed to helping people find their unique personal truths. Read more by visiting my website.

Lady Smoking Cigar

The Psychological Meaning of Drug and Alcohol Addiction

An addiction to drugs and alcohol is not really an addiction to the drugs or to the alcohol. Rather we become addicted to a way of life. Our drug of choice, for better or for worse, helps us find our bearing in the world, and it is much more difficult to let go of a way of existing than it is to let go of a simple physiological enjoyment… 

My Own Sweet Addiction:

Recently I tried to break my own addiction to coffee. Over a period of time I felt that my daily dose of mocha served more to keep me afloat than to enhance my well-being. Instead of giving me a pleasant kick, coffee had started to become my daily crutch; a simple means to not feel utterly exhausted. After two years of gradually increasing my daily fix to simply stay alert, I finally found the resolve to kick my habit.

The first days after quitting, were horrible, of course. I felt quite down, my body started aching, and I had trouble staying awake during important meetings. Gradually, however, the withdrawal symptoms started wearing away, and life started to get back to a new normal. And just when I was feeling the wonderful clarity that comes with a sober mind, I started realizing that I am not the kind of person who wants to live a life without coffee.

Coffee for me is more than just a kick in the morning or a tool to stay awake. It is the enjoyment of sitting on my sun-bathed patio reading a book while treating myself to an aroma filled cappuccino. It is the satisfaction of sharing laughs with friends after a well-deserved meal that needs just that finishing touch which only coffee can provide. It is a reason to go out on a Sunday afternoon  and spend a couple of hours in a coffee shop for a slight change of ambience… It is not just a cup of coffee, but a lifestyle. Its effects go far beyond the simple physiological kick…

What this tells me is that: The addiction to coffee, just as the addiction to alcohol, cannabis, or any other drug or habit, is mainly a psychological addiction.

Addiction as a Love Affair with Life

It is easy (relatively speaking) to beat the physiological part of an addiction, but it is a monumental task to rid oneself of the addiction to life as we know it and enjoy it WITH our cherished addiction.

In the addiction literature, this psychological component of addiction is often minimized. It is referred to as the secondary gain or the reinforcement enhancing effect of addiction. And yet, it is this psychological, social, and contextual significance of the habits we form that is most likely to make us return time and time again to that cigarette, scotch on the rock, or sweet cup of Joe…

If there is any doubt in your mind about the power of our psychological needs in shaping our behavior, lets turn to an episode of the TV-show Frasier for support. In the episode “Where There’s Smoke There’s Fired”, Frasier agrees to use his psychiatric expertise to help his “manager” Bebe, break her smoking addiction. At one point, as Frasier and Bebe are sitting at the dinner table, Frasier asks her “What do you like so much about smoking?” Bebe’s answer, although fictional, is quite illuminating of the psychological impact a drug can have:

I like the way a fresh firm pack feels in my hand. I like peeling away that little piece of cellophane and seeing it twinkle in the light. I like coaxing that first sweet round cylinder out of its hiding place and bringing it slowly up to my lips, striking a match, watching it burst into a perfect little flame and knowing that soon that flame will be inside me. I love the first puff, bringing it into my lungs. Little fingers of smoke filling me, caressing me, feeling that warmth penetrate me deeper and deeper till I think I’m going to burst. Then whoosh!… watching it flow out of me in a lovely sinuous cloud, no two ever quite the same.

After hearing Bebe’s monologue, we are bound to wonder: Is this an addiction or a love affair with life? Surely giving up smoking will for Bebe not simply be about giving up on cigarettes, but about letting go of a very meaningful engagement with life…

Treatment of Drug Addiction is Treatment of a Lifestyle

The problem with many of our understandings of psychological phenomena, not least in the field of addiction, is that we are mired in a dualistic understanding of the world. What this means is that we separate objects in so-called objective reality, from our subjective experiences and the lives we live. This often creates a barrage of treatment approaches and techniques intended to target the physiological or brain-based components of our psychological experience, or that focus squarely on our behaviors and not the motivations, intentions, and meanings of our behaviors.

And yet, a cup of coffee, a cigarette, or a glass of wine never really exists outside of a life context of real people who fill their lives with experiences of a meaningful nature. An alcoholic beverage is never just that, but is always in some way a meaningful activity. It is a drink I have as a part of feeling included when I am out having a good time with my friends. It is a drink I need in order to deal with emotions or stress, which would otherwise eat me alive. It is a symbol of living the high life, a way to protest against lack of meaning in another area of life, or an enjoyable ritual in its own right. Regardless of whether or not the drink helps fulfill a healthy or unhealthy need, it is never just a drink, but a slice of life.

Coming to terms with addiction is therefore always about coming to terms with the psychological choices and meanings of the particular existence I live. Treatment of drug addiction is not the treatment of a drug, but the treatment of a life. Beating the physiological part of addiction is the easiest part. Creating a new life, and finding new ways to organize what one finds enjoyable and meaningful about life is by far the hardest.

At the end of the day, this is one of the reasons why the desire to change a habit, frequently requires a change in self or a new outlook on life. Therapy, of course, is one way to facilitate this process…

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Want more? To read more about my meaning-based take on the treatment of drug and alcohol addiction, download my article: The Value of Adopting a Human Science Approach in the Management and Treatment of AddictionYou can also read an interview with me on a Humanistic Approach to Addiction published by Sociedad Iberoamericana de Informacion Cientifica (SIIC) in both English and Spanish

About me: I am Rune Moelbak, a psychologist in Houston, TX, providing individual and couples therapy for people who want to get to the root of their problems. To read more, visit my website: www.bettertherapy.org.

Picture of Person with Borderline Personality Disorder

Borderline Personality Disorder and the Fear of Becoming Oneself

The concept of Borderline Personality Disorder is often understood as being synonymous with an impossible individual who acts out in the most ostentatious ways. The concept conjures up images of suicidal threats and acts, as well as intense anger and aggression. However, there is a more subtle kind of borderline anxiety that is less “in your face” and yet quite widespread in many romantic relationships. This kind of borderline phenomenon is not the kind that would require hospitalization, but it nevertheless has its own insidious and very destructive effects on the health of a relationship…

The kind of borderline anxiety I am talking about is different from your common garden-variety of anxiety. It is not related to the fear we can all feel sometimes of messing up an important presentation at work, or the existential fear that comes naturally when having to make an important decision about our life direction. Nor is it related to the everyday anxieties of getting a parking ticket in an area with unclear signage, or the worries about things going wrong that are outside of our control.

These kinds of anxieties are adaptive in the sense that they help us prepare better and consider risks, so that we may make better decisions. Even when these anxieties and worries become excessive and unrealistic, they are still in some sense about external things, and in this sense never pose a danger or threat so fundamental as to reach the level of the anxiety of someone with a borderline personality.

Losing Oneself to Gain Love:

Borderline Personality is in my opinion a fear of being oneself. Not the kind of fear experienced by someone with social anxiety, who may in many instances like themselves when alone and even develop a preference to spend time by themselves.

Unlike the socially phobic individual, the borderline fear of being oneself is paired with a need for others that is as fundamental as the need for oxygen.

This conflict between the need to be close and the fear of being oneself plays itself out in very destructive ways that involve not just the person who experiences these anxieties, but also their partner, who may in many instances end up suffering just as much.

For the person with borderline personality disorder or borderline anxieties, individual expression or being oneself equals loss of love and affection. The fundamental belief here is that “I am unlovable” as myself, therefore to attract and keep the love I need, I must become the object the other person needs or desires. I must obtain love by becoming a chameleon who changes and adapts to become exactly what the other person wants.

Unfortunately, this strategy, although temporarily eliminating the anxiety of being rejected, also leads to built-up of anger and resentment. The person with borderline anxiety soon starts to get annoyed, angry, and frustrated with the lack of love they ultimately receive. They feel loved not for who they are, but for who they have become to please their partner. Although their partner might enjoy having found someone who likes the very things they like or who always wants to go to the restaurants they themselves enjoy eating at, they will soon experience the anger and frustration of their partner who feels chronically love deprived.

Borderline Personality and the Fear of Choosing:

The dilemma, however, is often an impossible one, for if one were to ask the person with borderline anxieties to make a choice about where to go for dinner or where they would like to go on a day retreat, you would soon bump up against the fear of self-expression. To the person with borderline anxieties, making a decision means being exposed and risking rejection. Afterall, we are defined as people by the choices we make, and it is in the freedom of choosing that we cease being an object for another person and start to become a subject or a person in our own right.

The outcome of this dilemma is usually as follows: The person with a borderline personality makes a tentative choice, but now becomes acutely aware of any sign of disapproval. He or she scans the facial expressions and actions of their partner for signs of the loss of love, just like a person who was just robbed, would scan the environment for suspicious people.

The partner is thus often up against a certain paranoia that leads the person with borderline anxieties to attribute motivations, thoughts, and feelings to them on the basis of unfounded fears rather than facts. The borderline is always ready with interpretations such as: he’s just doing it to please me, or she really doesn’t want to be here. And ultimately jumps to the conclusion: He doesn’t care about me! OR she doesn’t love me!

The Impossible Dilemma of the Borderline’s Partner:

A movie night where the person with borderline anxieties has chosen which movie to watch might thus quickly turn into a fight: The anxious person who is already feeling guilty and bad for having made the “choice”, might quickly find a reason to think that the partner is not enjoying the movie, is not paying enough attention, or is using a tone of voice that indicates annoyance with the movie. When accused of this, however, the non-borderline partner cannot persuade their borderline partner otherwise. The conclusion has already been made in the mind of the borderline who now walks up and turns off the video, furious at the partner for the lack of interest shown.

The non-borderline partner is now left with his or her own impossible choice: to insist on watching the movie is to be accused of just humoring the other person, while to do nothing is to prove that every time the other person chooses something, the partner shows no interest.

This kind of scenario where the partner is accused and sentenced on the basis of borderline fears, and feels damned if I do and damned if I don’t, gradually conditions the partner to become fearful or anxious him or herself. He or she may now start to limit their own choices and fear their own self-expression, since it is quite unpredictable when they will incur the wrath of their borderline partner for saying the wrong thing, or making the wrong decision. It is as if by living with someone with borderline anxieties, one has to always walk on eggshells, which by the way, is the title of a popular self-help book for partners who find themselves in these dilemmas:

Stop Walking on Eggshells Book Cover

Click on book cover to read description of book

Borderline Personality and the Fight to Exist:

These kinds of impossible dilemmas, which are now transmitted to the partner, exactly mirror the impossible dilemmas at the heart of borderline pathology: I can’t be myself (without losing love) and I can’t not be myself (without feeling that I don’t exist and am not loved for who I am). I am stuck in the borderland where no choice can be made. My life is an impossible existence, where I am always teetering on the edge of disaster no matter what choice I make.

Borderline personality is thus in most cases a fight to exist, and the emotion that is most symbolic of this fight is: Anger. The person with borderline personality is angry at having to always accommodate others, and angry at having the right to their own existence stolen from them. But they are also angry that if they dare to assert themselves, make choices, and be themselves, the other person likely will lose interest in them or stop loving them.

Anger is here in some sense a sign of health, even if the situation one is angry about is created on the basis of anxiety rather than facts. The anger is a protest. It communicates a desire to be oneself, to have one’s own needs met, and to come into existence as an individual in one’s own right.

About Me: I am Rune Moelbak, a psychologist in Houston, Texas. I provide psychodynamic therapy for people who want to get to the root of their problems.

Picture of being vulnerable

Secrets of Successful Relationships: #1 Learning to Be Vulnerable

What is it that makes some couples have more successful and rewarding relationships, and others teeter on the brink of relationship disaster?

The Secret of Successful Relationships:

If you ask me, the secret to a successful relationship or marriage lies in the capacity to be vulnerable. Most relationship conflicts are the result of people’s distaste for admitting to themselves and to their partner that they depend on each other, that they worry that the other person doesn’t love them, that they feel disappointed or hurt, or that they miss the other person and wish they could be closer or spend more time together.

What is communicated, however, is often not these things. Instead of the softer, more vulnerable emotions, we instead communicate our frustrations and our anger, our jealousy and our self-righteousness. Instead of asking for what we really want, we blame our partner for being faulty, inconsiderate, or wrong.

The Prescription for Successful Relationships:

It doesn’t really matter what couples therapist you ask, the prescription for successful relationships will almost always be the same: To have successful relationships, you must learn to communicate from a more vulnerable and more genuine place. Rather than pick fights about peripheral concerns or substitute emotions, you must be able to address the real issue.

Instead of focusing on your anger, for example, your couples therapist will help you redirect the focus to that underlying vulnerability which precipitated the anger, and will help you communicate that emotion instead.

If your spouse is out having a good time with his work colleagues, for example, the immediate reaction might be one of anger at him for never being home to help with the household chores. If we dig a little deeper, however, we might discover that the real reason for the anger is one of jealousy about sitting home alone while your husband is out having a good time. Further digging, might even reveal that the jealousy is but a veil for an underlying fear that you are not really very fun to be around and a wish you have that your husband would choose to spend his time with YOU.

Anger as a Veil for Other Emotions:

Instead of communicating the longing, the fears, and the doubts, however, it is often safer and less painful to communicate your anger.

Psychologists refer to emotions that are reactions to other emotions as secondary emotions. Although anger at someone, can sometimes serve as the original response to an event, it is more often a way of protecting yourself from a more vulnerable emotion.

To say to your wife that you feel like she may not be as attracted to you anymore and that you are worried of losing her, is a lot more difficult than giving her the silent treatment when she speaks at length and with great excitement about activities at work that don’t include you.

What Prevents Us from Being Vulnerable?

Exposing and communicating the more vulnerable emotion is what most couples therapist recommend to create and maintain successful relationships. But why is it so difficult?

The first reason for this difficulty is that you might judge yourself for having your vulnerable emotions. A voice inside of you might be telling you that you are weak for feeling jealous, or that you should be stronger than having a need for more closeness or more affection.

The second reason, might be that you are not certain that your partner will treat these vulnerable emotions delicately and respectfully. You may be worried that your partner will stomp on you when you are already down, or that your partner will use your admissions against you at a later time.

Finally, a third reason might be that your vulnerable emotions are not always rational and can seem immature. You may therefore be too ashamed to even admit to them, not to mention, to speak of them out loud.

The result of all these prohibitions, judgments, and dangers is that instead of communicating our longings, our fears, our doubts, and our needs, we end up attacking our partner and creating distance between us instead.

Why Couples Therapy Can Help:

Couples therapy is therefore both about facilitating greater insight into our vulnerabilities, and about facilitating a safe, respectful, and trusting relationship where these emotions and needs can be communicated.

When done right, the end result is often less conflict and more closeness.

About me: I am Rune Moelbak, Ph.D., an experienced couples therapist in Houston, Texas. Read more about my approach to couples therapy and learn how you can schedule an appointment. 

Therapy as Art

A Beautiful Truth: Why Good Therapy is Like Art

The Beauty of Therapy:

My many years of experience as a therapist have taught me that therapy is a beautiful experience.  People change by finding connections between memories, thoughts, and feelings, forming beautiful new patterns out of the fragments of their life.

Suffering on the other hand is ugly. It is a sign of a pattern that has not yet emerged, of a thought has that been severed from a feeling, or a feeling that seems isolated and without meaning.

Beauty has flow; suffering is disharmonious.

Good Therapists are Artists:

Good therapists are more like artists than technicians. They don’t seek to produce a predetermined outcome through their interventions, but seek to join with the client, to help the musical harmony of the client’s life come to expression.

I often think of myself as a jazz musician who has to jump into a musical piece that is already being played, the goal being to add a guitar string here, and add a drum there. I think of my therapeutic interventions as producing resonance, along the lines of French philosopher Gilles Deleuze, who said, “You should not try to find whether an idea is just or correct. You should look for a completely different idea, elsewhere, in another area, so that something passes between the two which is neither in one nor the other”.

What is needed in therapy is not an accurate interpretation of facts, but movement in a client’s capacity to think new thoughts and access new experiences. The words and observations of the therapist have to make new connections possible. The most skillful way to do this  is to insert a new element into the client’s speech or experiences that makes something resonate in a way that wasn’t possible before.

The therapist must hear something between the lines or outside of the client’s conscious awareness; something that has fallen outside of the structure of the clients conscious story line.

A client might be speaking in a way that repeats the significance of the word “eight”, which seems to pop up in multiple contexts unbeknownst to the client. The client has been in a relationship for eight years, the client likes the brand of mint chocolates After Eight, and the client complains of being overw-eight. The therapist hears the refrain that has fallen out of the clients awareness, and asks the client to talk about what happened around the age of 8. If this question resonates, the client will be able to access new important memories or feelings. Maybe his parents got divorced when he was 8. Maybe she was eight when her cousin sexually abused her. Or maybe nothing at all comes to mind, in which case the intervention would fall flat.

The point is that the therapist’s job is to listen for the music that is being played, and to re-introduce elements that might make new thoughts possible. When such connections are made, beauty or harmony is the result.

A Joint Master-Piece:

The therapist is not some master mind who offers universal truths and prescriptions, but someone who knows how to jam with the client. The therapist must receive the beauty from the client’s life story, and help the clients play their music.

Good therapy is never about applying eternal truths and knowledge to universal problems, but about creating something unique and new from out of the always particular elements of a particular person’s life.

As a result, good therapy happens not as transfer of knowledge from the therapist to the client, but as a veritable co-production.

Therapy as Creation:

In therapy, as in life, there is no clear sense of the end goal from the outset. One must discover what is possible by being open to what happens. What happens is never something that can be predicted in advance; it represents a possibility beyond one we can control and plan for. Turning towards this “unknown” happening, and cultivating it by paying attention to it, is probably where the real work of therapy happens. It is where client and therapist each become capable of receiving something new, which they had not known before. It is the place of pure creation: therapy as art rather than science.

Therapy as art allows us to receive a future that is not conditioned by the past, and to envision new goals of which we were not in possession prior to the actual therapy.

If you would like to read more about the connection between therapy and art, read my article: On Cultivating the Therapeutic Moment. To schedule a therapy appointment please visit my therapy website.