It was a lot of fun doing an interview last week on Finding A Therapist with Nina Del Rio, who is the host of Lite FM NYC’s “Get Connected.” One of the things we discussed was that the challenge of finding a good therapist in NYC is compounded be there being so many choices of therapists. We talked about what it means to see beyond the psychoanalytic options (of which there are so many in NYC) and how to think about group therapy as an effective option.

You can listen to it here: Finding A Therapist (Credit: 106.7 Lite FM, WLTW NY).

The post Finding A Therapist: A radio interview with Lite FM NYC appeared first on Tribeca Therapy.

An absurd question, obviously. Punch back! Run away! But investigate why? Pretty crazy.

And yet the slightly-less-ridiculous equivalent of this question gets asked all the time:

Your partner gets home from work and is banging around in the kitchen and barking, “Where’s the damn pepper!”

“Honey, why are you so upset?”

Your daughter runs into your bedroom screaming, “I hate you! I f$%#ing hate you!”

“Sweetheart, what’s wrong?”

A coworker throws a binder across the conference room after hearing that his budget is getting slashed in the next quarter.

“Roger, how come you’re so upset about this?”

I’m a huge fan of being curious. I think there’s not enough of it in the world. But when someone’s out of line, acting aggressive and ignoring basic rules of decency, there just isn’t an environment for it. The sane response? “[Partner/ Daughter's Name/ Roger], knock it off! You can’t talk to me (us) that way! I know you’re upset, but this is out of line!”

Psychology is perhaps complicit here, in teaching us that why is the most helpful question. But when someone’s being nasty (and we all have our moments, don’t forget) it’s just not that important why they’re doing it. What matters is that they knock it off! By failing to express this clearly we send an implicit message: I’m willing to be curious about what’s going on for you emotionally regardless of whether or not you present your feelings to me in a decent way.

When does why come in?

Later, as in “Why did you punch me in the face?”

If there’s a relationship there that you care about, that you feel can survive the indiscretion, then once things have calmed down that becomes a great question to ask.

The post “Why are you punching me in the face?” appeared first on Tribeca Therapy.

Mind Hacks, a psychology and neuroscience blog, posted a piece called Trust me, I’m a brain scan. They report on a study (a meta-study, actually—a study of studies) that found that, when the results of a particular piece of research are presented alongside a picture of a brain scan, readers were considerably more likely to find the results credible as compared with those not presented with such a picture, even when presented with otherwise identical information.

Ooh, science!

We’re willing to put a tremendous amount of faith in science even if we don’t understand or investigate the foundations of that science. The more science-y information seems, the more we’re willing to believe it.

The local news in New York seems captivated with science-y sounding studies, and nary a 6:00 pm broadcast can pass without some “new” bit of information on the merits (or demerits, seemingly alternately) of chocolate or red wine, or of a particularly outlandish exercise routine. The credibility line is always, “Researchers have found…” (Or, more often, “Researchers at New York Presbyterian Hospital have discovered…”—the script likely written entirely by the hospital’s publicist.)

Psychology gets its turn at this science-y game as well. Psychology is a science–the subset of science–after all, that speaks to the captivating mystery of human behavior. Psychologists, we’re told, have discovered why men cheat, why “opposites attract,” why some people vote for Republicans, and why New Yorkers prefer to stay up late.

We’ve come to view psychologists as experts on what’s really going on, deep inside.

Why?

We also recognize that psychologists—professionals from the same discipline as these research psychologists—are the one’s we ought to seek out for help when we’re in emotional pain. (Representatives of a number of disciplines provide psychotherapy, but “psychologist” is most commonly whom we think of.)

A logical connection to make, then, is that somehow a psychologist’s knowing what’s going on deep inside, their understanding of why I’m doing whatever it is I’m doing, i.e. the cause underlying my pain, is central to the method they will use to help.

Certainly many clinical psychologists (which is to say those who practice psychology—psychotherapy, really—with clients, as differentiated from research psychologists) operate that way. Whether it’s through a psychoanalytic lens (grounded in the methods of psychology originating with Freud) or through a more behavioral lens (flowing out of a psychological methodology that studies, empirically, the faculties of cognition and behavior—from which flow those studies most likely to show up in your 6:00 pm new broadcast), the central question is: Why do you do what you do?

Why can be helpful, and is a part of any work in therapy. Developing a picture of why we do what we do can lend a productive self-consciousness to our lives. We can address these causes on their own terms, find emotional release, or use that understanding to shape new habits.

What too often gets lost, however, is that when we’re seeking help in therapy why is less important than how. If we’re struggling with emotional pain, we want a therapy that can help us make changes in our lives; the bottom line is, we need to discover how.

From Why? to How?

Psychoanalysis is far and away the most prominent form of therapy available in New York. While there are countless varieties of psychoanalysis, all are grounded in Freud’s belief that adult struggles emerge, primarily, from the experiences of early childhood. The process of psychoanalytic therapy is, roughly speaking, uncovering those experiences and seeing how they relate to our current lives. Freud believed that the cure was to “make the covert, overt” and in so doing, cure neurotic (i.e. historically grounded) pain.

This sort of therapy has been helpful to countless people, but the intense focus on why to the exclusion of how leaves many people wanting. Quite regularly I encounter in my New York practice a new therapy client who reports the following, nearly verbatim: “I’ve been in a ton of therapy. I’ve worked through my childhood, and I feel at this point that I am completely aware of why I do what I do. Now I just need some help to change it.”

Having an expertise on why is great for landing an interview as an expert on the local news, but when you’re shopping for a therapist you need an expert on how.

If you’re looking for a plumber do you want someone who can explain the cause of your clogged-up toilet, with a deep understanding of the complexities of modern residential plumbing, or do you want someone who can fix it?

We give away trust too easily based on an expertise in why people do things.

You’re a you, not a “people”

One of the things that makes science-y stories particularly juicy is a research study backing them up that can make a broad assertion about human behavior. The standard for why to be credible is that the tendency articulated in the study has been seen repeatedly, across a large number of study participants.

A huge assumption made in research psychology is that if something is demonstrable in a large group of people it can be seen as a general principle or human behavior. Among other things, such research is normative, which is to say that it presumes to define a set of behaviors or traits as normal, and by extension, an absence or dysfunction in those behaviors or traits as abnormal.

The application of the results of such studies to the clinical practice of psychology, in your therapy, presumes a huge leap by conflating what is normal with what is desirable or, most importantly, desirable for you.

It’s also worth noting that a significant amount of the time, the “people” this research studies are often college students, and in particular psychology and sociology majors; after all, they’re the most available to participate in the studies!

A matter of trust

Trust is a critical part of any relationship, and particularly in therapy. Obviously. If you’re getting into the gory details of your life, tackling issues long left untouched and signing on to make big changes in your life, you’ve got to trust your therapist. Too often this is seen as solely a matter of credentials. A therapist has a degree and a license and looks the part and talks the talk. While none of this is irrelevant, it is simply not sufficient as a basis for trust. No one, no matter where they went to school, or how many times they’ve been quoted in the news should get a free pass. Expertize on why things happen, while a novelty that’s occasionally helpful, isn’t enough.

The post “Trust me, I’m a psychologist” appeared first on Tribeca Therapy.

Do you have a wanting problem?

I think you might. It’s pandemic.

A question of what’s possible from therapy

So, so many of the people I work with at my NYC therapy practice set deep, broad limits on what they imagine they’ll be able to accomplish, in therapy and in life.

Some examples:

• “Anxiety is just a part of my life, and I know I’ll have to live with a lot of it, for a long time.”
• “I don’t have a college degree, so I’m just not going to make that much money.”
• “Sex is just something I’ve given up on.”
• “I’m fat. I’ve accept that’s just a part of who I am.”
• “I’m lazy.”
• “Depression runs in my family, so it’s something I have to live with.”

What strikes me about these assumptions is that they are so deeply held, so much so that they’re rarely recognized as assumptions; they’re simply seen as “just the way things are,” like gravity or taxes.

Where does this wanting problem come from?

Most people are pretty cynical about making our lives better and getting emotional help. For many, the limits placed on them in regard to what might be possible for them to achieve are staggering. People believe they’re going to stay fat because they’re surrounded by diets scam diets and unclear directions on how to lose weight. People believe they’re less-than, incapable, destined for a life without accomplishment, and deserving of little because they’ve been told that–by parents, teachers, and portrayals in the media of people who look like them.

Others have inherited a set of beliefs about the moral downside of excessive wanting. To want, it seems, is greedy, selfish or unrealistic. At times this is reinforced by religion, though growing up poor or experience a difficult process of immigration (or having parents who’ve had these experiences) can also reinforce these beliefs.

In a period where there is very little, materially, wanting is pointless or even risky. It makes sense to quiet our wants. Too often, though, the suspension of wanting long outlives these periods of scarcity.

In therapy, you might get all the help you asked for

Which is to say not much.

Even in such a therapy-friendly town as New York therapy doesn’t exactly have a great reputation for success. The old story of the therapist who charges a fortune, sits back and listens while taking vigorous notes (or not) and occasionally tells you what’s wrong with you (or your mother) comes from somewhere: it’s sadly the experience of therapy that many New Yorkers have had.

And yet in New York so many still go to therapy, even with these low-expectations in tow. Perhaps I’ll feel a little less depressed, or get some tools to cope a bit better with my anxiety.

It doesn’t occur to most people I encounter that they might, with good help and tons of work, get rid of depression! Many don’t bother to ask for help to create a life without anxiety! Few people consider that maybe they could go after their bosses job, make more money, write a book, live bigger (or slimmer around the waist).

Be needy. Be want-y. Be greedy.

Be needy: Let it be known to those around you, your therapist, your friends, your family what it is you need to make your life work, to feel better and to grow. They have every right to say no, but without asking for you what you need, it’s not likely gonna happen.

There’s a lot of fear out there around seeming “too needy.” It’s grounded in a scam. Human beings have needs. Lots of them. And we are a fundamental social species, which means we need one another to get those needs met.

Be want-y: Why stop at needs? For most people reading this, there’s plenty of room to go beyond needs. Being wanting of the world, and of other people is a gift. It allows you to give more and get more from the world.

Be greedy: I want an awful lot, and I’m not even a little bit ashamed to say it. I also want a lot for the people I care about, especially the people I work with in therapy. I want them to grow, to live a life unburdened by anxiety, depression, fear and stress.

I want them to want more.

The post Wanting more from your therapy (and your life) appeared first on Tribeca Therapy.

Ok, I hate the word therapy. Or, more to the point, I hate the word therapy as a word to describe what I do.

How come?

I hadn’t looked up therapy until just this moment, but it’s always smelled of illness to me. When I hear “therapy” I think less about the coming together of two or more people than I do of sickness and disorder. I think of words like chemotherapy and phrases like intensive reparative therapy.

Looking up the etymology brings this sense of therapy into focus: From 1846, we see the word therapy defined simply as “the medical treatment of disease.”

How about psychotherapy?

That’s even worse! Psycho historically means simply the “whole of the human mind” (thus its root in the discipline psychology, meaning the study of the mind). Sure. But for the last 50 years or so “psycho” has come to be a stand in for crazy–and not “ha, ha, my sunglasses have been on my head the whole time” crazy, but rather “that guy’s looking at me like he wants to eat my liver” crazy.

Kidding aside, the pairing of the prefix psycho with the word therapy, whatever their historical origins, seems to suggest “getting your crazy self fixed.”

Two histories of therapy

A clinical history:

Psychotherapy has its origins in the treatment of psychopathology. Traditionally the subjects of this treatment were “the mentally ill.” If this evokes images of ice baths, leather restraints and Victorian-era insane asylums, you’re not far off. Critically, this work was done entirely under the guidance of doctors. Mental illness wasn’t differentiated all that much from other sorts of illness. The disruptions these patients suffered were extreme and assumed to be the products of the same sorts of physical dysfunctions that cause other sorts of illnesses.

Medicine invented all sorts of responses to these disorders. Many of them were barbaric and altogether unhelpful (I wasn’t joking about the ice baths; lobotomies did considerably more damage) while others provided some relief, even with the expense of serious side-effects (anti-psychotics have evolved considerably, but all of them still cause distressing side-effects for most users).

Talk therapy (as it’s referred to to contrast it with medical therapy for “mental illness”) began with Freud, its most famous practitioner. Freud’s breakthrough was the discovery that there were ways of easing emotional suffering other than the medical (i.e. drug) interventions employed thus far by doctors. Thus Freud invented an entirely new sort of therapy–psychotherapy–differentiated from medical or physical therapy. (Freud’s particular approach to therapy is called psychoanalysis, but in employing talk as the method of treatment he invented the entire category of psychotherapy, which includes modalities that aren’t necessarily psychoanalytic, i.e. “Freudian.” In this sense even therapists who aren’t Freudian owe a great debt to Freud.)

A socio-cultural history

From the vantage point of medicine, that Freud’s “talk therapy” worked (and it most certainly did) was a profound revelation that changed the way we think about our mental/ emotional lives (in domains far beyond the field of psychology).

But from the vantage point of human history, the idea that we could engage in a particular sort of talk that could make our lives better and help us feel better is pretty ordinary. From the dawn of history (it seems pretty clear) human beings have helped improve one anothers’ lives through verbal discourse.

Freud was hardly the first professional to formalize this tradition. Variably through history and across cultures we have called such professionals priests, mentors, mothers, fathers, friends, cousins, psychics, teachers, spiritual advisers, soothsayers, medicine men (so named by Westerners) and (yes) doctors (who have always provided help of the verbal variety).

The fundamental activity employed by Freud (using talk to improve the lives of people who came to him for help) wasn’t at all new. The revolution Freud started was the legitimizing of talk as an acceptably scientific approach to be considered good medical practice.

Talk therapy needed this formalizing. It allowed a profession to form (initially psychiatry, but later clinical psychology and psychotherapy), which created a financial incentive in its practice. It also legitimized the suffering of those historically thought of as weak-willed or even possessed by evil spirits. The groundwork was laid for mental anguish to be validated as legitimate suffering alongside physical anguish. It became worthy of formal study. Much later this foundation lead to mental health parity laws which require insurers to cover mental health treatment on a level equal to that of other kinds of health care.

The consequences

Validating and formalizing the practice of talk therapy, and bringing it into the domain of medicine was a double-edged sword. On the one hand, stigma was reduced, the work was taken seriously and money flowed in ways that helped bring innovation and services to those who were suffering.

On the other hand, in the process of gaining legitimacy, talk therapy gave up an awful lot. Everything under its ever-expanding domain (the DSM, the psychiatric manual that defines all mental disorders, has increased in size dramatically with every addition, with more recent inclusions such as “adjustment disorder”) is seen in light of the language of medicine.

This necessarily means that all emotional suffering, in order to be granted the status of medical legitimacy, must be understood within the conception of the disease model, which has been the formulation of medicine since it became a formal discipline. Put simply, the disease model insists that at the root of all suffering is some sort of disease or disorder. (For e.g., chronic headaches can have a number of causes, but there is a cause, and that cause is a malfunction in the body.) The practice of medicine employs diagnostics (identifying the source of the disease or disorder) and the execution of a treatment (also known as therapy–ah, hem!) according to the prevailing medical standard.

As mental suffering moved under the domain of medicine, this disease-model understanding of it became heavily privileged, not just by professionals but in the eyes of most everyone; when we experience mental suffering, when we find ourselves in emotional pain, we assume that there is a “root cause”–some sort of dysfunction at the root of it–that needs treatment (i.e. therapy).

Or, in other words, something’s broken that needs fixing.

And gone are…

…all sorts of other ways of conceptualizing what’s happening when we’re in emotional pain. Sure, the wisdom of your grandfather or your priest is valid, but what’s “really going on” can only be “legitimately” understood within the framework of what’s included in the latest edition of the DSM.

The pain is real, my friend

Oh, yes. Very real. Emotional suffering is all too real. And, it must be stated clearly: Many, many people get all kinds of help from therapy grounded in a conception of disease.

It would even be wrong to say that we don’t employ this conception of therapy in our work at TriBeCa Therapy. Sometimes it is of great help to investigate suffering through the cause-and-effect lens of disease and cure. But often (quite often) that framework falls short.

One of the guiding principles of creativity is that of keeping as many options open as possible. When people come to us for therapy who’ve been suffering for some time, they’ve generally tried all kids of things to get help. They’re stuck! And when you’re stuck, you need to get creative, which is supported best by keeping LOTS of options open.

This means exploring non-disease oriented ways of seeing what’s wrong. Can we understand what’s happening through a cultural or even spiritual lens? Is there a learning issue that can be addressed to create the sort of growth we’re looking for (learning how to build relationships, learning how to get a better job)? Does this suffering necessarily reside in you (is it perhaps in the world, or better understood as grounded in your relationships?)? Is the search for a “cause” of this suffering the only way to fix it?

Yes, emotional pain is real. There’s much to much of it. The invention of psychotherapy has done a tremendous amount towards curing this problem. Freud and those who’ve come after him were pioneers in bringing legitimacy to the age-old practice of talk-as-cure. In the bargain, however, we’ve closed off creative possibilities. We’ve insisted that those who are suffering first buy into the notion that there is something wrong with them that needs to be fixed. It’s time we move beyond “therapy.”

So, what are you going to call it?

I’m going to keep calling it therapy. Why? Because whether I like it or not, therapy is what we’ve come to call the activity of employing a professional to sit with us and use the medium of talk to make our lives better.

What I’m going to DO however is far more to the point. I’m going to work to challenge conceptions of what emotional help can look like. I’m going to help my therapy clients be as creative as they can be in tackling their emotional pain. I’m going to continue to write about the importance of valuing culturally-grounded approaches to therapy.

It doesn’t really matter whether I like the word therapy or not. What matters is creating new ways of helping people grow.

The post I hate therapy (and don’t even get me started on psychotherapy) appeared first on Tribeca Therapy.

Resentment comes up a lot in my work as a therapist here in New York City. I suspect it’s a frequent topic in therapy everywhere. It was also a frequent topic of the sermons at the Presbyterian church where I spent most Sunday mornings as a child. While the faces of the ministers changed over time, the message around resentment remained consistent. It was bad, and ought to be avoided.

How it was to be avoided was left to interpretation, but the implication seemed to be that one ought do this stoically. Which is to say that we ought find a way to garner the strength to forgive our trespassers. In my extensive experience with Presbyterians, at least through the first half of my life, I’ve concluded that Presbyterians, along with most of us, are far better at asserting resentments’ shortcomings than actually giving them up.

The principle (resentment = bad) leaves us wanting for strategy. Stoicism rarely works. Why? Because we’d have to be superman or superwoman. Resentment is a powerful beast, and the only way to beat it is to destroy it before it comes into being.

Beat the grudge before it starts

Our challenge is to keep a grudge from forming before it starts. How?

1. Ask for what you need.

Most people are pretty shy about making their needs and wants known, yet we are quick to be disappointed or even victimized when we don’t get what we want. Being wanting, and making those wants clear may seem bossy, but it’s the best way to prevent resentment down the line, which makes it a pretty virtuous thing to do.

2. Make your limits clear. Say no.

Just as we don’t often ask for what we need or want, we are often slow to say no, if at all. In strong relationships, both parties ask freely for what they need and feel empowered to say no. If you’re not willing to do something but agree to do it anyway, you’re on the express train towards a grudge.

3. “Fool me once, shame on you, fool me twice…

…shame on me.” When people let you know who they are, take note. If someone rarely pays back a loan, is unreliable or consistently hurts your feelings, you need to allow the realization of those facts to inform the nature of your relationship ongoing. If your friend has let one of your secrets slip yet again, perhaps it’s time to stop sharing secrets with her.

4. I’m the one responsible for making sure I’m not taken advantage of.

Be vigilant. Think carefully before going along with any offers that are too good to be true. Plan ahead so there’s a Plan B if someone you’re counting on drops the ball. More than anything, keep site of that fact that you are in charge of your health, safety and welfare.

That doesn’t mean you have to go it alone. In fact, leaning on other people for support, asking for guidance or help when needed is a good policy. But recognize that seeking out that help, making sure it exists on terms that work for you and striving to make the help as effective as possible are responsibilities you have. When we place weight on other people as responsible for taking care of our lives, we’re setting ourselves up for resentment.

5. Drop the I-can’t-believe-you would-do-such-a-thing! fiction.

Believe it: Your husband bought the scented laundry detergent. Your sister didn’t call you on your birthday (just like last year, and the last 6 years before that). When we assert that we “can’t believe it,” we’re usually kidding ourselves into a willful naivete. What just happened actually happened. Often it’s happened before. Take a moment to be honest with yourself. Accept it.

Are you into grudges?

I know at least a few people who are. All of us probably have at least some pull towards hanging out in a grudge. In situations where we don’t feel very powerful, a grudge can be among a rare set of circumstances where we can. If you’ve been wronged then you get to be mad about that, and take that anger out on those around you–not the least of which is the person who’s done the wronging.

I find that many people who come to me for therapy hold resentments of people they haven’t seen in years or who’ve passed away. Grudges can last for decades and cause tremendous pain on the grudge holder as well as the object of the grudge.

We trick ourselves when we believe that resentments makes us powerful. In truth, they hurt relationships and they incite us to be hurtful in response (which builds–guess what?–more resentment).

When we’re honest and up front about what we need, set clear limits on what we’re wiling and unwilling to do and take ultimate responsibility for getting our needs met, we executing the best possible grudge-elimination plan: prevention.

The post Lose the grudge appeared first on Tribeca Therapy.

If you live in NYC, finding a therapist is easy. Finding a good therapist in New York is a bit trickier.

Perhaps you’re a New Yorker who feels like he or she really needs to find a therapist who’s in-network with your insurance plan (I don’t recommend it, but not everyone follows that advice). Maybe you don’t have insurance and have found poor low-fee or sliding-scale options. Maybe you don’t live in NYC and your options for therapy are limited. Finding a great fit is important and you should be picky, but you might not always have great options.

Bad therapy is bad therapy. If you don’t feel a good vibe with therapist, you don’t feel like you’re being heard, or there’s something creepy going on, head for the door. But if the therapy is so-so it doesn’t mean you’re destined to get so-so help. Even when your therapist doesn’t seem to provide the sort of leadership you feel is helpful, you can work to make the therapy helpful by providing some leadership of your own.

At TriBeCa Therapy we work to provide excellent, high-quality therapy. Part of why we believe our work is effective is that we build the therapy with you, as a co-collaborator. This means that both you and your Tribeca Therapy therapist will be responsible for the success of the work.

Get active in therapy!

When you take an active posture to anything, not just therapy, you make it better. The truth is, we’re trained to be passive, especially around those we perceive to be in authority. School is intense training for this sort of attitude. In most corners of education, at nearly all levels, our job is to show up and spend our time in class doing whatever the teacher tells us to do. If the teacher’s good, we learn; if she isn’t, we don’t.

Television trains us in a similar way. What happens on TV is wholly beyond our control. We can change the channel (just as we can leave a bad therapist) but that’s the end of our say.

In most of life, and certainly in therapy, we actually have a tremendous amount of control. You are a central character in the teleplay that is your therapy session, but you’re also the co-director, the co-producer and the sole financier of the project. Sure, there’s a distribution of labor, as there is on any collaborative project; you don’t get to pick the curtains or decide on the length of the sessions. But there’s a tremendous amount you get to decide or at least have a serious say in.

If the therapist wins, you win

Asking your therapist, in a variety of ways, how you can help make the therapy better can help you stay on the same page and the same side as your therapist. In good therapy, a therapist will give this sort of direction all the time, but perhaps an inexperienced therapist may not know to do so.

Be a tough customer

There are no bonus point for making your therapist feel good. Being active in the therapy doesn’t mean your job is to make your therapist feel like he’s always doing good work, for the sake of his ego. Yes, when things are working, be sure to make that clear. But pretending something that isn’t working is working is a bad plan.

Be demanding

In mediocre therapy, your therapist may not give you great guidance in helping you discover what you want help with. While from a distance this may seem a surprising problem (Why would someone go to therapy without knowing what she wants?) but wanting, asking for a lot (from the therapy and from life) is not often a given. In my experience as a therapist, most people set their expectations far too low.

The result? They miss out on a critical part of great therapy: being challenged to look at the implicit limits we’ve placed on what we might be able to build and problems we might be able to move past. Far too many people arrive in therapy assuming they’ll simply have to live with a certain about of panic, or believing they couldn’t possibly have a great relationship, or change careers.  If those issues are left unexplored, you might get all the help you’ve asked for, which might not be very much.

Ask for directions

Great therapists give directions. They know how to create an environment where their clients get to work, in and out of the therapy session. In so-so therapy, you might need to take the lead. Consider asking:

• How do you think I can get the most help from being in therapy with you?
• Can you recommend any homework assignments?
• What do the patients who get the most help from you have in common?
• Are there other things I can try to make [symptom x] get better?

Do the work

A huge assumption that so many people bring to therapy is that going to therapy makes our lives better. This is no more true than the belief that going to the gym is what gets your body in shape. Therapy is work. Being a tough customer, asking for a lot from the therapy and from yourself, and making sure you stick to the program in and out of the therapy session is the recipe for growing emotionally, even when the therapy isn’t perfect.

The post How to get good help from mediocre therapy appeared first on Tribeca Therapy.

Q: How come the rents are so high in New York City?

A: Because of all the people who want to live there.

We are here in NYC because of all of the people, the  jobs, the opportunities to date and build friendships, to experience culture. And yet for most people in NYC their therapy seems not to have noticed.

Our sociality is so fundamental to who we are as to be beyond question. Consider whatever it is you last ate. Whether it was a dish at a restaurant or a packaged meal from the supermarket, literally thousands of people worked to bring the various components together, design the packaging, market the product or restaurant, deliver the ingredients.

Consider your emotional life. Think about the last time you were overcome with joy. Or the last time you were devastated by a sad event. Who else was there? Chances are you were surrounded with other people who were much more than incidental to the significance of those events.

Now consider this: Do a quick Google image search for the word psychology. What you see is a page filled almost entirely with colorful images of brains.

It’s not a subtle image

The statement is pretty clear: Psychology is about YOU, the solitary individual. Sure, we’re interested in other people and social relationships, but only from the vantage point of how they effect and interact with you, your mind, your brain.

“It’s what’s inside that counts”

Or so we’re told. You’ve heard that a million times before. You’ve heard it in therapy, you’ve heard it on TV. But give it a second glance. Doesn’t that sound pretty… selfish? Doesn’t that notion seem at odds with who we actually are as human beings?

Maybe what’s on the outside counts, too

Other people are on the “outside.” In fact, so very much of what matters is on the outside. Or…

…maybe the whole inside/ outside thing needs another look

If we take a pile of all the component parts that make up your computer, you’d have an interesting assortment of technology, but you wouldn’t have a computer. The parts matter, to be sure. They’re essential to what makes a computer a computer, but it’s equally essential how those parts are put together. Or, more simply, that those parts are put together.

It’s just as much the case for us as humans. We can’t be understood separate from our relationships with one another. To do so quite literally distorts who we are, in just the same way that trying to understand a computer without taking in the ways the various parts are put together distorts what it is to be a computer.

What are the implications for therapy?

The inside/ outside dichotomy, commonly referred to by philosophers and social scientists as dualism, is one of the central tenets of modernism. Descartes more or less kicked this tradition off with his Meditations on First Philosophy, which was first published in…

…1641.

In Latin!

It’s old, people.

Freud is of this modernist tradition. As are the behaviorists such as Skinner and Pavlov. The two sub-divisions of psychology that these camps represent (psychoanalysis in the case of Freud, behaviorism in the case of Skinner and Pavlov) have informed almost all of the therapy you’re likely to encounter in NYC.

We’ve done some great philosophy since 1641. And there have been profound conceptual transformations in the field of psychology as well. Most of these are of the sort that challenge the idea of there being an internal you that relates to an external other. The field of post-modern psychology is thriving. Around the world are pockets of innovators who are working to create therapies based on a we rather than on an me/you paradigm.

Updating your therapy

Great therapy accepts that we live our lives in the we. The emotional pain you experience, whether it’s related to depression, or and anxiety, or takes some other shape can’t be understood as a phenomenon that’s merely happening to you. That pain, and those emotional experiences that you bring into the therapy office, must be understood as existing within the various relationships you have in your life–to your friends and loved ones, with your coworkers, and with the world.

Breaking boundaries

One of the principles of the practice of therapy is the notion of boundaries. The idea is that the patient and the therapist must stay very separate. Having “good boundaries” in therapy means that the therapist never talks about herlelf and that she keeps her affective responses to her patients’ to a minimum. The subject of the work, as implied by this practice, is the patient as discrete individual. The relationship with the therapist, insomuch as it’s a topic of the work at all, casts the therapist as a “blank slate,” a neutral party on which the patient “projects” his or her internal states.

If we recast our understanding of human life, and update our therapy to match this recasting, then the institution of boundaries must break in favor of a therapeutic relationship that is a real relationship.

So, group therapy?

Yep. But here’s a twist: Even so-called “individual therapy,” if upgraded to include an appreciation of just how social a species we are, can be seen as group therapy–i.e. a small group of two. At TriBeCa Therapy we love group therapy because it brings so many relationships into the therapy room. In a sense, by bringing more people together the therapy becomes even more social.

If you’re looking to start therapy, or considering making a change, consider this question: Where’s the we?

The post We are a social species. Maybe our therapy should start looking like it. appeared first on Tribeca Therapy.

As a therapy center in the heart of New York City that offers several options for group therapy, we get a lot of calls from prospective therapy patients asking if we offer support groups.

Nope. No way. Why? Because we don’t believe in the premise.

There are a lot of modalities of therapy and counseling we’re into, and we love group therapy. But the assumption of a support group is that the thing you’re struggling with (anxiety, depression, PTSD) is something you’ll just have to live with, so it’s good to get support to help along the way.

Maybe that seems unfair. But hear me out: People call me all the time looking for various sorts of help. I ask questions about what they’re struggling with, what kinds of help they’ve tried in the past and with what level of success. I’m interested in getting to know what’s happening with them, but also in understanding how they’ve come to understand those issues. So very often (too often) what becomes clear is a deep resignation to the problem just being there, fixed, as part of life. What they’re looking for isn’t so much help to get over their anxiety or depression, but help to cope with it.

And that’s exactly what I’m not interested in doing.

Your depression doesn’t need any extra help

Depression (and anxiety, and trauma, etc.) are plenty powerful, thank you. Of course no one involved in running a support group (and they’re also often self-run) wants to make the pain you’re experiencing worse, but that’s often exactly what’s happening. Why? Because they’re giving that pain support.

Huh?

That’s what “support group” means. You’re dealing with a painful thing and this group will help you cope better with that painful thing.

Okay, smart guy, so what do you guys do?

Emotional pain has this funny way of making us cozy up and get comfortable with it. That pain is what we’ve known for so long. We’ve learned to make friends with it. It’s when it gets less comfortable to deal with, in fact, that we’re liable to reach out for help.

The last thing I want to do is help you get (more) comfortable!

Sorry about that. Making dramatic, powerful changes in your life necessarily means getting uncomfortable. Great therapy for anxiety and great therapy for depression (trauma, pain) demand that the pain, the bad habits, and the isolation need to be pried loose from our bodies and from our lives.

Supportive groups, not support groups

Therapy groups are fundamentally supportive. That’s a given. They’re a place to talk about the rough times and share your struggles with sympathetic crowd. They also need to be genuinely challenging places. A premise of all good therapy needs to be that it’s unacceptable for you to continue to live in pain, feeling small and cut off from living your life fully. The group needs to challenge you make serious changes, not help you get more comfortable with where you’re at.

Groups help us examine the ways we’re living our lives that keep us in pain. They push us to take the risks of getting closer to people, developing new habits, learning new emotional performances to the end of making our lives bigger and better.

It’s about wanting more

You can do better than coping. Depression and anxiety are powerful forces, but you simply don’t have to live with them. Consider what it means to create places in your life where you can get help not just to cope, but to obliterate depression and anxiety! Look beyond support.

The post No, we don’t offer support groups at TriBeCa Therapy appeared first on Tribeca Therapy.

Wherever I wander in New York City, people make a lot of assumptions about me as a therapist. People figure I’m psychoanalyzing them (I’m not–I don’t even do that in the therapy room). They wonder how I can “handle listening to people’s problems all day” and they nearly universally figure I must be a good listener.

Maybe I am a good listener. Okay, I am; any therapist should be. But the assumption bugs me. I don’t think of what I do as a therapist as being about, well, listening. Not at all.

If that brings to mind the image of me sitting in my downtown Manhattan therapy office staring past my therapy patients, ignoring their every utterance, that’s not the image I mean to convey. I listen in the most fundamental sense. I listen very well, thank you, but what I do, or, more importantly, what my therapy patients and I do together is create conversations together.

To me, this distinction is as fundamental to understanding how I see psychotherapy as anything I’ve ever discussed.

Enough with the listening talk!

If I see another “inspirational” blog post or TED talk about the virtues of listening I’m going to vomit!  There’s this one on the “5 ways to listen better,” this one on listening as part of leadership, and this one on how to truly listen.

I can’t take it anymore!

I’m not proposing we all start ignoring each other, or that we ignore the fact that we’re not doing such a great job at building conversations with one another; discourse, both public and private, is in a sorry state and in need of much improvement.

My argument, however, is that what isn’t needed is more talk about listening.

How come? I can explain it best with an example:

You and your buddy decide to toss around the football in the backyard. Your buddy digs out the old Nerf from behind the jumper cables in his trunk, and you take a short jog to the other end of the yard. Your buddy tosses the ball–a neat spiral. You catch it, and then stand there holding the ball and exclaim, “Great pass!” followed by a list of all the attributes of the pass. You toss it back and your buddy does the same thing: “Wow! Great pass! I really like how you got such great lift under it!” You and your buddy really work to show your appreciation of one anothers’ passing choices and technique, carefully observing the others’ form, taking note, in detail, of the execution of each and every pass.

And then you do that again.

And again.

And again.

This sounds nuts, of course, but it’s not far off from what so many of the listening advocates seem to propose we work at to become better listeners.

How about a paradigm shift?

This almost surely sounds pompous. But hear me out: Most of us look at the functions that go into communication between two people as the interaction of two entirely discrete parts. Person A expresses a sentiment that is received and interpreted by Person B, who then “responds” by expressing a sentiment of her own, informed to some degree by the sentiment of Person A.

Here’s the paradigm shift: I’d like to argue that that isn’t the only way to understand what’s happening in a conversation. What if we introduce the concept of a conversation as something generated by the relationship, rather than by its participants as separate parts? What if we examine what happens in the course of a rich conversation in a way that accepts that we couldn’t possibly dissect it, as with a scalpel, into two pieces, each representing the contributions of each participant in the conversation? What if we simply assigned ownership of the conversation, as a whole, to the relationship, without any further separation?

In a sense the paradigm shift is away from focusing on the individual parts and more on the relationship as an entity in itself.

I would argue that such a separation dramatically changes how we value the sort of attitude we should bring to conversations in a way that renders much of the talk about listening meaningless. Why? Because listening implies honoring the contributions of the other as separate from ourselves. It relates to what the other person is saying as a unit of meaning that must be received and processed, rather than as a shared contribution to a collaborative task. Just as in the “catch” analogy, listening focuses much too much on the separation between the conversants and far too little on the conversation.

Consider the wisdom of listening talk

One of the cherished principles we’re charged with is active listening: Make the other party “feel heard.” Strategies include nodding, repeating back key phrases in summary form, and mirroring the other person’s body language and facial expressions.

This sort of rhetoric is so cherished, and so ubiquitous that it’s hard to imagine challenging it. But if we slow down and consider a conversation not as the interaction of two parts but as something created by a we then these sorts of suggestions start to seem stultifying and even patronizing. Exercising them may well be considered good manners, and may sometimes even make your conversation partner feel good, but it doesn’t do much in the service of creating together.

Creating, not having conversations

Many of these TED talkers pontificate on the global wisdom of doing more listening. Getting better at listening to others, they argue, can reduce conflict not just in personal relationships but can even do so on a global scale.

To me, this makes a huge assumption that misses the point. In building relationships, especially when conflict emerges (or where conflict has existed for some time, which is too often the case in issues of international relations) it isn’t listening that we need to work for. We need to build relationships with one another. We need to sit with our friends and loved ones, and with those with whom we have conflict, and build new sorts of things together. We need to build new types of relationships, new kinds of treaties and partnerships, and even new kinds of nations. We need to do all kinds of things together that listening doesn’t begin to touch.

What do I do instead of listen?

Stop using those “techniques,” for starters. They’re patronizing, they feel forced and artificial, and they keep you separate from your conversation partner from the beginning.

Consider these steps:

1. Work to be in conversations where you’re open to going new places. When we set about creating with someone else, it’s impossible to know where thing will go. You might end up talking about something you’ve never thought about before.

2. Resist the pull to be passive. Find ways of including you in the conversation. Does that mean drowning out your conversation partner? Of course not. But if you’re focused on “making sure she feels heard” you’re keeping your own voice out of the picture as well, and that’s not any nicer.

3. Great conversations are chocked full of curiosity, which is a seriously challenging activity. Curiosity demands asking questions about the most uncomfortable things our conversation partner raises, and asking them in ways where we’re genuinely suspending a belief that we know the answer ahead of time.

4. Don’t throw out disagreeing. It’s often the best part, and it’s a fact of who we are. Agreement, as it turns out, isn’t a pre-condition of building at all (in fact, if you agree there may not be much to talk about).

We’ve got a lot to build in the world, much of it involving new kinds of stronger, more decent relationships. How are we going to get there? Don’t just listen, create a conversation.

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