The Goal of Therapy

Question:

After much self work and therapy it is apparent that I suffered some type of traumatic abuse while a young child. My therapist and I have tried regression hypnosis and I just won’t reveal those memories. All I do is cry. That part of me is just a black hole. I function reasonably well as a wife, mother, and employee but it takes a tremendous amount of energy to manage my deep seated rage. My therapist seems to think my inability to remember is related to my firm belief that safety is an illusion and I can never truly be safe. My questions is, should I just trust my defense mechanisms and stop trying to dig out these memories? I’ve been functioning with my anger and depression for almost 40 years. Should I just settle for this level of normalcy and be grateful that I’ve made it this far?

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Answer:

There are many different ideas about how therapy is supposed to work. One of them that is quite widespread goes something like this: Long ago you were damaged by the world. A dragon came to live within your heart and head and its poison infected the rest of your life. In order to help you recapture your vitality and innocence again it will be necessary to dive down into the muck of your heart and head, do battle with the dragon, and conquer it. Only then will you be healed. This is a vision of therapy as enacted myth – you get to be the hero or heroine who does the battles and is rewarded at the end. This is a beautiful vision I think. Only problem with it is that it is not the only good vision of therapy out there. Sometimes it is the wrong vision for the problem at hand. I think that might be the case here.

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p>It is just not always helpful to go exploring in the depths of the psyche. A good and proper alternative goal is to help you adapt and cope with your moods, thoughts and relationships with others. There is a need to help you to deal with your rage. An outward focus (rather than an inward one) might be more helpful. Work with your therapist to manage your depression and anger in the present (or find another therapist who will work with you on these issues) and don’t feel you need to remember everything. Consider going forward into your present life rather than backwards into your past.

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Psychology of Anger

  1. Anger, Thoughts,
  2. Anger: A Substitute Emotion
  3. Defining Anger
  4. Benefits and Costs of Anger: Social, Emotional, and Health

Introduction

Anger is a natural and mostly automatic response to pain of one form or another (physical or emotional). Anger can occur when people don’t feel well, feel rejected, feel threatened, or experience some loss.The type of pain does not matter; the important thing is that the pain experienced is unpleasant. Because anger never occurs in isolation but rather is necessarily preceded by pain feelings, it is often characterized as a ”secondhand”emotion.

Introduction

Anger, Thoughts, & Social Behavior

  • Pain alone is not enough to cause anger. Anger occurs when pain is combined with some anger-triggering thought.
  • Thoughts that can trigger anger include personal assessments, assumptions, evaluations, orinterpretations of situations that makes people think that someone else is attempting (consciously or not) to hurt them.

In this sense, anger is a social emotion; You always have a target that your anger is directed against (even if that target is yourself). Feelings of pain, combined with anger-triggering thoughts motivate you to take action, face threats and defend yourself by striking out against the target you think is causing you pain.


Anger: A Substitute Emotion

  • Anger can also be a substitute emotion. By this we mean that sometimes people make themselves angry so that they don’t have to feel pain. People change their feelings of pain into anger because it feels better to be angry than it does to be in pain. This changing of pain into anger may be done consciously or unconsciously.
  • Being angry rather than simply in pain has a number of advantages, primarily among them distraction. People in pain generally think about their pain. However, angry people think about harming those who have caused pain. Part of the transmutation of pain into anger involves an attention shift – from self-focus to other-focus.
  • Anger thus temporarily protects people from having to recognize and deal with their painful real feelings; you get to worry about getting back at the people you’re angry with instead. Making yourself angry can help you to hide the reality that you find a situation frightening or that you feel vulnerable.
  • In addition to providing a good smoke screen for feelings of vulnerability, becoming angry also creates a feeling of righteousness, power and moral superiority that is not present when someone is merely in pain. When you are angry, you are angry with cause. “The people who have hurt me are wrong – they should be punished” is the common refrain. It is very rare that someone will get angry with someone they do not think has harmed them in some significant fashion.

Defining Anger

The definition of whether someone’s anger is a problem often turns on whether or not other people agree with them that their anger, and the actions they take in the name of their anger, is justified.

Angry people most always feel that their anger is justified. However, other people don’t always agree. The social judgment of anger creates real consequences for the angry person. An angry person may feel justified in committing an angry, aggressive action, but if a judge or jury of peers do not see it that way, that angry person may still go to jail. If a boss doesn’t agree that anger expressed towards a customer is justified, a job may still be lost. If a spouse doesn’t agree that anger was justified, a marriage may have problems.


Benefits and Costs of Anger: Social, Emotional, and Health

Whether justified or unjustified, the seductive feeling of righteousness associated with anger offers a powerful temporary boost to self-esteem.

  • It is more satisfying to feel angry than to acknowledge the painful feelings associated with vulnerability.
  • You can use anger to convert feelings of vulnerability and helplessness into feelings of control and power.
  • Some people develop an unconscious habit of transforming almost all of their vulnerable feelings into anger so they can avoid having to deal with them.

Man having a seizureThe problem becomes that even when anger distracts you from the fact that you feel vulnerable, you still at some levelfeel vulnerable.

  • Anger cannot make pain disappear – it only distracts you from it.
  • Anger generally does not resolve or address the problems that made you feel fearful or vulnerable in the first place, and it can create new problems, including social and health issues.
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What is anger

Anger is a basic human emotion that is experienced by all people. Typically triggered by an emotional hurt, anger is usually experienced as an unpleasant feeling that occurs when we think we have been injured, mistreated, opposed in our long-held views, or when we are faced with obstacles that keep us from attaining personal goals.

The experience of anger varies widely; how often anger occurs, how intensely it is felt, and how long it lasts are different for each person. People also vary in how easily they get angry (their anger threshold), as well as how comfortable they are with feeling angry. Some people are always getting angry while others seldom feel angry. Some people are very aware of their anger, while others fail to recognize anger when it occurs. Some experts suggest that the average adult gets angry about once a day and annoyed or peeved about three times a day. Other anger management experts suggest that getting angry fifteen times a day is more likely a realistic average. Regardless of how often we actually experience anger, it is a common and unavoidable emotion.

Anger can be constructive or destructive. When well managed, anger or annoyance has very few detrimental health or interpersonal consequences. At its roots, anger is a signal to you that something in your environment isn’t right. It captures your attention and motivates you to take action to correct that wrong thing. How you end up handling the anger signal has very important consequences for your overall health and welfare, however. When you express anger, your actions trigger others to become defensive and angry too. Blood pressures raises and stress hormones flow. Violence can ensue. You may develop a reputation as a dangerous ‘loose cannon’ whom no one wants to be around.

Out of control anger alienates friends, co-workers and family members. It also has a clear relationship with health problems and early mortality. Hostile, aggressive anger not only increases your risk for an early death, but also your risk for social isolation, which itself is a major risk factor for serious illness and death. These are but two of many reasons why learning to properly manage anger is a good idea.

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Intro To anger Management

The Experience of Anger

Anger is a fundamental emotion that everyoneexperiences from time to time.From a very early age, people learn to express anger by copying the angry behavior they seemodeled around them, and by expressing angry behavior and seeing what they can get away with.

The Experience of Anger

As our culture has an uneasy relationship with anger expression, many people are brought up to think that it is inappropriate to express anger directly; that it must not be tolerated; that it is always dangerous. Such people learn to distrust anger, to bottle it up and ignore it, to express it only in indirect ways or to use it as a weapon.

Healthy Expression of Anger

The idea that anger is dangerous is not without merit. Angry people are capable of great violence.However, while anger can certainly be abused, it is more than a simple destructive force.

Anger is also a critically important part of what might be called the self-preservation and self-defense instincts. People who are incapable of getting angry are also incapable of standing up for themselves. It is important then that people learn how to express anger appropriately. People need to learn healthy and socially respectful ways to express angry feelings, and to not to let anger get out of control to the point where it negatively affects relationships, employability and health.

  • If you are reading this document, there is a good chance that you (or someone you care about) have an anger problem. An anger problemexists when people become dependent on anger as a primary means of expressing themselves; when they inappropriately use anger or the threat of violence as a weapon to get their way.

Effects of Anger

Inappropriate and uncontrolled anger is harmful for both targets of anger and the angry person as well. Inappropriate anger destroys relationships, makes it difficult to hold down a job, and takes a heavy toll on angry people’s physical and emotional health.

Help for anger problems exists in the form of anger management programs which are coordinated interventions designed to help angry people learn and practice methods of bringing their anger under control.


What You’ll Find in This Sectionpointing fingers

This section reviews what is known about anger and anger management.

  • It starts with a discussion of the nature of angerand anger’s effects on people’s social, emotional and physical welfare.
  • Reasons and motivations for pursuing anger management are discussed, and then specifictechniques used in anger management courses are described.
  • The document concludes by describing ways motivated people can use anger management techniques to learn to control their anger so as to protect their health, promote the quality of their relationships and become more socially effective.
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Yoga for Mental Health

Frequent visitors to this website know that I write an advice column, “Ask Dr. Dombeck”. A typical question I tend to see again and again is, “How can I best manage my (condition)?”. Because I strive to be an ethical advice-giver, and because there are severe limitations of information in the online question and answer format, I usually recommend that the writer visit his or her doctor to get an accurate diagnosis of the problem, and then follow the doctor’s treatment recommendations. There is simply no substitute for a face-to-face personal relationship with one’s own physician, psychologist or psychotherapist.

Beyond this necessary ‘stock’ answer, I often try to provide a further pearl or two of wisdom that the writer might consider. Specifically, I tend to recommend activities known to be generally helpful in promoting mental health and peace of mind including socialization, exercise and relaxation. It occurred to me that it is fully possible to get the benefits of all three of these recommendations by performing only a single activity which is called Yoga.

Yoga?

Despite the fact that over the last maybe twenty years, Yoga has gone from a marginal activity to an almost mainstream one here in the West, my impression is that Yoga is still not altogether well understood. Most everyone has heard of Yoga, but not everyone really knows what it involves.

Yoga originated in India several thousand years ago as a system of physical and spiritual practices. It was formalized in the second century BC in the form of the Yoga Sutras, attributed to the scholar Pantanjali. The word ‘Yoga’ means ‘union’ or ‘yoke’ or ‘joining’. Originally, Yoga was (and is in places where it is practiced as such) a method for joining a regular imperfect human being with the divine principle, or God. You could liken it to a form of prayer which serves a similar purpose, only prayer tends to be verbal, while Yoga tends to involve action.

Importantly, the bulk of the religious aspect of Yoga has not traveled to America, probably because it is more esoteric and mystical than the materialist and practical Western mind can easily appreciate. What has successfully traveled to America is a highly developed disciplined system of physical exercise that offers many benefits (physical, social, psychological and ‘spiritual’) to those who practice it. Personally, I see this ‘stripping’ off of the parts of Yoga that Americans can’t easily appreciate as a good thing. While probably regarded as a bit of an abomination by yogis back in India, the secularization of Yoga has made accessible a set of powerful techniques for tangible self-improvement that would otherwise not be available.

American Yoga then is really about one subset of Yoga proper; Hatha Yoga (or the Yoga of physical postures). Hatha Yoga is specifically concerned with the learning of special physical postures which are typically named in imitation of the way animals and structures move. Some examples include ‘cat pose’, ‘downward-facing dog pose’, ‘mountain pose’, ‘boat pose’ and ‘corpse pose’. There are a lot of these postures, and they are harder to get into than they look. Where very basic practice might focus on learning individual poses, more advanced students learn to link different poses together so that they flow into one another gracefully and, in so doing, complement one another. A good example is the ‘Sun Salutation’ posture flow which combines standing, lunging, and arching poses into a graceful flow.

Yoga lends itself to being non-competitive. There are no Yoga teams, and no Yoga trophies to win. There are no Yoga belts to earn. You simply practice Yoga because it is good for you and helps you to feel good while you are practicing it, and you get better at it (more able to do advanced poses) at your own pace. Each posture or pose is designed to one degree or another to help the person performing them to improve their physical strength, their bodily flexibility and range of motion, and their balance. My understanding is that these desirable attributes originally helped spiritually-minded yogis to be healthy enough to not have to worry about bodily pain so as to better concentrate on God. Here in America the same attributes help us to be more physically healthy, to concentrate better, to relax more fully, and to gain greater control over our emotions.

Yoga Benefits For Mental Health

I’m a clinical psychologist by education. When I recommend Yoga as a great practice to take up in order to promote one’s health, I’m thinking more about the mental benefits than the physical ones although both are present. To my mind, Yoga offers the following benefits:

  • Yoga Provides The Health Benefits Of Physical ExercisePsychologists have long known that moderate exercise is good for depression and anxiety. Such exercise can easily be found in Yoga practice. Yoga postures are designed to promote physical strength, flexibility and balance. Anyone who has ever taken a Yoga class will attest that there are cardio/heart benefits to be had; your heart rate is frequently up while performing postures much as it would be if you were performing more conventional exercise. Though Yoga gets your heart rate up and your endorphines pumping, it also provides for many rest periods. These rest periods lend a gentle quality to the conditioning that makes it easier to endure than ‘marathon’ style exercise. You seldom feel as though you can’t go on.

    By emphasizing gentle stretching of the joints and spine, Yoga promotes increased range of motion, and joint health. It helps work out muscular kinks and minor problems that might otherwise lead to back pain or stiffness. In promoting joint and spinal flexibility, Yoga also seems to promote a certain kind of mental freedom; there is a definitive feeling of mental ease and comfort that you experience at the end of a Yoga class that is linked to being free to move muscles that were tight before the class started. It doesn’t always last long, but it is very real and very soothing while it lasts.

    As with any physical workout, Yoga practice concentrates your mind on the physical sensations and on the perfection of the postures. The immersive concentration factor Yoga provides works as a helpful tonic for anxious and obsessional people. The practice of Yoga (or most any other demanding physical exercise) can be a great distraction from worry as it forces the mind to attend to the body and the breathing; the moment.

  • Yoga Promotes Relaxation And Emotional ControlAs much as us mental health types like to emphasize language and verbal expression (or the blunt hammer of Valium) as the best ways of dealing with emotional problems, body-based therapeutic interventions have a role to play too. After all, the ‘stress response that so many anxious and depressed people have problems with begins with the fight or flight reflex – the physical preparation of the body to defend, or flee. Chronic stress has an impact on the body in the form of chronic muscle tension and stiffness, and this very stiffness and tension seems to produce some of the worry and agony that anxious and stressed out persons report.

    Yoga is a very effective stress reduction and relaxation tool. Performance of various postures requires the tensing and stretching and then relaxing of muscle groups and joints, which effectively produces relaxation in much the same way that a massage or Progressive Muscle Relaxation (a technique used by behavioral psychologists) does. Yoga practice also draws attention towards breathing, which produces a meditative and soothing state of mind. Yoga methods for stress reduction and self-soothing are generally cheaper than other professional interventions (Yoga can be done for free if you know what you’re doing, and classes are no more expensive than group psychotherapy prices), pretty much safe, free of side effects, and empowering in comparison to medication alternatives.

    On a more theoretical note: In the last decade, leading therapists have discovered that coupling a self-soothing, relaxation-inducing group of techniques with action oriented (cognitive behavioral) therapy often produces better results for difficult-to-treat patient populations than action-oriented therapies alone. I’m thinking of Linehan’s Dialectical Behavioral Therapy (aimed primarily at Borderline Personality Disorder patients), and Hayes’ Acceptance and Committment Therapy as examples. Yoga techniques promoting relaxation, self-soothing and body awareness skills are a good fit with these newer therapeutic approaches, and might prove helpful in getting impulsive and chaotically driven patients to engage the structured tools and techniques of cognitive therapy that could help them progress.

  • Yoga Provides Structured Social OpportunitiesWith due respect to stereotypes of yogic mystics sitting cross legged in splendid isolation on a mountain top, most Yoga in the west (and I suspect in the east) is done in classrooms. As such, the practice of Yoga on any regular basis becomes a significant social opportunity as much as anything else. You don’t necessarily get to know everyone, or quickly, but if you commit yourself to the practice of Yoga, you’ll soon enough find that you recognize faces in the class, and sooner or later, you end up making friends unless you do something to discourage that from happening. The friendships of our childhood were formed in just such a group crucible, only this one is available to adults. I know I don’t have to mention that participation in social events is a way to combat depressive withdrawal, but I will anyway (grin!).

Not For Everyone

As practiced in the West, Yoga is basically a form of exercise. Many of the things about Yoga that promote mental health can also be gained from other forms of exercise, as Psychologist Kate Hays will tell you. This is important to keep in mind, becuause not every personality will click with Yoga. To my mind, Yoga works best for people who are anxious or depressed or frantic or impulsive or obsessional and who are looking for stress relief, self-soothing and a calm way to get in some gentle exercise. More competitive persons may find Yoga boring, but might derive similar benefits from some other form of exercise more to their liking.

If You’re Thinking About Attending A Yoga Class…

  1. Check With Your Doctor Before AttendingBecause Yoga is a form of exercise, each person contemplating actually signing up for a Yoga course is advised to check with their physician beforehand to make sure they are fit enough to safely participate in such a class. This warning applies double to any person who has a pre-existing medical condition.
  2. Pick The Right Kind Of Yoga ClassThere are as many different sorts of Yoga out there today as there are people teaching it. Some of the Yoga forms are safer and more gentle than others. I’ve personally had very good experiences with Iyengar style, and with Kripalu style Yoga teachers. Be careful around Astanga “Power” Yoga, any Yoga that occurs in a “hot” room, and especially Bikram Yoga as these Yoga forms tend to be very physically demanding. Databases listing classes are available on the Internet in various places, such as this one offered by Yoga Journal

    For your best bet, look for a teacher who has been teaching for a while and who is certified by a national or internationally recognized Yoga school (like the Kripalu Center in Lenox, MA or the Iyengar Foundation). Tell the teacher you are interested in ‘gentle beginners hatha Yoga’.

  3. Be Careful!Like any physical exercise, Yoga can be dangerous if not practiced properly! Although not common, physical injuries can occur if you follow incompetent instruction (e.g., your teacher pushes you to do something improper), or (more commonly) if you push yourself too hard. When practicing Yoga properly, you should push yourself somewhat (so that improvement occurs), but never so hard that you hurt yourself or experience serious pain. Stop what you are doing if it hurts.

A Closing Anecdote

One of the things I like best about my own personal Yoga practice is how it has helped teach me patience. When I first started classes in the Spring of 1997, I was unable to touch my toes. This galled me as many people around me were able to do this. I had a wise teacher named Stella at the time, and I recalled her noticing how I was straining to get to the floor. She talked to me about it one night, telling me that Yoga was more about experiencing where you are now than about where you should be. She told me I should relax because the floor would be there when my body was ready to reach it. Sure enough, a few weeks later it was.

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