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A Psychologist's Thoughts on Clinical Practice, Behavior, and Life

Reducing the Terror of Psychological Symptoms and Length of Treatment

The treatment of a psychological disorder is often long. Yet to paraphrase Freud's comment of a hundred years ago, it would be nice to have a rapid cure for severe medical problems too. But the problems of living do differ. A traumatic event troubling a previously healthy person may require only one to two months of therapy but not those reflecting a lifetime of distress.


For these sufferers it is important to intermittently relate their current (adult) symptoms to the early developmental experiences which produced them, as can result when one lacked a "good enough" parenting. This enables the patient to understand their life, why they repeat their mistakes. It also reduces their fear from believing that anxiety and depression are magical and may invade their consciousness at any time. All symptoms have a logical reason for existing. Learning their unconscious cause reduces the terror they inspire and gives hope.

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Why Your Child is Sometimes Impossible

While all children are sometimes irritating, occasionally they're completely impossible. I've joked with parents that the business office next to mine has a Saturday swap meet where children are exchanged.


But troublesome behavior has meaning since when a child is unhappy they don't spontaneously speak of their distress but instead act difficult. This is why Oppositional Defiant Behavior is the most common mental health diagnosis of children.


When asked to do something by their parent a child will usually comply since they want to grow up, to be an adult. Resistance thus indicates their inability to do what is asked because of illness, exhaustion, emotional upset, or an unspoken reason making sense to them but isn't logical. Then, speaking with the child is more productive than yelling, which should only be done when confronting a potentially dangerous or harmful situation. Otherwise, frequent yelling by a parent will cause warnings that a child should respect to be ignored.

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The Unavoidable Stress of a New Parent

While a child's birth is joyously anticipated, their parents' initial reaction is stress. This, even with a child who is generally considered easy to parent since this pain is both universal and unavoidable.


Beginning at birth, a newborn makes unceasing demands of their parents to become a more effective caretaker. Demands that are critical since a child is dependent on their parents for survival. But the adult mind is conservative and resists the rapid personality change that is needed. This clashing of demands and wills creates parental stress but, slowly, a melding of the needs of both.


An added stress is that a newborn is inserted into an ongoing (family) social system that has developed over time, and must now transform itself to incorporate this unselected newcomer.

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Pentagon Police Officer Killed or, Dangerous With Any Bail

The recent murder of a Pentagon police officer was made more shocking upon learning the prior behavior of his killer. In April, twenty-seven-year old Austin W, Lanz was arrested for trespassing and burglary after breaking into a neighbor's home where security cameras recorded him leaving inappropriate pictures and messages in their mailbox. He took nothing but spoke of police aircraft flying over the neighborhood and his phone being tracked.

 

While being booked into jail and without provocation, he attacked and seriously injured two sheriff's deputies, then asked that his restraints be removed so he could fight the deputies one-by-one. After being charged with aggravated battery on police, making a terrorist threat, and rioting in a penal institution, he was released on $30,000 bail, ordered to submit to a mental health evaluation, and barred from using alcohol or drugs and possessing firearms. For all the good this did!


While hindsight has 20/20 vision as the adage insists, one can't help wondering why Mr. Lanz wasn't hospitalized or jailed since the failure of court restraint against impulsive, disturbed people is countless as evidenced by the killing of the divorced by their former partners and road rage and street assaults on strangers though these can't be wholly stopped. A psychiatrist once told me of a colleague eating in the cafeteria who had been attacked by a patient with whom he had no prior contact.


The only possible explanation for these frequent crimes is that many still don't believe that some people are, perhaps temporarily, inherently dangerous. Failing to respect the power of the unconscious over behavior despite its continuing reminders.

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The Inescapable Pain and Benefits of Anxiety and Depression

While the pain of anxiety and depression cannot be denied, neither can it be avoided since they are part of the human condition, enabling us to become more fully human, more of who we can be.


Anxiety signals impending danger, actual or not, thus attempting to protect one from harm. An unrealistic danger indicates that an unconscious conflict, which may involve anything, is causing distress. Perhaps the desire for intimacy conflicting with its fear because of early life experiences, these being the bedrock of the adult personality.

 

Depression indicates a "depressing" of feelings for one of three reasons: being "stuck" because of an inability to decide what to do; sensing that one has deep problems and giving up; or having unsuccessfully attempted to emotionally reach a parent during early childhood, this creating feelings of inadequacy that can persist into adulthood and affect functioning.


Making significant life changes require confronting the unconscious conflicts which can afflict us all for these too are part of being human.

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Psychology: The Amazing Power of the Unconscious Mind

Long ago a co-worker revealed a persisting nightmare which caused her to awake, screaming in panic, several times a week: that she was being held down by her wrists and sexually abused. This happened to her repeatedly when she was a child. Upon awakening there would be marks on her wrists where, in the dream, the attacker held her down. As I never tire of repeating: the unconscious mind is powerful and one must respect its power.

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Classical Psychoanalytic Treatment Today

Classical psychoanalytic treatment, which utilizes long-term multiple sessions a week while lying on the couch, has declined since the 1970s. There are a dearth of analytic patients many of whom now receive treatment modifications that embrace the basic psychoanalytic concepts of resistance and transference and the unconscious but also the later developments of Kernberg and Masterson and Guntrip and Mahler and others who emphasize the critical importance of early infancy and toddler interaction with their mothering figure to the development of psychopathology, there not having been a "good enough" parenting. Harry Stack Sullivan, with his Interpersonal Theory of Psychiatry, is important too for, as has been said, all clinicians today are Sullivanian since they accept the importance to development of their patient's interpersonal relations. Sullivan died before the later (1960s and thereafter) treatment advances.

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An Unnerving Teenage Behavior

A behavior that parents find disheartening is their teenager's tendency to form rapid judgments about friends. Quickly deciding if a friend is "good" or "bad" and, if the latter, instantly removing them from their phone and online "friend" status.

 

Yet this behavior is analogous to that of infants who relate to their mother in black/white terms, whether or not she satisfies their momentary need. Only after maturing can a child relate to others in terms of shades of gray, understanding that one can possess both good and bad characteristics.

 

Similarly, the teenager whose personality is slowly developing into their fixed adult structure, requires maturing to accomplish this anew, and some with emotional difficulties never do.

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The Protective Function of the Unconscious Mind

A common complaint of patients during psychotherapy is wishing that they had the greater self-knowledge they now possess as a youth. This universal longing reflects both the benefit of life experience and the protective function of the unconscious mind.

 

The psychological damage from an unhealthy childhood can be great. Sensing this, the unconscious mind creates false explanations to protect self-esteem and avoid the despair which might cause suicide. Only after positive development has occurred can many tolerate realizing their earlier emotional deficits.

 

And not only of psychotherapy patients is this true. Many, at the end of their education or working career, are amazed by how they endured the difficult, painful course over which they traveled.

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Crime: Murder, Mayhem, and Evil

During my first job, as a psychologist at a psychiatric hospital, I told my psychoanalyst/supervisor my adolescent patient's statement. "That's psychotic," the doctor replied. Though able to define "psychotic," until that moment I hadn't grasped the power of this condition.

 

Similarly, when the latest horrors become public, the perpetrators are usually viewed with surprise since they look so normal, lacking the twisted features of horror film characters and speaking coherently though of bogus beliefs. Columnists then ask the usual question of "why," and provide their usual answer that "no one knows" but this is not true. While predicting violence cannot be certain, it correlates highly with several factors: failure in life; substance abuse; the psychological (ego) capacities governing thinking and behavior being inadequately developed; and having a fragmented "sense of self" (sense of who they are).

 

The killer's frequent decision, to suicide in "glory," is considered preferable to their continued painful existence.Though their act is horrendous, these individuals are not often considered "insane" which is a legal term determined by state statute. Most usually whether a person can distinguish "right" from "wrong" and, contrary to popular belief, rarely succeeds as a defense.

 

But to describe these individuals as sane does not imply that they possessed normal control over their behavior. Still, except for those possessing extreme psychological limitations, this should not influence their punishment. There is evil in the world and some succumb to its temptation. Yet even for others, the unconscious is very powerful and one must respect its power.

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