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

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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Why the Treatment of Autistic Children Often Fails

Psychologists have long known that children in every nation become capable of speaking their nation's language not by learning that one word follows another but because the mind innately inducts the grammatical structure of their nation's language. Understandably so since the purpose of all cognition is to make sense of the personal world as quickly as possible.


It is not true that autistic children avoid communication but rather that they try to communicate in their own way. Thus, treating them with the same behavior modification method that one would use with a dog is doomed to failure. Instead, one must enter their world and wean them into the larger world, one that is unproblematic unlike the unsatisfying, psychologically non-nourishing developmental experiences that drove them from it originally.


One caution: misdiagnosis of autism in children is widespread and traditional play therapy can often reduce or eliminate a few autistic symptoms in mere months.

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Treating the Diagnostically Hopeless Psychiatric Patient

To successfully treat those with severer mental health disorders, the therapist must take little for granted, ignoring accepted beliefs about prognosis and motivation  since clinician prejudice can arouse unjustified feelings of defeatism and hopelessness.

Each person is unique with another being unable to know their experience fully and the depth of their suffering. The sicker patient knows much about themself but, from guilt or fear of acting-out impulsively, is afraid to allow themselves to feel what they know. Nor because of their low self-esteem do they value this knowledge. So they retreat from what is most useful: to feel what they know.

Thus when a patient refers to the presumed hopelessness of the diagnoses they had formerly been told, they should be reminded that they are a complex human being and not a simple diagnostic classification.

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When a Child Complains to Their Parent

Communication isn't always straightforward. About the only thing that a parent can be sure of is if their child complains of feeling ill, this being evidenced by fever or another serious symptom. Otherwise, a child's complaint may be valid or indirect, which is similar to the behavior of adults.

Consider the man who is asked to purchase something by his wife and "forgets." This may be accurate if he has pressing issues on his mind or indicate his indirect expression of anger by behaving passive-aggressively. Similarly, a youth may behave in a puzzling way or make a puzzling statement to express a concern about the parent or another which they fear to express openly. Perhaps wanting greater independence than the parent allows or to react against what they interpret as the parent's deprecating comment.

As I never tire of repeating, the unconscious is very powerful and one must respect its power.

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How to Survive Your Courtroom Experience

Testifying in court is a stressful experience and just being there can be nerve-racking. During my first visit to a judge's chambers I asked where to sit though this was obvious. With experience I came to enjoy testifying in court as the government's expert witness. Providing information which always helped the participants since the more accurate information which a judge has the better will be their decision.

Judges have great power and making a mistake when testifying can elicit their verbal wrath and more. The following tips may help avoid this.


1. Never lie when testifying no matter how attractive this possibility may seem since the consequence can be severe. A New York psychologist who falsely embellished his excellent credentials lost his license after an attorney's investigation and complaint.

2. Never express anger when testifying since this works against you. Remain calm no matter how upsetting or even ridiculous is the attorney's question. It's not personal, he only doing his job.

3. Prepare yourself before testifying, winging it in court can be problematic even for an experienced lawyer. After describing the nature of the Thematic Apperception Test, a psychological instrument in which a subject creates a story in response to a drawing, the lawyer asked, "Well, Dr. Goldstein, if I made a story that I had sexual difficulty with my wife, how would you interpret my problem?" I could hardly believe the opening he gave me. With a straight face I responded, "Sir, I can express no professional opinion about your sexual adequacy with your wife." The courtroom broke up in laughter and even the judge smiled though I probably should have avoided temptation since there is no laugh line in court transcriptions.

Yet even with the best preparation pitfalls can occur. I once earned the verbal wrath of a judge by mentioning that I had been originally referred the plaintiff by his insurance company though I had not been instructed to avoid stating this. Nor, testifying under subpoena, did I even know who he was suing or why.

Remember that every new experience creates some degree of anxiety. Thus, because most people experience a courtroom only once in their life if ever, this discomfort should be expected.

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