Wise Counsel Podcasts

Procrastination, defined by putting things off, falling behind, and then feeling badly, is a normal behavior but one that can cause real problems when taken to extremes. It can present as a symptom of depression or anxiety or perfectionism. it's remediation can help create a sense of relief or respite from these other conditions. A first step in addressing problematic procrastination is to raise awareness that procrastination is occurring so that it becomes more of a conscious choice rather than a simple reflex. Next, it is helpful to understand the motivations that cause the behavior, which vary across different people. Some people procrastinate as a simple short-term means of avoiding having to do tasks they find aversive. Others avoid due to social evaluation fears or self-doubt. Others procrastinate due to poor organizational skills and difficulty accurately estimating the time it will take to accomplish a goal. Procrastination can also occur as a practical means of social manipulation (such as when delay in cleaning one's room will cause another to do it for you), or as a result of existential paralysis over not being able to complete tasks with a (self-imposed) required level of skill or quality. Its important to pick a single instance of procrastination to address rather than try to stop the pattern globally. Keeping change goals small and manageable makes it possible to maintain motivation to change and to measure change as it occurs.

John Doe Transformed in Prison. Mental Help Net (www.mentalhelp.net) presents the Wise Counsel Podcast (wisecounsel.mentalhelp.net), hosted by David Van Nuys, Ph.D. His first years in prison were a continuation of his earlier experience; he continued to use drugs, later giving them up for exercise as a means of self-protection. He met a woman visiting the prison and formed a platonic friendship with her. When she became pregnant (by another man) he formed a relationship with her child. This experience helped him to realize that the purpose of life is found in relationships. About ten years into his sentence, he shifted from a motivation to "do something crazy" so as to secure his "lifer" status within the prison (apparently something experienced as comforting by prisoners) to wanting a life outside the prison. Also about this time he was tricked into participating in a substance abuse treatment program involving a good deal of psychotherapy which he found very valuable. He dealt with chronic neck pain with intensive meditation which ultimately produced in him a feeling of great contentment and peace despite continuing pain. At this moment he realized that his purpose was to be helpful to others.

Long-term PTSD often co-occurs with independently diagnosable and treatable sleep disorders including insomnia and apnea. Dr. Krakows research suggests that many chronic insomnia patients also have undiagnosed apnea like conditions they are not aware of. He frequently prescribes an imagery technique for treatment of nightmares called Imagery Rehearsal Therapy or IRT. In IRT, patients are taught that nightmares are habitual learned behaviors and therefore modifiable. Patient are then instructed to change their nightmares however they wish and to practice this between sessions. The technique is associated with symptom relief. IRT has no exposure therapy component, but Dr. Krakow does think incorporating one might be helpful. Other sleep disorders are treated using appropriate techniques including use of breathing assistance machines such as adaptive servo-ventilation (ASV), which PTSD patients more readily tolerate than CPAP. Imagery techniques are taught as distraction devices to help patients cope with the discomfort associated with breathing machines. Addressing co-occurring sleep disorders helps PTSD patients rally and cope better during waking hours.

Hanno Kirk on End of Life Care. Mental Help Net (www.mentalhelp.net) presents the Wise Counsel Podcast (wisecounsel.mentalhelp.net), hosted by David Van Nuys, Ph.D. Hanno Kirk, LICSW, Ph.D. had a successful Army and political policy career before deciding to retrain as a social worker and focus his career on end-of-life care. In the United States, the dying process has become highly medicalized such that some 80% of people die in hospitals (contrasted to 80% of people dying at home 50 years ago). Death has become more hidden and taboo than in the past, and younger people have little experience with it. Several consequences of this shift in how people die are that people put off planning for their own dying process, failing to set up advanced directives, and that dying people are offered more interventions designed to prolong their lives, often without careful thought as to how these interventions will affect the quality of life remaining. Life extension is a fine goal for otherwise healthy people, but when body systems approach becoming irreversibly damaged, especially during the terminal drop phase of dying, such efforts are counter-indicated as they will cause more harm than good. Efforts to promote advanced directives, provision of realistic end-of-life education and education regarding hospice services end up producing dramatic health care savings, as people then willingly avoid costly life extension efforts as an affront to their dignity. Dr. Kirk suggests that end of life should be a spiritual and sacred time during which families can share, reconcile and grieve, rather than a series of stressful crisis interventions.

Sharon Rivkin, a Marriage and Family Therapist and author of Breaking the Argument Cycle, argues that in most cases, repetitive conflict within a relationship occurs when partners' deep-seated family-of-origin issues cause them to misinterpret one another's behavior as more of a personal attack than it really is. Ms. Rivkin's central insight is that a couple's first argument, usually still vividly remembered but distant enough in time to be objective about, is a fertile laboratory for unpacking and identifying what the core issues driving conflict are. To break out of a repetitive argument cycle, partners must become aware of their individual root issues underlying their arguments and then use this knowledge to become more compassionate towards themselves and their partner.

Dr. Strunk, a cognitive-behavioral therapy researcher, describes results of his recent psychotherapy research. Specifically, he has examined the contributions of two aspects of the psychotherapy process, rapport (or the quality of the relationship between therapist and client) and technique (or the consistency with which the therapist sticks to teaching core cognitive therapy principles within therapy sessions, and found that, given a pool of reasonably competent therapists (some masters and some journeymen), there is a direct relationship between the consistent teaching of cognitive techniques and early symptom remission, but not really a relationship between how well therapists and clients think of each other and symptom remission. Dr. Strunk is quick to point out that rapport would likely have become more important if therapists taking part in the research had been seriously lacking in rapport building skills. He emphasizes that both cognitive therapy for depression and medication therapy for depression have been shown to be effective treatments for depression, and that since the majority of depressed people go untreated, the most important thing is that people who are suffering get themselves into an effective treatment of some kind.

Joshua B. Lerner on the History of Object Relations Theory. Object Relations Theory is an important development of psychoanalysis which is widely supported today within the psychoanalytic community. The term object is really a stand-in word for people, as the theory really speaks to the importance of how a person's early relationships, particularly with caregivers, strongly influence their psychological development. The importance Object Relations Theory applies to early relationships is in contrast to Freud's original conception of child development which was understood to be more biologically or instinctually driven. In this Wise Counsel interview, Joshua Lerner, a social worker and psychoanalyst, talks about the historical development of Object Relations Theory; its origins with analysts like Melanie Klein, and how it developed over time under the influence of other analysts including Winnicott, Balint, Fairbairn, and Bowlby.

Secure attachment helps people survive temporary bouts of pain, discomfort, doubts and distress, and helps them reestablish hope, optimism, and emotional equanimity. Securely attached parents are able to protect children from parental grief (by keeping it private between parents), and to offer children their freedom but in a manner that conveys support rather than indifference or anxiety. Insecurely attached parents tend to polarize in terms of their coping, becoming either more indifferent and detached or to deny the importance of the bond, or conversely, more hyper-vigilant, worried and anxious in such a way as to magnify the importance of the bond overly, conveying dependence and a message that separation is harmful to the parent. Parents' secure attachment allows them to both support and to let their children go simultaneously, whereas their insecure attachment ends up burdening children, either by conveying their unimportance to the parent, or their over-importance.

An Interview with Wilma Bucci, Ph.D. on Psychoanalysis and Cognitive Science. Bucci views the fundamental nature of the mind to be revealed in the partial interaction of the various brain systems. Another way to say this to note that the most fundamental thing about consciousness is dissociation, which can be adaptive or dysfunctional, depending on its causes and how it plays out. Adaptive dissociation occurs when we are having a peak experience that we cannot put into words (stuff that poets try to capture), or when we are driving a car and able to operate the stick shift. If we try to narrate what we need to do to ourselves (e.g., to understand the motor memory in verbal terms), we are likely to mess up our ability to function on this subsymbolic level. Dysfunctional dissociation happens when the various parts of the brain which should be talking to one another so as to support our ability to function become, for whatever reason unable to talk to one another, resulting in emotional dysfunction and avoidance.

Meg Hutchinson on making Music and Bipolar Disorder. Mental Help Net (www.mentalhelp.net) presents the Wise Counsel Podcast (wisecounsel.mentalhelp.net), hosted by David Van Nuys, Ph.D. Dr. Van Nuys interviews accomplished singer-songwriter Meg Hutchinson about her music and her life with Bipolar Disorder. Ms. Hutchinson experienced her first substantial depression at age 19. While bipolar is normally associated with swings between depressive and manic mood episodes, Ms. Hutchinson experienced mostly depressive states until her late 20's in the aftermath of her beloved grandmother's death at which point she had her first experience of mania, then profound depression, then a mixed state, then depression again, this time severe enough that hospitalization was required. It was at this point that her condition was officially diagnosed. In the years before her diagnosis she was fairly secretive and defensive about her episodes, viewing them as par for the course for an artist, or due to some physical condition. It took some months for the meaning of the diagnosis to sink in, but when it did, she felt more at peace with herself, recognizing finally that her condition was not her fault, and that she was not a weak person for accepting treatment. She was helped to this understanding through therapy and a supportive network of family and friends. Today she recognizes the importance of carefully balancing her ambition and desire to take on many musical committments with the practical demands of maintaining her emotional balance.

Dr. Zylowska, a UCLA-affiliated psychiatrist with a private practice in West Los Angeles, discusses mindfulness practice as a clinical intervention for adult ADHD. She describes mindfulness as the cultivation of heightened awareness, and points out that this can occur for anyone as a spontaneous state of mind, but that it can also be cultivated through regular practice of various forms of meditation so that a person's experience of mindfulness becomes more frequent and trait-like. She describes the history of mindfulness practice as a psychotherapy intervention, noting that Mindfulness Based Stress Reduction (MBSR) program was the first application, followed on by Mindfulness Based Cognitive Therapy (MBCT). Both intervention protcols involve an eight week training period. In her own pilot research she has adapted mindfulness practices from the MBSR model for use treating adults and teens diagnosed with ADHD. Modifications including making practice sessions shorter, and encouraging walking meditation as opposed to sitting meditation. Her results, published in the Journal of Attention Disorders in 2007, showed that patients generally liked the intervention and that their ability to sustain attention under distracting circumstances was improved at the conclusion of mindfulness training. Together with Elisha Goldstein, Ph.D., she has co-authored a CD of mindfulness practices for ADHD. The summary of the exercises used in the research study is available for download from her website.

An Interview with Holli Kenley, MA on Surviving Betrayal. Mental Help Net (www.mentalhelp.net) presents the Wise Counsel Podcast (wisecounsel.mentalhelp.net), hosted by David Van Nuys, Ph.D. Ms. Kenley became highly attuned to the idea of betrayal after noting it as a common theme in multiple clients and dealing with it in her own life. Her efforts to understand what people refer to when they say "betrayed" resulted in her identification of three common experiences or states of being: confusion, worthlessness, and powerlessness, which she describes as stages that occur in that order, respectively. The difficulty a person will have in processing a betrayal and moving through these stages is affected by multiple factors, including one's personality or ego strength, the degree to which the betrayal affects identity investments in particular social roles, and the chronicity of the betrayal (whether it is a single event or a recurring theme). People who have experienced multiple and chronic betrayals may find that they are dealing with a pool of residual betrayal, in that they have come to identify themselves as a victim and self-effiacy is low. Such stored or institutionalized betrayal must be addressed and worked through in therapy or the client's progress may stall. An important componant of this work involves helping the client move from a passive/victim core sense of self to a more active and empowered persona capable of self-authorship and able to right herself. This shift from passive victim identity to a self-authoring identity opens up the possibility of anger and blame, which must also be worked through so as not to become the new basis for the client's identity, as this is also a trap.

An Interview with Leslie Greenberg, Ph.D. on Emotion-Focused Therapy. Mental Help Net (www.mentalhelp.net) presents the Wise Counsel Podcast (wisecounsel.mentalhelp.net), hosted by David Van Nuys, Ph.D. Dr. Van Nuys interviews Leslie Greenberg, Ph.D. with regard to Dr. Greenberg's Emotion-Focused Psychotherapy. Dr. Greenberg is not so interested in promoting yet another name brand psychotherapy but has felt complelled to package his work in this fashion so as to get it out there, in the face of the dominant cognitive-behavioral mode of therapy which deemphasizes the importance of what he wants to talk about. His therapy is focused squarely on helping patients to experience and comprehend their emotional process through the communication of an intellectual framework for understanding emotion, and the direct experience of emotion in the therapy. It is the conceptual framework and the large base of research it sits upon that differentiates this therapy from older emotion-focused therapies such as gestalt therapy, Rogerian client centered therapy, and (shudder) Janov's primal scream. The approach recognizes emotions as action-tendencies motivating behavior, and as people's most fundamental synthesis of their understanding of their situation. It seeks to put people back in touch with avoided fundamental emotions as without awareness of avoided emotions, people are rudderless and disoriented. Multiple research studies of this Emotion-Focused therapy have been conducted, resulting in firm support for the efficacy of the approach.

An Interview with Steven Richfield, Psy.D. on Parents as Coaches. Mental Help Net (www.mentalhelp.net) presents the Wise Counsel Podcast (wisecounsel.mentalhelp.net), hosted by David Van Nuys, Ph.D. Drs. Van Nuys and Richfield discuss Richfield's coaching cards, a deck of cards designed to be used by pre-teen children and parents so as to help children understand, in a concrete and developmentally approprite manner, methods for coping that might otherwise be just above their understanding. For instance, the cantaloupe skin card shows the image of a child putting on a cantaloupe skin. This is a concrete representation of the idea that some people have thin skins (e.g., are sensitive and vulnerable) while others have thicker skins, and that thinner skinned children have the option to metaphorically choose to put on a thicker skin by focusing their minds on success experiences which help shore up their fragile self-concepts. The cards offer key concepts to children that enable them to cope better, helping to advance their development of social maturity. Richfield sees this approach as offering parents a way to fundamentally better understand what their children are going through and therefore respond in a developmentally sensitive manner promoting maturation (in the manner of an athletic coach) rather than as simple rule setters and enforcers.

Interview: Bruce Ecker, MA, LMFT on Memory Reconsolidation and Psychotherapy Mental Help Net (www.mentalhelp.net) presents the Wise Counsel Podcast (wisecounsel.mentalhelp.net), hosted by David Van Nuys, Ph.D. In this episode of the Wise Counsel Podcast, Bruce Ecker describes the core treatment method of Coherence Therapy. Ecker relates this method to emerging neuropsychological research on memory reconsolidation, a naturally occurring phenomena through which emotional memories can be dissolved and erased. Reconsolidation studies by brain scientists have shown that under special circumstances, the physical storage of emotional memories is unlocked by reactivation of the stored knowledge and is then reconsolidated back into a stable condition after a few hours. During that window, it is possible for new learnings to revise and even erase the existing emotional knowledge and the behavioral responses that it drives. Ecker maintains that the same reconsolidation process demonstrated in contemporary neuroscience research seems to be at work in coherence therapy and accounts for clinical observations of profound change and lasting relief from longstanding symptoms of many kinds.