Houston Southard
a name that looks so fake you'll care just as little to learn it's not
Maybe you should talk to someone
lori gottlieb
1 Idiots
Sometimes, hell is us. Sometimes we are the cause of our difficulties
We can’t have change without loss, which is why so often people say they want change but nonetheless stay exactly the same.
No matter how open we as a society are about formerly private matters, the stigma around our emotional struggles remains formidable
what are we so afraid of? It’s not as if we’re going to peer in those darker corners, flip on the light, and find a bunch of cockroaches.
Fireflies love the dark too. There’s beauty in those places. But we have to look in there to see it. My business, the therapy business, is about looking.
And not just with my patients.
We learn how to accept feedback, tolerate discomfort, become aware of blind spots, and discover the impact of our histories and behaviors on ourselves and others.
2 If the queen had balls
The presenting problem is the problem that sends the person into therapy.
If the queen had balls, she’d be the king.” If you go through life picking and choosing, if you don’t recognize that “the perfect is the enemy of the good,” you may deprive yourself of joy.
3 the space of a step
If I were a gynecologist, would you ask if I was about to give you a pelvic exam?”
Will you see the human in my being?
Therapy elicits odd reactions because, in a way, it’s like pornography. Both involve a kind of nudity. Both have the potential to thrill. And both have millions of users, most of whom keep their use private. Though statisticians have attempted to quantify the number of people in therapy, their results are thought to be skewed because many people who go to therapy choose not to admit it.
Attachment styles are formed early in childhood based on our interactions with our caregivers. Attachment styles are significant because they play out in people’s adult relationships too, influencing the kinds of partners they pick (stable or less stable), how they behave during the course of a relationship (needy, distant, or volatile), and how their relationships tend to end (wistfully, amiably, or with a huge explosion). The good news is that maladaptive attachment styles can be modified in adulthood—this, in fact, is a lot of the work of therapy.
8 rosie
This is called working in the here-and-now. Instead of focusing on a patient’s stories from the outside world, the here-and-now is about what’s occurring in the room.
In idiot compassion, you avoid rocking the boat to spare people’s feelings, even though the boat needs rocking and your compassion ends up being more harmful than your honesty. People do this with teenagers, spouses, addicts, even themselves. Its opposite is wise compassion, which means caring about the person but also giving him or her a loving truth bomb when needed.
Every therapy session belongs to both patient and therapist, to the interaction between them. It was the psychoanalyst Harry Stack Sullivan who, in the early twentieth century, developed a theory of psychiatry based on interpersonal relationships. Breaking away from Freud’s position that mental disorders were intrapsychic in origin (meaning “in one’s mind”), Sullivan believed that our struggles were interactional (meaning “relational”). He went so far as to say, “It’s the mark of a senior clinician that he or she is the same person in their living room that they are in their office.”
Neuroscientists discovered that humans have brain cells called mirror neurons that cause them to mimic others, and when people are in a heightened state of emotion, a soothing voice can calm their nervous systems and help them stay present.
people are often at their most interesting when they’ve got a proverbial gun to their head.
We think we make bucket lists to ward off regret, but really they help us to ward off death. After all, the longer our bucket lists are, the more time we imagine we have left to accomplish everything on them. Cutting the list down, however, makes a tiny dent in our denial systems, forcing us to acknowledge a sobering truth: Life has a 100 percent mortality rate.
Before diagnosing people with depression, make sure they’re not surrounded by assholes
Without thinking about it, what three adjectives come immediately to mind in relation to your mom’s [or dad’s] personality?
10 types of personality disorders (grouped into clusters)
Cluster A (odd, bizarre, eccentric):
Paranoid PD
Schizoid PD
Schizotypal PD
Cluster B (dramatic, erratic):
Antisocial PD
Borderline PD
Histrionic PD
Narcissistic PD
Cluster C (anxious, fearful):
Avoidant PD
Dependent PD
Obsessive-Compulsive PD
In outpatient practice, we mostly see patients in cluster B. People who are untrusting (paranoid), loners (schizoid), or oddballs (schizotypal) don’t tend to seek out therapy, so there goes cluster A. People who shun connection (avoidant), struggle to function like adults (dependent), or are rigid workaholics (obsessive-compulsive) also don’t look for help very often, so there goes cluster C. The antisocial folks in cluster B generally won’t be calling us either. But the people who experience difficulty in relationships and are either extremely emotional (histrionics and borderlines) or married to people like this (narcissists) do make their way to us. (Borderline types tend to couple up with narcissists, and we see that pairing often in couples therapy.)
In other words, personality disorders are ego-syntonic, which means the behaviors seem in sync with the person’s self-concept; as a result, people with these disorders believe that others are creating the problems in their lives.
From time to time—on a doozy of a bad day or when pushed until a fragile nerve is struck—everyone exhibits a tad of this or that personality disorder, because each is rooted in the very human wish for self-preservation, acceptance, and safety.
Diagnosis has its usefulness. I know, for example, that people who are demanding, critical, and angry tend to suffer from intense loneliness.
The answer to the unasked question is always no.
Most people's biggest problem is that we don't know what our problem is.
Therapists use three sources of information when working with patients: What the patients say, what they do, and how we feel while we’re sitting with them
What makes therapy challenging is that it requires people to see themselves in ways they normally choose not to
9 what we dream of
We are afraid of being hurt. We are afraid of being humiliated. We are afraid of failure and we are afraid of success. We are afraid of being alone and we are afraid of connection. We are afraid to listen to what our hearts are telling us. We are afraid of being unhappy and we are afraid of being too happy (in these dreams, inevitably, we’re punished for our joy). We are afraid of not having our parents’ approval and we are afraid of accepting ourselves for who we really are. We are afraid of bad health and good fortune. We are afraid of our envy and of having too much. We are afraid to have hope for things that we might not get. We are afraid of change and we are afraid of not changing. We are afraid of something happening to our kids, our jobs. We are afraid of not having control and afraid of our own power. We are afraid of how briefly we are alive and how long we will be dead. (We are afraid that after we die, we won’t have mattered.) We are afraid of being responsible for our own lives.
The therapist explained that often different parts of ourselves want different things, and if we silence the parts we find unacceptable, they’ll find other ways to be heard.
PEACE. IT DOES NOT MEAN TO BE IN A PLACE WHERE THERE IS NO NOISE, TROUBLE, OR HARD WORK. IT MEANS TO BE IN THE MIDST OF THOSE THINGS AND STILL BE CALM IN YOUR HEART
Therapy is about understanding the self that you are. But part of getting to know yourself is to unknow yourself—to let go of the limiting stories you’ve told yourself about who you are so that you aren’t trapped by them, so you can live your life and not the story you’ve been telling yourself about your life.
You are your own jailor.
I’d learned in my training about the unique challenges faced by older adults, and yet this age group gets short shrift when it comes to mental-health services. For some, therapy is a foreign concept, like TiVo, and besides, their generation grew up largely believing that they could “get through it” (whatever “it” was) on their own. Others, living on retirement savings and seeking help at low-cost clinics, don’t feel comfortable seeing the twenty-something therapy interns who predominantly staff them. Before long, these patients drop out. Still other older people assume that what they’re feeling is a normal part of aging and don’t realize that treatment might help. The result is that many therapists see relatively few seniors in their practices.
We marry our unfinished business.
Being silent is like emptying the trash. When you stop tossing junk into the void—words, words, and more words—something important rises to the surface. And when the silence is a shared experience, it can be a gold mine for thoughts and feelings that the patient didn’t even know existed
What most people mean by type is a sense of attraction—a type of physical appearance or a type of personality turns them on. But what underlies a person’s type, in fact, is a sense of familiarity. It’s no coincidence that people who had angry parents often end up choosing angry partners, that those with alcoholic parents are frequently drawn to partners who drink quite a bit, or that those who had withdrawn or critical parents find themselves married to spouses who are withdrawn or critical.
Why would people do this to themselves? Because the pull toward that feeling of “home” makes what they want as adults hard to disentangle from what they experienced as children. They have an uncanny attraction to people who share the characteristics of a parent who in some way hurt them. In the beginning of a relationship, these characteristics will be barely perceptible, but the unconscious has a finely tuned radar system inaccessible to the conscious mind. It’s not that people want to get hurt again. It’s that they want to master a situation in which they felt helpless as children. Freud called this “repetition compulsion.” Maybe this time, the unconscious imagines, I can go back and heal that wound from long ago by engaging with somebody familiar—but new. The only problem is, by choosing familiar partners, people guarantee the opposite result: they reopen the wounds and feel even more inadequate and unlovable.
This happens completely outside of awareness. Charlotte, for instance, said that she wanted a reliable boyfriend capable of intimacy, but every time she met somebody who was her type, chaos and frustration ensued. Conversely, after a recent date with a guy who seemed to possess many of the qualities she said she wanted in a partner, she came to therapy and reported: “It’s too bad, but there just wasn’t any chemistry.” To her unconscious, his emotional stability felt too foreign.
His laugh is his shelter.
He liked Rita’s worldliness and wry observations and wise counsel whenever he asked her advice. He adored her throaty laugh and her eyes that were green in the sunlight and brown indoors and her bright red hair and her values. He loved that if they started a conversation on one topic, it would segue into two or three others before it would loop back around or that sometimes they’d get so immersed in their tangents that they’d forget what they’d been talking about in the first place. Her paintings and sculptures made his heart thrill. He was curious about her, wanted to know more about her kids, her family, her life, her. He wanted her to feel comfortable telling him and wondered why she had been like a cipher, revealing so little of her past.
In conversion disorder, though, the patient is actually experiencing these symptoms; it’s just that there’s no identifiable medical explanation for them. They seem to be caused by emotional distress that the patient is completely unconscious of
people procrastinate or self-sabotage as a way to stave off change—even positive change—because they’re reluctant to give something up without knowing what they’ll get in its place. The hiccup at this stage is that change involves the loss of the old and the anxiety of the new
People with cherophobia are like Teflon pans in terms of pleasure—it doesn’t stick (though pain cakes on them as if to an ungreased surface). It’s common for people with traumatic histories to expect disaster just around the corner. Instead of leaning into the goodness that comes their way, they become hypervigilant, always waiting for something to go wrong.
I’ve thought about how Richard would say he would change, and how much he wanted to change, and how he still wouldn’t change, at least not for long, and how despite all of this, none of what he said was ever a lie.
The inability to say no is largely about approval-seeking—people imagine that if they say no, they won’t be loved by others. The inability to say yes, however—to intimacy, a job opportunity, an alcohol program—is more about lack of trust in oneself. Will I mess this up? Will this turn out badly? Isn’t it safer to stay where I am?
Suffering shouldn’t be ranked, because pain is not a contest.
paradoxical intervention. Given the ethical considerations involved, a therapist has to be well trained on how and when to use paradoxical directives, but the idea behind them is that if patients believe that a behavior or symptom is beyond their control, then making it voluntary, something they can choose whether or not to do, calls that belief into question. Once patients realize that they’re choosing a behavior, they can examine the secondary gains—the unconscious benefits it offers (avoidance, rebellion, a cry for help).
10 The Speed of Want
You wont get today back
30 percent fewer patients received psychological interventions in 2008 than they had ten years earlier and that since the 1990s, the managed-care industry—the same system that my medical-school professors had warned us about—had been increasingly limiting visits and reimbursements for talk therapy but not for drug treatment. It went on to say that in 2005 alone, pharmaceutical companies spent $4.2 billion on direct-to-consumer advertising and $7.2 billion on promotion to physicians—nearly twice what they spent on research and development.
People wanted a speedy solution to their problems, but what if their moods had been driven down in the first place by the hurried pace of their lives? They imagined that they were rushing now in order to savor their lives later, but so often, later never came. The psychoanalyst Erich Fromm had made this point more than fifty years earlier: “Modern man thinks he loses something—time—when he does not do things quickly; yet he does not know what to do with the time he gains except kill it.” Fromm was right; people didn’t use extra time earned to relax or connect with friends or family. Instead, they tried to cram more in.
The four ultimate concerns are death, isolation, freedom, and meaninglessness.