Sep 07, 2014 00:55
[entry code: Auto-Therapy]
I know I was gonna start doing this, just a little hard to get the time. The point of 'this' was two fold: practice concepts I'm learning about (and demonstrate them for 'anyone curious'); and focus on my own mental health, to compensate for 'losing' my own psychotherapist. His leaving actually hit me pretty hard...and not just 'cuz he was hawt :P . After my break-up, I was feeling extra distrustful and abandoned, cuz, you know, I don't have many people stay 'with' me, partly because I move around but partly...
Alright. I'm kinda starting from the 'wrong end,' so to speak. See, one of the main philosophies of cognitive-behavioral therapy is that people develop belief systems not directly based off their environment, but based off their PERCEPTIONS of their environment. The distinction is sometimes pretty subtle, so I'll just briefly remind you that there is a LOT of stuff in your environment and despite the awesomeness of the human brain, we don't take in and process it all. Rather, much of it is filtered.
Some is filitered simply through inadequacies of our sensory systems ('sensation'), but a lot more is filtered via through various shortcuts that our brain makes. Some of these are learned, and some are sorta pre-programmed (i.e. nature vs. nurture), but really there's interplay between these two.
I'll give an example: Jane goes to math class as a kid, and has trouble learning division. The teacher's already subtly treating her as if math is difficult for her, and it's all new anyway, so she begins to feel frustrated. And soon she develops this belief. "I'm no good at math," she thinks. And she thinks it frequently, every time she hears her teacher make a biased comment, and every time she gets her grades back with 'red' all over the paper. Can you see the 'conditioning'? She's doing it to herself, but so is the teacher, by making all math-related activities less-rewarding via her comments. Jane associates these math activities in this classroom as negative...but notice she's not specificying that situation, but generalizing it to all "math." Part of what's happened is she's developed a hypothesis and repeated experiences confirm the hypothesis - "I'm not good at math, so I'll prolly get poor grades again and Mrs. X will prolly get annoyed and try to 'help' me like she does..." And lo and behold, she's right. If she's wrong once or twice, she may just discount it (our brains do this naturally, minimizing the import of infrequent events). The minimizing and the generalizing are both cognitive shortcuts we use, and we're pre-programmed to use them in making decisions to save us time. You probably know another such shortcut: stereotypes. The important thing to remember is that these shortcuts are neither inherently good nor bad...but if we aren't mindful (which we generally aren't as children), the results can be bad. Racism, for example. Or in Jane's case, an internalized belief of not being good at math (and perhaps this reinforces an even more deep-set belief of inadequacy, failure, or helplessness...).
So there's the example. People develop core beliefs slowly but surely in their development. They 'learn' these beliefs in a very similar way to learning what a 'cat' or 'dog' is. Input, test against existing knowledge, affirm/modify/challenge schema. Cut is not just a furry small animal, but a furry small animal that purs, whiskers, etc...oh, but what about Tigers? That sorta thing.
In therapy, you start with the automatic thoughts. The therapist tries to find something important to the patient that also incites emotion (because generally distress and dysfunction in a patient is evidenced through negative emotions). In Jane, she may feel annoyed, anxious, or sad when she's confronted with math. Let's say she's anxious - the therapist notes this and asks, "what's going on - what's happening right now?"
They eventually find that she thinks "I don't like math" and "I'm just not good at math," and they explore this. They consider alternative explanations. They explore what would happen if she did math and failed (because it turns out she's been 'avoiding' even simple math for years). They discover that failing at math 'confirms' for her the intermediate belief that she's "stupid." Eventually they realize an important negative core belief of hers is that she feels inadequate, helpless, powerless... The trouble with math was only one piece of this belief, but it could be effective at uncovering and the belief and hopefully altering it by challenging some of the faulty shortcuts and assumptions she's been using.
I've kinda figured out one of my negative 'core beliefs,' but I'm not quite ready to work on it. It sucks. And since I'm not an objective therapist (for myself), it's harder to work therapeutically. BESIDES, as I mentioned, the therapist starts with an 'automatic thought' - preferably a simple one. Why? Because 1) the client is always aware of these thoughts, even though they aren't consciously coming to the decision to make them - they're just habit. And 2) automatic thoughts are relatively easy and simple to challenge. Cognitive shortcuts in CBT are called "cognitive distortions" - they are generally shortcuts and conditioned thoughts, as I mentioned, but the relevant ones in therapy are also weak to logic, so we can generally just 'argue' them away (therapists AND clients can do this; it's generally better to get the client to do it, but keep in mind the client is not used to challenging these habitual thoughts, so they'll likely still need help).
So here's mine: "I don't want to work that much - I don't want to be a workaholic." See, I have this belief that workaholicism is bad. Which...well...the label 'workaholic' kinda says that off the bat. And there are some good logical reasons to be wary of workaholicism, but the other day I realized that's not what was driving that thought.
This is me actively working on this in 'real-time'...I'm thinking now that perhaps the 'workaholiphobia' is perhaps more of an intermediate belief. What I'm REALLY thinking is "people shouldn't work so many hours in a week anyway," and "work is hard," and "why are there all these different things to do? I can't keep track of all that!"
There's...huh. There's a bit in there. I can tell...I get panicky about keeping track of things, cuz I think I'm forgetful and I'm worried about failing because of a minor detail... That's happened before too, but it's an odd coincidence that my mom tended to be quite harsh about 'stupid mistakes' when I was a kid, so probably extra 'conditioned' there. And just thinking about this has me feeling scared.
I wasn't expecting that...I thought my issue with workaholicism came just from my dad (he worked extra when I was young, and he always came home tired, doing nothing in the evening but resting). I'm scared of working? Scared of making a mistake. Annoying - I don't want to think about that.
Alright, let's focus on one. "Work is hard - I don't want to do it." So generally, there are two sorta-models that you can use to break down our thoughts and behaviors (and emotions). First, there is "ARC": antecedent, response, and consequence. The automatic thoughts are part of our "responses" - but there's more. First, I tend to have these thoughts in one of two scenarious - one, when for whatever reason I'm supposed to get some stuff done, and two, when something remeinds me of how many hours I have been, will be, or potentially could be busy... Like, if I hear about how I need to have my coursework, my hours at the clinic, my research hours, and other sorts of activities to buff-up my curiculum vitae, and that I should be doing these things if I'm serious about my career in psychology - well, I think many things when this happens, but one is a bit of self-righteous "why the hell is our society programmed like this, where only those who work 'too much' are rewarded? Why did I pick a career where you HAVE to work that much just to make it? ...only it's not just my career, it's most all the worthwhile ones, isn't it? Even to be a good teacher you have to work yourself to the bone...it's not fair."
Er, I need to focus. The second 'antecedent' is a bit more complex and perhaps a bit less emotionally salient - and it's always good to use emotionally salient material when working with a patient. So let's go with an example of the first antecedent: I have something I should be working on. That's not hypothetical either - I've been working on my time-management skills, and I give myself a list of things to do every day. I try to always give myself "research" in one form or another - that includes work on my thesis project and/or work on another research project or research lab work. So today I was supposed to e-mail a professor I've never met to ask about the practicality of getting certain data - I made it easy for myself. I still haven't done it (and look at the time - I won't get it done).
SO: A-R-C. Antecedent, I got a thing to do. Responses: "I don't want to do that, it's too much work, it's hard. It's gonna make me tired and I'm not gonna have anything left in the day, and then my day will be miserable again, just like the day before..." Consequence: I don't do the thing. Often times, this gives me MORE work later, it gives me a 'cram' session I'll have to do, and it leaves me feeling crummy and anxious. It also has me looking less competent to others, such as my research supervisor.
When a therapist looks at the client's "response" in A-R-C, there's actually THREE pieces (although they overlap). There's our thoughts, our feelings, and our behaviors. "Thoughts" include our automatic thoughts, images, etc; "feelings" include any physical sensations, emotions, etc. "behaviors" include the things we do, whether by reflex, habit, or conscious choice. Of course, one could argue that our thoughts are a sort of mental behavior, our senses are an extention of our 'thoughts" in a mental sense, etc...there's overlap. But it's useful to consider all elements - that's the point. Often times a client will only focus on one element. For example, I know "avoidant behaviors," the procrastination, is because I don't wanna do the work, but I don't realize that I get anxious about the work and that there's something about the 'work' that worries me. At the moment, it seems like the thought of "i don't wanna be a workaholic" is less salient emotionally, but we're gonna focus on that area anyway (against standard therapeutic procedure). Are there any behaviors with this thought? ...no, my procrastination behaviors tend to be towards related thoughts, but not this particular one. Are there any feelings? I'm indignant. Repulsed even. The idea of 'working' so much seems terrible. I also feel...tired... I'm tired anyway, mind you (it's late), but it does seem like I'm tired about the idea of working like that.
Hm. "Working like that." What does that mean? Well I'm referring to how it doesn't come easy - work is necessarily effort. "Because I have ADHD," part of me says. "It's so hard to focus, to continually do the same thing, to keep at it." Hopefully the therapist cuts me off. "Work is a lot of effort," he reflects. "It takes a lot of energy from you." Then client-me continues, "yeah, plus if I'm working 8+ hours a day, then I get home and I have little energy...maybe I do some chores and stuff, or maybe I don't, and I just get dinner, relax, and go to sleep. I don't DO anything. Is that what I want my life to be?"
...and I could go on. This automatic thought is harder than I originally thought, because it ties into a lot of other long-standing difficult stuffs... But I can still practice some techniques. One, there's a cognitive distortion there - ALL work is tiring? ALL work is hard to focus on? On some level I assume this is true (another automatic thought?), but that's likely a cognitive distortion - overgeneralization or something. Similarly, assuming that 'doing work' means I have to do 8+ hours a day is not necessarily true. The 8+ hours a day is the thing I'm particularly against of course, but sometimes I find myself avoiding ANY work and getting indignant about even smaller 'bouts' of work. That's all-or-nothing thinking, assuming 'work' is 'workaholicism.' "But I have to do that much work to be effective," I sometimes tell myself. And my field can be competitive. But that's a choice I'm making - and I don't mean choosing my "field," but choosing to compete. It's possible I can be effective without doing quite so much work.
Which is why I'm working on the time-management stuff.
It's also possible I can do a good amount of work in a day without getting so tired, and having no 'other' stuff to do. So I can challenge certain assumptions, cognitive distortions, etc., here.
There are other things we can do with regards to behavior - and this is often a more useful area to intervene, but since we didn't find any for workaholicism specifically (and since that'd take even MORE time to go over), we can just skip that. INSTEAD, we'll consider the second 'model':
The downward arrow technique. This gets from the automatic thought to the core belief...potentially. There are cognitive distortions here too (in the connections between the former to the intermediate thoughts to the latter). The main idea is to make our intermediate thoughts and hopefully our negative core beliefs more 'conscious' - because often times we aren't aware of them. To do this, the therapist can ask, "alright, let's consider this concern of yours, about being a workaholic. You very much don't want to make your life working that much."
Client: "That's right - I just don't want to have that be my life. It's disgusting. And sad. And empty."
Therapist: "But you say that this is a problem, because it seems you'll have to be working that much for your field - at least for the rest of school, internship, post-doc work, and probably any entry-level work. That could be at least eight years - maybe more."
Client: "I know - why did I choose to do this? I'm an idiot!"
Therapist: "I see your expression's changed. What are you feeling now?"
Client: "Oh, I'm feeling kinda panicky - I dunno if I can do that! It's too much! I'm gonna fail."
[and, again, it looks like the better path would be to follow this 'too much work' or 'work is too hard' line, but we'll focus on the workaholicism line]
Therapist: "So you're seeming confused about why you even chose this path, if you didn't want it. You seem stuck."
Client: "Not stuck. I thought about it hard - I wanted a job that meant something, but those aren't common, ya know? And I like thinking, and I like the idea of progressing research, doing science, helping people...it's a good profession. I just...don't want to work that hard."
Therapist: "So, I'm anticipating there are a lot of other thoughts, feelings, etc., going on in your head. You've said before that you feel guilty and embarrassed for even feeling this way, because you feel lazy. Other people do as much or more work all the time, and they don't complain. Your dad did that much work, came home tired and grumpy, and he didn't complain - all to provide for the family."
Client: "Yeah...I feel like a jerk. But I still don't wanna be that person."
Therapist: "It sounds like you're feeling very conflicted. I wanna explore more with a thought-experiment. We've already talked about how some of the things you do to avoid doing work are actually pretty exhausting [let's pretend we did that]. You agreed to try a behavioral experiment and you found that when you don't procrastinate, you actually feel a bit less tired and a bit better at the end of the night."
Client: "That's right."
Therapist: "But you still don't want to be a workaholic - you don't want 'work' to be all that you're doing, five days a week."
Client: "Yeah, and then catching up on the weekend with chores, or stuff I didn't get done for work, or just recuperating cuz it's been a long week. I hate that!"
Therapist: "So you have this belief that you shouldn't be working that much - you should have time for yourself."
Client: "Yeah."
Therapist: "What would happen if you were? If you did work that much, every day, week after week. If you were a workaholic."
Client: "Well I wouldn't have time for me."
Therapist: "And what does that mean for you?"
Client: "I don't...I mean, I don't even know who I am now. How am I going to figure that out? How am I going to get better if all I have to do is work?"
[...okay, some relevant therapeutic stuff here. could talk about how current behaviors aren't really letting the client be himself either - effectively does almost the same thing as if he were a workaholic...tired, procrastinatory behaviors aren't productive or 'being himself' really anyway... but we'll continue with the downard arrow technique]
Therapist: "It sounds like you feel that if you worked that much, as much as you think you have too, then you'd always be in the same place you are now - not knowing who you are, not getting 'better'."
Client: "Yeah...and I need to get better. I don't like how I am now."
Therapist: "So if you were to work 'that much,' you wouldn't get better or learn about yourself. What would happen if you didn't get better or learn about yourself?"
Client: "Well *sniff* I'd be stuck like this. Alone and broken."
Therapist: "I can see this is hard for you... I know it's painful, to feel that you won't get better. [pause] I want to point out though that you are saying you are now alone and broken, but before you said you didn't know yourself - so you feel there's more to you then this."
Client: "Yeah. I mean, it can't be like this forever, can it? I dunno."
[alright, good sign: patient got visibly upset - always good if the emotional experience is in the 'present' - often times the 'problem' occurs because the client is trying to avoid thinking about the problem, or avoiding the triggers]
Therapist: "So let's assume just for the moment that you had to work that much, and working that much had you 'stuck' as you are, which is alone and broken (as you said). What does that mean about you?" [This part is interesting. According to our textbook, asking "What does this mean to you?" will generally get you intermediate thoughts, whereas "what does this mean ABOUT you?" will more likely get core beliefs...arguably we already have a core belief, about the client feeling 'broken', and perhaps 'alone'...but generally negative core beliefs are in one of three areas: "useless," "hopeless," and ...uh, I tried to make the third rhyme, but any word I'd use would be inaccurate, so, it's "unloveable'.]
Client: "No one will love me. I'll be like this forever."
Therapist: "So you don't want to work because you want 'get better,' and someday be loved."
So, there we go. Stupid personal vulnerable core belief: I'm worried about never being loved. Yeah, I knew that. That's kinda the one I was avoiding. *sigh* Stupid breakup. I was procrastinating like crazy before the break-up too (because, remember, there were other reasons I was procrastinating - not just to avoid over-working and not being loved). I actually needed to work more to get to the point that code-name: Fox could be with me...grr...
Anyway. My point, now we have a core belief. And we can work on it. It's not as realistic when it's considered in the light, and we can do things to challenge our behaviors and thoughts, to promote the less-activated positive core beliefs (because there are positive ones too). Generally the therapist works on a number of automatic thoughts before going to the deeper stuff...and generally the therapist doesn't target the core belief directly (it's quite resistant), but they can promote positive core beliefs anyway, and give evidence for them. "I can be loved," "some people like me," etc. It helps.
...well...it's not helping me much now. But again, it takes time. *sigh*
procrastination,
auto-therapy,
cbt,
workaholic,
workaholiphobia,
automatic thoughts