If you’ve ever typed “types of therapy” into a search tool and felt more confused after reading the results, you’re not alone. Terms like cognitive behavioral therapy, dialectical behavior therapy, and EMDR can sound clinical and intimidating, but this guide helps you understand these approaches with definitions written for real people like you.

Whether you’re considering therapy for the first time, exploring options for a loved one, or simply trying to ask better questions when working with a therapist, we can help you through it all.

Why Knowing Your Therapy Options Matters

The beauty of therapy is that there is no one approach: it looks different for everyone, depending on their needs. The right treatment for someone navigating grief may look very different from what works for someone managing borderline personality disorder or processing childhood trauma. You may have heard of cognitive-behavioral therapy (CBT), which is very effective for many people, but it’s just one of many therapy approaches that trained professionals can use.

Knowing what’s available and which modalities address different needs empowers you to have informed, meaningful conversations with potential therapists or current therapists. It also helps you trust the process once you begin the healing journey.

The Most Common Types of Therapy, Explained

How Do You Know Which Type of Therapy Is Right for You?

The truth is: You don’t always know in advance, and that’s okay. Most skilled therapists are trained in multiple modalities and will tailor their approach to your specific needs, history, and goals. The most skilled therapists have a diverse toolkit of methods they can draw from, adapting their approach to match each person’s unique needs, interests, and developmental stage.

That said, going in with some knowledge gives you the ability to ask meaningful questions. When looking for the right therapist, or during your next session, try asking your therapist these questions:

Asking these questions will help you find the right fit for your healing journey, and a good therapist will welcome them.

A Quick Reference: Therapy Types and What They Address

There are so many therapeutic approaches out there, and we’ve only covered a few. Still, here’s a breakdown of the theories we discussed and what they can help support:

Taking the Next Step

Understanding these approaches is the first step in building a better you. Finding the right therapist is a significant part of improving your mental health, but you don’t have to do it alone. GoodTherapy’s therapist directory allows you to filter by therapy type, specialization, location, and more, so you can find someone who truly fits your needs.

If you’re still exploring whether therapy is right for you, our blog on what to expect in your first therapy session can help you get started.

Remember, reaching out is not a sign that something is irreparably wrong with you. It’s a sign that you know your well-being is worth investing in.

Rational Emotive Behavior Therapy (REBT), developed by Dr. Albert Ellis in 1955, laid the foundation for the cognitive therapies. REBT is often taught in academic counseling programs and its techniques are still used by many therapists today.

Dr. Debbie Joffe Ellis is a licensed psychologist from Australia, a licensed mental health counselor, a presenter and writer, and an adjunct professor at Columbia University in New York City. She is also the wife of the late Dr. Albert Ellis, and she is widely recognized as an expert on REBT. She presents on REBT throughout the United States and abroad and wrote the second edition of the book Rational Emotive Behavior Therapy (2019).

On November 19, 2020, GoodTherapy will host Dr. Debbie Joffe Ellis for a 2-hour continuing education webinar, Rational Emotive Behavior Therapy: The Compassionate, Pioneering Cognitive Psychotherapy, available with 2 CE credit hours. You can learn more or register for the webinar, here.

In this interview, Dr. Joffe Ellis answers common questions about REBT and shares her take on its impact.

1. REBT was developed in the 1950s by your late husband, Dr. Albert Ellis. How different and/or relevant is the model today?

REBT is imbued with common sense, wisdom, tools, and techniques for achieving greater well-being, tranquility, compassion, and humor. This approach, model, and framework–as both a powerful and empowering therapeutic approach and also a way of life–is timeless. In some ways it may be more relevant than ever today, when there appears to be unique stresses and challenges impacting people across the globe.

REBT is not essentially different today than it was back then. However, as the person who my husband entrusted to carry on his work, I continue to emphasize–perhaps more strongly–the importance and benefits of gratitude and unconditional acceptance along with REBT’s basic philosophy, tools, and techniques.

2. How does REBT work? Is it evidence-based?

“We are empowered with the knowledge that we can create and control our emotional destinies.”A major premise in REBT is that it is not events or challenges that create our resultant emotions, but what we tell ourselves about those events and challenges that create them. REBT teaches that when we think in healthy rational ways, we create healthy emotions; when we think in irrational, demanding, and dogmatic ways, then we create unhealthy or debilitating emotions. With awareness and motivation we have choice. We are empowered with the knowledge that we can create and control our emotional destinies–no matter how difficult our circumstances may be. REBT encourages people to make ongoing effort to create and maintain healthy and life-enhancing changes in their lives, and to that end, it provides a variety of cognitive, emotive, and behavioral techniques and tools.

REBT is scientific and evidence-based. Unfortunately, it appears to me that some younger students and professionals in the therapy field may be unaware that REBT heralded in the cognitive revolution in psychotherapy, or may wrongly think that REBT came after cognitive behavioral therapy (CBT) or is a branch of CBT. Those ideas are incorrect.

REBT was first presented to the psychotherapeutic community in the early-mid 1950s. Prior to REBT, Freud’s Psychoanalytic approach dominated the field of psychotherapy. CBT was presented some 15 years after REBT’s presence in the field. Dr. Aaron T. Beck, known as the father of CBT, has often acknowledged Dr. Albert Ellis for the influence of REBT on his work and the inspiration and help Ellis gave him when he was working on his early research on depression and additional areas. Some correspondence between them can be seen in the Ellis autobiography, All Out!. In addition to there being a good amount of evidence-based research on REBT’s efficacy, the research on CBT also validates REBT since CBT is based on the major premises of REBT.

3. You’ve presented on REBT around the world to other mental health professionals. What do you find resonates with other therapists about this approach?

A person working as a mental health professional, or in other professions related to healing, human care, and/or education, is as fallible a human as any individual in other professions, but they may be more prone to professional burnout than people in other professions. Therefore, many of the healing professionals I have presented REBT to connect with reminders or teachings about the importance of self-care; unconditional acceptance of themselves, of others, and of life; the benefits of striving to apply compassion to ourselves; and to “walk our talk” by doing our best to practice what we preach.

Whether applying it to themselves, their clients, or sharing it with friends and loved ones, I hear from other professionals that they enjoy the practicality of REBT and its simplicity, elegance, and humor. The desire for such elements, and enjoyment of them, is universal.

4. How does REBT compare or differ from other models of therapy? What makes it unique in your opinion?

In my view, REBT is the most holistic of all the models I know of. Whilst other approaches contain elements that are seen within REBT, none that I know of contain all of those elements. REBT is no-nonsense, practical, and do-able for vast numbers of people, and as mentioned earlier, it is imbued with compassion. It gives as strong and equal an emphasis on the importance of understanding emotions as it does on the importance of training ourselves to be in the habit of thinking in rational and life-enhancing ways.

REBT is unique in its focus on psychoeducation. In particular, teaching people how to, on their own, distinguish between rational and irrational thinking and between the healthy and unhealthy so-called ‘negative’ emotions. (‘Negative’ in this context does NOT mean bad, but indicates that they may be less pleasant than happy emotions, yet they are enriching and appropriate).

REBT is also unique in that it is both scientific and philosophical. It is humanistic to its core. A number of approaches that came after REBT, including some of those known as “Third Wave Cognitive Approaches,” are based on several of REBT’s principles. And REBT is believed by many to be the original contemporary ‘Mindfulness’ therapeutic approach. 

REBT also encourages self-sufficiency and empowerment, and it is an original ‘Self-Help’ approach. In addition to being contained in many forms of therapy, REBT elements can be at the foundation of coaching, executive coaching, and assertiveness training, and can be seen and heard to be enfolded into teachings of a variety of traditional and new age spiritual teachers.

5. What kind of concerns is REBT best-suited to help with?

REBT is proven to be effective in helping people with common everyday neuroses, as well as with complex disturbances and/or personality disorders. For the former group of people, short-term REBT therapy sessions can be marvelously effective, and REBT can become a way of life and living. For the latter group, longer-term help may be needed for successfully achieving therapeutic goals.

“REBT seeks to heal and change the root causes of disturbances, not simply to alleviate symptoms.” REBT has helped countless people suffering from disturbances and maladies that include addictive behaviors, obsessive-compulsive disorders, borderline personality, and posttraumatic stress. It seeks to heal and change the root causes of disturbances, not simply to alleviate symptoms.

6. What advice would you give a person in therapy who is trying REBT for the first time?

The advice, or rather encouragement, that I might give a client in therapy using REBT for the first time might include my urging them to reflect on their lives and the fact that our lives are filled with both probabilities and possibilities. I would encourage them to take time to cherish the power and opportunities they have, and if they choose to embrace and apply them, to craft a marvelous life:

• in which they experience daily gratitude,
• in which they apply their ability to adopt an attitude of realistic optimism and create healthy emotions–no matter how challenging the circumstances,
• in which they can also choose to help other people, animals, the environment, and/or other causes that enrich their lives and make the world a healthier place,
• in which they can focus each day on what is positive and good.

I would remind them that, with ongoing effort, change is not only possible, but inevitable. The choice and power to live a great and meaningful life is both achievable and in their hands!

Find a Therapist Near You

If you want to hear more from Dr. Debbie Joffe Ellis about REBT–its theory, principles, and common techniques–you can register for Rational Emotive Behavior Therapy: The Compassionate, Pioneering Cognitive Psychotherapy, a 2-hour online continuing education presentation on November 19, 2020.

References:

1. Ellis, Albert & Ellis, Debbie Joffe (2019). Rational Emotive Behavior Therapy. 2nd Edition. Washington DC: American Psychological Association.

As a mental health therapist, I often work with people who have difficulty making and keeping healthy friendships, as well as other relationships (coworkers, family members, partners, and the list goes on and on). Among the struggles I often hear is not knowing how to sincerely connect with someone.

One way to connect is by giving sincere compliments.

Compliments are a great way to connect because they make both the giver and the recipient of the compliment feel good. People enjoy being around other pleasant people, so if you make someone feel good, that person may be more likely to want to spend more time around and with you.

It might sound simple on the surface, but the people I work with in therapy sometimes struggle with how to give sincere compliments to others. I offer the following four tips to keep in mind:

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1. Be Genuine

Don’t give a compliment if you don’t mean it. If you tell someone you enjoy something when in reality it disgusts you, and they find out later, it may hurt your ability to be trusted or be taken seriously in the future. You don’t want to be considered a liar, no matter how good your intentions are. Genuine behavior is generally appreciated, and people may be more likely to respect what you say if you truly mean it.

2. Look for the Good

People enjoy hearing positive feedback. By focusing on the good, or the benefit, of someone’s personality, skill, interest, or other area you wish to compliment, you make it easier for a receptive response. If you find it difficult to compliment someone sincerely in a certain area, try looking at the situation from their perspective and what may have influenced their choices.

3. Focus on Your Feelings

When you focus on the pleasant feeling the recipient of your compliment feels, it feels good to them as well. When someone brings joy, love, or another pleasant emotion to someone else, it often makes them feel that same emotion in return.

4. Keep It Simple

Keeping your compliments simple and to a minimum may help strengthen your connection to the other person. When you give too many compliments, or engage in giving grandiose, complicated compliments, it can feel uncomfortable and a little off-putting. Keep your compliments to one to three at a time. In these situations, less is often more.

Dialectical behavior therapy (DBT) offers an entire module focus on learning skills to improve one’s interpersonal effectiveness (the way one communicates and connects with others). One of the skill sets in this module is a great way to help people learn how to give sincere compliments. To remember these skills, DBT uses the acronym GIVE:

• Gentle: Have a soft, gentle approach to your tone, word choice, and attitude.
• Interested: Be genuinely interested in the person and the content of your conversation.
• Validate: Think about and let the other person know their experience is real and understandable, even if you don’t agree with it.
• Easygoing: Be flexible and have an easygoing manner.

An example of a sincere compliment using the GIVE formula is as follows:

• Gentle: “You’re a good friend.”
• Interested: “I really appreciated your help with my project the other day.”
• Validate: “It wasn’t easy, but we got through it. Your helpfulness is really great!”
• Easygoing: “Thanks, buddy.”

I’d love to hear your experiences giving and receiving compliments. Please share your most appreciated compliments below and how it felt to give or receive them.

Somatic psychotherapists often use the informal metaphor of a “container” in describing a person’s state of overwhelm or resilience.

It’s a simple concept: If Janelle is experiencing a lot of stress, and/or her system isn’t very resilient, then one can say her container is overflowing, or close to it. On the other hand, if she successfully deals with her feelings and the external situations that cause them, she would create more “room” in her figurative container and she wouldn’t be so vulnerable to becoming stressed out. She could also work with a therapist in order to develop affect tolerance and self-regulation. She would then be making her container larger and less brittle, increasing her resilience across many life situations.

The container can be filled by our response to events earlier in our lives that we’ve repressed and not dealt with. Researchers and clinicians working with intergenerational trauma believe our containers hold the trauma passed down to us from the experiences of earlier generations. Such experience includes but is not limited to systemic racism and oppression. The field of epigenetics looks at changes in gene expression (which pieces of our DNA strands are being expressed, and which aren’t). These changes are thought to be responses to the environment, either current or historical. On the other hand, our containers can also be filled by present-day, acute stressors that we’re all too aware of. In practice, it’s usually a mix of both, and they can be interrelated.

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Sometimes it isn’t immediately evident how full the container is becoming, because we are experts at hiding this from ourselves and the world. When talking about this with a person in therapy, I’ll often use the metaphor of my coffee cup. It’s a metallic travel mug, and when I hold it up, you can’t immediately tell how full it is. It could be nearly empty, or it could be close to overflowing. (It’s just a visual example. No fair trying to gauge my mood in order to figure out how much coffee is inside me rather than still in the cup!)

If the level inside the cup gets too close to the top, it overflows easily. This overflow would represent having a “meltdown”: panic attack, relapse into addictive behavior, major depressive episode, etc. Sometimes this surprises the person, as they hadn’t been consciously aware of the rising level in their container.

Psychology is the study of human thoughts, feelings, and behaviors. It shares some overlap with sociology, political science, anthropology, etc. However, most clinical psychology focuses on the individual and their cognitive, developmental, marital, or family dynamics. After many years in this field, I would guess that the majority of what’s discussed in therapy rooms does not focus on larger cultural, sociopolitical, large-scale economic, or environmental factors. Or such factors may be acknowledged, but therapeutic interventions usually focus on the micro (person/family) rather than the macro (environment). In that sense, therapy can be a bit myopic at times.

If the level inside the cup gets too close to the top, it overflows easily. This overflow would represent having a “meltdown”: panic attack, relapse into addictive behavior, major depressive episode, etc. Sometimes this surprises the person, as they hadn’t been consciously aware of the rising level in their container.

However, just because we’re repressing something doesn’t mean it’s not affecting us and filling our figurative containers. The emerging fields of ecopsychology and ecotherapy assert that humans have an ecological unconscious. That is, since we are born of earth and our entire existence depends on our fragile biosphere (and the other species we share it with), anything threatening our planet causes stress and anxiety in us. Just about everyone I talk with has tremendous anxiety about the future of our environment, and for good reason. This often invisibly adds to the total “volume” inside our containers; and since people often tend to feel helpless about large-scale events, it may increase their tendency toward immobility and dissociation.

For some people, it might be a useful exercise to write out a list of all the things they can think of that could be impacting their stress levels. However, for many other people, if their container is filling up, then the exercise of looking at everything at once could send them into depression, immobility, or even panic (“Oh, my god, it’s so much worse than I’d thought!”). Somatic therapists are trained to gauge a person’s autonomic stress response on a moment-to-moment basis and intervene as needed, coaching the person in taking on a manageable amount at any one time, and using that experience to grow stronger.

In my opinion, the goal of therapy is to increase a person’s self-regulation, which increases coping, health, joyfulness, and myriad other desirable outcomes. People who are able to self-regulate tend to be more aware of their overall stress levels, including “whole-world issues.” They may be less prone to anxiety, depression, and immobility, so they can engage in effective self-care, including taking action to better their lives and the greater world.

References:

1. Bell, A. (2016). What is self-regulation and why is it so important? Retrieved from https://www.goodtherapy.org/blog/what-is-self-regulation-why-is-it-so-important-0928165
2. Sashin, J.I. (1985, April). Affect tolerance: A model of affect-response using catastrophe theory. Journal of Social and Biological Structures, 8(2): 175-202. Retrieved from http://www.sciencedirect.com/science/article/pii/0140175085900089
3. Shulevitz, J. (2014). The Science of Suffering. New Republic. Retrieved from https://newrepublic.com/article/120144/trauma-genetic-scientists-say-parents-are-passing-ptsd-kids
4. Smith, D.B. (2010). Is There an Ecological Unconscious? New York Times Magazine. Retrieved from http://www.nytimes.com/2010/01/31/magazine/31ecopsych-t.html
5. Weinhold, B. (2006, March). Epigenetics: The Science of Change. Environmental Health Perspectives, 114(3): A160-A167. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1392256/

Enmeshment, a family dynamic that can be described as blurred boundaries between members, can make it difficult or impossible for a child to develop an individual sense of self because they are overly concerned about others. Family therapist Salvadore Minuchin brought this concept to light in the 1970s, and the topic has become common in psychological discussion of late. But what exactly constitutes enmeshment? How does it develop? And how can it be addressed?

Recognizing Enmeshment

Typically the roots of enmeshment can be traced back to parents who over-identify with a child, a dynamic often passed down through generations. Within this dynamic, boundaries are blurred—and may even be viewed as undesirable—and the parent may regard the child as an extension of the parent, rather than their own person, and treat them accordingly.

As a result, children of enmeshed family systems often develop emotional ties that elicit confusion, and they may fail to develop autonomy. An underdeveloped sense of autonomy may make it difficult for the child to act on desires that differ from the parent’s or lead a child to feel guilty when attempting to act on their own feelings. The enmeshed parent may also take it personally when a child attempts to demonstrate autonomy or independence, which can have a harmful impact on the child and the family dynamic overall. [fat_widget_right]

Enmeshment between a parent and child makes it difficult for the emotions of the child to be separated from the emotions of the parent. It can be said, then, that a child may take on emotional pain the parent carries from enmeshment in their own family of origin. This is not uncommon and is often done unconsciously—a child does not realize they are taking on the parent’s emotional pain or that it is not theirs to carry.

Another way of looking at it is to think in terms of “absorbing” the emotional pain of the parent. A parent who is projecting emotional pain is likely not consciously aware they are doing it but simply repeating the cycle that played out in their childhood.

Avoiding Enmeshment

To avoid becoming enmeshed with their children, parents must have their own sense of purpose in life, their own hobbies and passions separate from their children. A parent’s self-worth cannot rely a child’s behavior or accomplishments.

To avoid becoming enmeshed with their children, parents must have their own sense of purpose in life, their own hobbies and passions separate from their children. A parent’s self-worth cannot rely a child’s behavior or accomplishments. When one’s self-worth is defined by the actions or choices of one’s child, the pressure on the child to perform, to fulfill expectations, becomes heavy and burdensome. A parent’s self-worth is not the child’s responsibility, and children who take on this charge, consciously or unconsciously, often fail to develop self-esteem and/or a sense of personal identity.

Children generally rely on their parents for support. But before a child can expect to receive this support, they generally need to know the parent is emotionally strong and that the parent will support the child as they are, not only as who the parent wants them to be. When a child is secure in this knowledge, they will typically feel free to be themselves and to follow their own passions without feeling responsible for a parent’s emotional pain or disappointment.

In families affected by enmeshment, children may avoid seeking help when they experience difficulty or dilemma in life, fearing that the parent will impose their own agenda rather than offer guidance and support. When parents model good self-care habits, appropriate boundaries, and regulated emotions, on the other hand, children are more likely to desire to spend time with them, as opposed to when a child simply feels obligated to take care of their parent or manage their parent’s emotions. (Experiencing difficulty with dysregulated emotions? A therapist can help.)

Addressing Enmeshment

What can parents do to address enmeshment? Seek the help of a qualified family therapist or counselor if you recognize any of the following signs in your parent-child dynamic:

• Your child is your sole purpose in life.
• You take care of your children at the expense of taking care of yourself.
• Your self-worth is defined by your child’s behavior, accomplishments, or lack of accomplishments.
• Your child is the barometer for your happiness.
• Boundaries between you and your child are blurred or frequently crossed. For example, you find it necessary to know everything about your child’s daily life, such as what they say or do when not in your company.

What can an older child or adult child do to remedy the impact of an enmeshed relationship with a parent?

• Seek professional help from a family therapist who works from a family systems model, once the dynamic of enmeshment is recognized.
• Practice taking responsibility only for individual feelings instead of taking responsibility for the feelings of others.
• Further, practice taking responsibility for individual feelings instead of expecting others to do so.
• Those who recognize the dynamic of enmeshment being repeated in their relationships can work with a therapist who uses a family systems model and take steps to address this pattern and break the cycle.

Children in enmeshed families may view the parent-child relationship as an obligation or burden and, when they reach adulthood, seek out relationships that perpetuate this dynamic. Parents who take responsibility for their own self-worth and emotional pain, however, are likely to have healthier relationships with their children, where the children make the choice to be involved in their parents’ lives and are able to establish their own healthy, independent relationships.

Reference: 

1. Heru, A. M. (2015). Families in psychiatry: Unpacking enmeshment issues. Clinical Psychiatry News, 43(5). Retrieved from https://www.questia.com/magazine/1G1-417736319/families-in-psychiatry-unpacking-enmeshment-issues
2. Lewis, C. (2013, July 8). The enmeshed family: What it is and how to “unmesh.” Retrieved from http://www.mariadroste.org/2013/07/the-enmeshed-family-what-it-is-and-how-to-unmesh

No matter how comfortable you may be with your sexuality, the idea of sex therapy can be intimidating. Many of the people I work with in sex therapy struggle with sexual functioning or desire, issues that often come loaded with complicated emotions such as anxiety. These things can be difficult to talk about, let alone try to do something about—even when it is understood that the person you’ve enlisted to help you is a compassionate and nonjudgmental professional.

For men in particular, socialization related to sexuality can add to these complexities. Although not uncommon, the experiences of premature ejaculation or erectile dysfunction can bring deep feelings of shame—even in committed relationships with partners who are understanding and patient. Many men are socialized to believe sex should be easily enjoyable and they should always be in control. When it doesn’t work out this way, some may feel intensely inadequate or weak. Men in these situations may question their worth as partners and even as human beings. If a partner isn’t understanding or patient, these feelings can be amplified.

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As a sex therapist, I am trained in specific techniques that men can utilize to resolve a variety of sexual concerns. However, these techniques are often insufficient in addressing premature ejaculation and erectile dysfunction. Given the complexity of these issues, holistic sex therapy can play an important role.

It’s natural to seek out strategies that focus on physical functioning—the most obvious symptoms of sexual issues—but sex is more complicated than that. There are thoughts, narratives, emotions, and processes associated with the act of sex. These elements can greatly affect desire and pleasure. They can also impact bodily control and responses.

Sensory issues must also be addressed. The body tells its own story. Sometimes this story matches up well with the mind’s story about a problem, other times not so much. In these situations, people can benefit from learning about the activation cycles of their bodies—knowledge they can then incorporate into their sex lives.

It’s natural to seek out strategies that focus on physical functioning—the most obvious symptoms of sexual issues—but sex is more complicated than that. There are thoughts, narratives, emotions, and processes associated with the act of sex.

Holistic sex therapy is also about identifying cultural and social narratives surrounding sex. Not only can this exploration help people understand some of the roots of what they experience, it can also help them learn about ways their sexuality has been impacted, and how their bodies respond to these ingrained stories. Through sharing and understanding, validation can lead to healing and growth. It can also lead to sexual confidence that reflects acceptance of these influences while also challenging them.

Religion and spirituality can also play a role. These two elements can be related, of course, but they can also be very different. In fact, they can even contradict each other. Certain forces of religion, when deeply embedded, can overtake a person’s ability to sexually express themselves. Meanwhile, spiritual meaning can be difficult to ascertain.

In holistic sex therapy, self-esteem work is also relevant. When people recognize the barriers that are leading to their sexual issues, they may have to rediscover what they value about themselves.

Certainly, relationship issues can be a factor as well. Many men masturbate with no problems but struggle with sexual function with partners. Sometimes, this can be related to feelings about partners and their expectations, which may or may not be based in reality. When men unpack this in therapy, they’re typically better able to see what’s getting in the way of arousal, control, and desire.

Sound like a lot? Well, that’s because it can be. Sex can be complex, especially when you delve beyond the presenting physical issues and explore emotions and cultural influences. It’s rarely just one thing. Although many people tend to think of sex as primarily a physical act, there’s a lot more to it. Therapy that doesn’t explore these often hidden aspects does a disservice to the people who seek it.

Recently, when I put my 6-year-old son to bed, he reminded me of something I can sometimes lose sight of, particularly when I’m anxious or worried. As I kissed him on the forehead, he said, “No fair.”

“What’s no fair?” I asked.

“You kiss me more than I kiss you,” he said.

“Well, and isn’t that good? When I give you a kiss, doesn’t that raise your love meter?”

My son rolled his eyes in the greenish glow of his Teenage Mutant Ninja Turtles night-light.

“Your love meter gets higher from giving love,” he said.

This idea—that love is something we get more of by giving it away—is a radical one, though it’s nothing new. Folks as varied as St. Francis of Assisi, Mahatma Gandhi, and Martin Luther King Jr. have encouraged people to cultivate true wealth and freedom through conscious unconditional loving, for their own and the world’s sake.

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For many of us, though, living from this principle is easier said than done. The experience of feeling vulnerable and threatened triggers our fight-or-flight response, and it becomes hard to remain aware of ourselves and of our options as we relate to others. Usually, we default to our habitual defensive positions—blame, avoidance, projection, rationalization, just to name a few. And yet, being able to tap into our capacity to give love—even when we’re scared—may be an urgent necessity if we want to preserve our sense of agency and balance in the aftermath of one of the most anxiety-provoking transfers of power in American history.

For one thing, our agendas and ulterior motives have a way of creeping into our words and actions, influencing how the love we try to give those around us is experienced. Sometimes, it’s not attuned to what the recipient needs, like the porridge in Goldilocks and the Three Bears. It’s too hot or too cold, too much or too little. Sometimes, the love we offer reaches its recipient contaminated by our concerns and preoccupations, and we feel hurt when it’s shrugged off, minimized, or ignored.

Defenses against receiving love, or giving it, aren’t necessarily good or bad. We learn to defend ourselves against taking in the very things we deeply want for important reasons, including our own psychic survival.

When the tables are turned and we’re on the receiving end, we get to experience firsthand how hard it is to take love in: whether it’s in the form of a goodnight kiss, a hug from our partner, or a stranger’s compliment, opening our hearts requires something from us we’re not always willing to give: trust, surrender, vulnerability, emotional availability, or even self-love. If you feel unworthy of it yourself, how can you accept it from another?

Defenses against receiving love, or giving it, aren’t necessarily good or bad. We learn to defend ourselves against taking in the very things we deeply want for important reasons, including our own psychic survival. Even if we can’t remember having ever truly trusted another human being to love us selflessly, for exactly who we are, we’ve all counted on someone’s appreciation or approval only to experience it withheld or withdrawn. We’ve all opened to another’s concern and felt it suddenly morph into something suspect, a projection or judgment, a form of control. As sensitive beings imprinted with these types of experiences, it’s not unusual to grow up wary about receiving the emotional gifts others offer us, lest they turn out to be Trojan horses or a version of Narcissus using us for a mirror.

As therapists, one of our jobs is helping people understand what gets in the way of taking in the love that’s already in their lives, even when circumstances are difficult. The more people can access and metabolize the love they’ve been disregarding or ignoring, the more it can nourish them and help them love others. In accelerated experiential dynamic psychotherapy (AEDP), the way in which people take in others’ emotional offerings—referred to as our “receptive affective capacity”—becomes rich ground within the therapeutic relationship for exploring, understanding, and expanding this ability well beyond the therapy session.

The relationship between giving and receiving love can seem like a riddle worthy of a sphinx—a human conundrum we begin grappling with early in our lives, as my 6-year-old son reminded me with his take on the true metrics of love. However you frame it, being able to receive love from another seems to be inextricably linked with our own desire and ability to give it. Finding ways to expand our own and others’ capacity to take in and produce love locally, rather than seeking it elsewhere, has the potential to create a more stable and sustainable psychic economy.

When a person is in need of an organ transplant, a process referred to in medical circles as a “transplant work-up” begins. This process is lengthy, as it is necessary to make sure the person is medically and psychologically fit for organ transplantation. Often, a social worker who works with transplant cases will conduct the psychological evaluation to identify any mental health issues the person may have that warrant consideration, as well as take stock of the emotional support network currently in place.

Typically, the emotional support network consists of family, friends, and the person’s transplant team. The transplant team includes doctors, nurses, and social workers. During the transplant work-up process, at the time of the transplant, and immediately after transplantation, the person has access to potentially dozens of people who can provide emotional support. The emotional support provided is almost ’round-the-clock if the person is hospitalized while waiting for transplantation. If the person is stable enough to remain at home while waiting for transplantation, they are in and out of doctor’s appointments so frequently that they, too, have consistent access to emotional supports as part of ongoing care.

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What happens after organ transplantation? In the year following the procedure, the person continues frequent visits to doctors’ offices and the hospital for invasive check-ups to control for rejection and illness, as the person is immuno-suppressed. These frequent visits allow for continued access to professional emotional supports. However, as the person begins to improve physically, the appointments steadily decrease and may decline to as little as once per year. With this decline in physical check-ups, the person gradually loses ready access to professional forms of  emotional support. The transplant social worker is constantly working with new patients, and the cycle continues.

Organ transplant recipients may not have identifiable mental health issues pre-transplant, but lifestyle changes, medications, and immuno-suppression—necessary for the organ transplant to be successful—can take a toll mentally. Transplant patients can experience depression, anxiety, grief, survivor’s guilt, and other concerns. Sometimes, life becomes much more difficult after transplant due to unforeseen complications, job loss/change, loss of insurance, and a shift in caregiver roles. Sometimes, people are not able to do the work they once did. Transplant recipients may not be accustomed to a daily medication routine.

How do we balance the “gift of life” that organ donation represents with the emotional toll a transplant can have on an individual?

Post-transplant, people may become hypercritical of their own thoughts, feelings, and behaviors, especially if those thoughts, feelings, and behaviors do not align with the “gift of life” ideology commonly associated with transplantation. How do we balance the “gift of life” that organ donation represents with the emotional toll a transplant can have on an individual?

Person-centered therapy can help transplant recipients by giving them more control, with appropriate guidance. Transplant recipients have not had control over their illness or their treatment. Person-centered therapy can help by allowing the transplant recipient to process their experience and develop a more cohesive sense of self.

The genuineness, unconditional positive regard, and empathic relationship that is the nature of person-centered therapy can allow for deep healing among transplant recipients. Each transplant recipient has a unique experience to share. Some have been sick for years, some caught a fast-acting virus while on vacation abroad. Some are young, some are not. Person-centered therapy encourages the individual to choose the topics discussed in session, navigate and find solutions to their concerns, and decide how often to meet and when to stop therapy. For many, it’s the first step toward regaining a sense of agency in their lives.

People seek counseling for any number of reasons, but something every person I have ever seen had in common is wanting to feel better quickly. I can hardly blame them. When I am not feeling well or things aren’t going right, I want things fixed in as little time as possible.

It is part of our human nature to seek solutions. When we are in pain of any kind, the brain immediately starts scanning to find a way out of the discomfort. The reality is that, for most of the people I work with in therapy, it takes time to work through and resolve the issues at the root of their pain. A longer-than-expected timeline for relief can be discouraging for the person seeking help. To give a person some degree of relief in the present moment, it is necessary to implement stabilization and coping skills so they can begin improving their quality of life and functioning.

There are so many options when we starting talking about coping and stabilization skills. Go to the self-help section of any bookstore and you will see several selections for coping with life. I have a bookshelf and a file drawer full of countless options, and it can be overwhelming to decide where to start. Each skill has its benefits and strengths, and it’s handy to have a variety of tools for handling life’s stressors. That said, I have a favorite: the simple, yet powerful, breath.

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This is where I start with most people: just breathing, paying attention to the breath, and noticing the depth and rate. It sounds so easy, right? As straightforward as it may seem, the breath has serious influence when it comes to calming the nervous system.

Let’s talk about science for a moment. Bessel van der Kolk (2012) does an excellent job of explaining how the nervous system operates in his book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. In the book, van der Kolk discusses Stephen Porges’ Polyvagal Theory, which is all about the role of the vagus nerve in arousal and social engagement.

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It comes down to this: We have two branches of the nervous system. The sympathetic nervous system, which can be considered “the accelerator in the nervous system” (van der Kolk, 2012), controls levels of arousal and the fight-or-flight response so we can effectively respond to threats. When this part of the nervous system is activated, the heart rate goes up, breathing becomes shallow and fast, and blood rushes to the extremities in preparation for fight or flight following the cues being sent from the sympathetic nervous system.

By connecting to the breath, you are able to be in the moment, becoming more mindful with what is happening now as opposed to engaging in the mental chaos that so often distracts us from what is actually happening around us.

Of course, this reaction is not activated only in response to actual threats to safety. It also happens in response to life’s stressors, including any core issues or traumas we haven’t yet worked through. Therefore, we end up experiencing all of the physical and mental consequences when are in a state of chronic sympathetic nervous system arousal (van der Kolk, 2012).

The other branch of the nervous system, the parasympathetic nervous system, is “the brake of the nervous system” (van der Kolk, 2012). The vagus nerve controls this part of the nervous system and can be broken down further to the dorsal vagal complex and the ventral vagal complex. The dorsal vagal complex is designed to drop your body into a freeze-and-flop response when the sympathetic nervous response is unsuccessful in achieving fight or flight. This is the state of shutdown or hypoarousal (van der Kolk, 2012).

Similarly, the ventral vagal complex also slows the body down, but it differs from the dorsal vagal complex in that its main function is not to respond in an extreme way to a threat or high levels of stress. Rather, it activates a relaxation response and helps the body to grow, heal, and digest. It also helps us to seek out and connect with others. When the ventral vagal complex is activated, we can feel a wide range of emotions but the nervous system is not overwhelmed and thus does not have to enter the shutdown response.

Here is where the breath comes in: When you breathe out slowly and mindfully, the ventral vagal complex is activated and your body is able to relax. More blood is directed to the parts of your brain that are involved in problem solving, and you are able to enter the state of social engagement. By connecting to the breath, you are able to be in the moment, becoming more mindful with what is happening now as opposed to engaging in the mental chaos that so often distracts us from what is actually happening around us. By specifically paying attention to exhaling, you are simultaneously calming the body and the mind (van der Kolk, 2012).

Harnessing the power of the breath is something we all can benefit from at any time. Regardless of whether a person is in therapy, we all need to calm the nervous system from time to time. Being mindful of the breath can help a person to deal with everyday stresses that we all inevitably encounter. Simply paying attention to breathing can help us to focus better and, therefore, make us more productive and effective in our lives.

Reference:

van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Viking.

As we begin, here is an invitation for you:

In your mind’s eye, create a mental picture of a wolf. The wolf is alone; perhaps he is a young male who’s just left his mother’s side, setting out for his first solo adventure. The sun is setting, and our wolf is atop a hill, standing, all four paws on the ground. His head is high, his eyes scanning the horizon. His ears are perked, swiveling to capture sounds from all around. His nose receives all sorts of information from the evening breeze, information that would be imperceptible to us, his human observers. Perhaps his tail is lifted ever so slightly as it curves gracefully behind him. He is fully alive, vibrant, and completely in the present moment.

Now imagine what it would feel like to be that wolf. Feel the pads of your four paws on the ground, the bones and sinews of your legs supporting your spare, muscular torso. Feel your spine elongate as you gently test the wind with your finely honed sniffer. Feel the strength and springiness in your shoulders, your haunches. Imagine you are ready to respond in a split-second to any tiny change in the environment, reacting from instinct before you can even think about it.

Feel the energy that arises in your body as you spend a moment with this experience. And congratulate yourself, because in doing this exercise, you are contacting your felt sense.

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The felt sense is a term coined by Eugene Gendlin to describe our innate sense of everything we know and experience in a wordless, non-cognitive way, from the interior of our bodies. The common term “gut instinct” is closely related, as is the scientific term interoception, the process of sensing inside the body. Dr. Gendlin founded a school of therapy he called focusing. Essentially, focusing involves paying attention to our felt sense, and learning how to work with what it has to say. As the focusing website says, “This sensation in your body is called a ‘felt sense.’ It lies behind your thoughts and feelings and is significant and full of meaning. It is a message from your body to you, and will speak to you when you listen.” As Dr. Peter Levine is fond of saying, its language is sensation.

Much of this non-cognitive, somatic information involves not only our body, but also our reptile brain. As I have noted in previous articles, we are interested in the body and the reptile brain because this is where most mental health symptoms “live.” The felt sense is the place where we can work with painful symptoms to get them to subside. Then, the energy these symptoms used to drain from us becomes available for more joy and more productive engagement with the world.

Although modern Western thought has been quite resistant to this idea, there are other valid ways of knowing things besides our thoughts. In some cultures, people regularly converse about this innate, biological, or instinctual source of knowledge. As owners of living, human bodies, our access to our intuitive felt sense is our birthright! It is where the experiences of pleasure, joy, and liveliness originate.

Our felt sense is incredibly useful when we cultivate a relationship with it. As the focusing website points out, “Your body knows more about situations than you are explicitly aware of. For example, your body picks up more about another person than you consciously know.” Although modern Western thought has been quite resistant to this idea, there are other valid ways of knowing things besides our thoughts. In some cultures, people regularly converse about this innate, biological, or instinctual source of knowledge. As owners of living, human bodies, our access to our intuitive felt sense is our birthright! It is where the experiences of pleasure, joy, and liveliness originate. Unfortunately, there is very little discussion or guidance about the felt sense in our culture.

So, then, how do we cultivate a better relationship with this “interior us”?

Well, some of us have to be careful about it. If we have a trauma history, whether or not we’re aware of it, the felt sense is (predominantly) where it lives. In my experience, this is why some people have a difficult time even accessing any of their interior sensations: They are dissociated (disconnected) from their inner selves as a protection from the traumatic residue.

Unfortunately, shutting down pain inherently involves shutting down at least some pleasure. On the other hand, some people experience emotional flooding, physical pain, or other distressing experiences when they turn their focus inward. Of course, this is not true for everyone. People’s experiences with their inner selves vary greatly, largely depending on their life histories. Many people already have a rewarding and lively relationship with their inner lives—and that is ultimately one of the primary goals of somatic psychotherapy.

For more information about focusing, please refer to the focusing website. For those who suspect or already know that contacting this aspect of themselves can be challenging, I would recommend working with an experienced guide, such as a somatic psychotherapist. The work of Dr. Levine uses the felt sense as one of several fundamental tools for trauma healing. Pursuing such therapeutic support can greatly help in reclaiming access to one’s birthright of joy and vibrant well-being.

References:

1. Gendlin, E. (2016). What is Focusing? The International Focusing Institute. Retrieved from http://www.focusing.org/newcomers.htm#what
2. Levine, P. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley, CA: North Atlantic Books.