Fighting Fear

Confronting phobias and other fears

Psychotherapy: Small Changes Can Have Big Effects

Don't snarl.

Psychotherapy is sometimes portrayed grandly as an attempt to change personality-- personality being no less than the sum of an individual’s feelings, thoughts and behavior, which together have grown up, in turn, out of the sum of that person’s past experience. Put in those exalted terms, psychotherapy cannot succeed. People are too complicated and too fixed in their accustomed ways. But the goal of psychotherapy is, nevertheless, to effect change; and meaningful, although modest, changes can take place. Therapy will try to make a patient who is fearful, less fearful, and someone else who is suspicious, less suspicious. Similarly, if someone comes to a therapist in trouble because he/she is angry all the time, or jealous, or inclined to give up too easily, or inclined to procrastinate, therapy will try to encourage that patient to be different.  It is a matter of learning to see the world and themselves more accurately. Patients do not necessarily want to learn anything new about themselves. They come to treatment because they feel bad in one way or another; but, in order to feel better, they must be willing to examine themselves, and they must change. Often, small changes have big effects.

A young, although not very young, woman came to treatment in the wake of a couple of disastrous love affairs, which overlapped briefly. She had a variety of minor OCD symptoms, but otherwise her complaints centered on her relationships with men. Talking to me, she went on at length about the shortcomings of men. Of course, I have heard many women point out to me many shortcomings of men, for example, “all they’re interested in is sex.” Or, “every man is going to be unfaithful.” These generalizations are not true, but they are not unfamiliar. I have heard them many times. This woman, whom I will call Cherise, had a view of men that I had never heard before:

“They fall into two groups,” Cherise said to me angrily. “They are either wimps, who live at home with their mothers and are super-passive, or they are super-competitive, macho types who are always boasting about their foreign cars and trying to put you down.”

This came as a surprise to me. I knew some women thought of men as a breed apart. I’ve heard men described as “narcissistic,” or “grandiose,” or “babyish,” or “self-centered,” or “unreliable,” or “sneaky,” even as “helpless”; but these two types had never been called to my attention before. When I expressed some skepticism, Cherise was able to tell me about four or five from each type, mentioning names. She had encountered them in her experience. Yet, she still wanted to get married, she told me.

Cherise tried to meet men in bars. This is not the ideal place for meeting someone you want to marry. I can think of two women who could only relax when they had been drinking—which meant that they spent an inordinate amount of time socializing in bars. They both married alcoholics that they had met in a bar. I think most people feel uncomfortable hanging out in a  bar. The men think the women are there only to cadge drinks; the women think the men are there only with the intention of finding someone for a brief, as brief as possible, sexual encounter.

This is what Cherise would do: she would stand at the bar, seething quietly and remembering all the miserable experiences she had with all those rotten men. And she drank. After a while, a man would approach her and say, hello.

“Whaddaya want?” she would reply with a snarl.

Now, think about that for a minute. Any normal, self-respecting man  being greeted in that way would smile, perhaps, and excuse himself. “Sorry I bothered you, lady,” one man said. But a certain kind of man—two sorts of men—would not.

1 Some men are so browbeaten, so passive, that they expect to be treated rudely. They are, in Cherise’s lexicon, wimps.

2. There are some men who regard encounters with the opposite sex as some sort of competition. They rise to the challenge of being treated rudely by responding in kind. Cherise would have called them Macho.

Cherise was constructing the world around her by her behavior.

After I got to know her, I made a suggestion. “Why don’t you—just as an experiment—try not snarling when a guy approaches you?”

By an effort of will, she smiled and said, “hello,” when the next man came up to her in a bar; and, guess what, she began meeting ordinary men who were not obviously, immediately, flawed. Sometime later, she married a man she had met in this setting. The marriage was holding together when I saw her last, a few years later.

Not snarling was a small change accomplished by psychotherapy. She was still recognizably the same person she had always been. Her personality had not changed, but her life had.

Similarly, someone’s life can turn around by:

Trying internet dating for the first time

Being willing to visit a doctor even though that person is terrified about what the doctor might say. (not only life-changing, but life-saving, in one case I know of.)

Applying for a job that seems out of reach.

Being willing to publicly address a business group.

And so on. These are all examples of how someone can be encouraged to engage in an unaccustomed, but critically important, act by psychotherapy. They are examples of how very small changes can have very big effects.(c) Fredric Neuman 2012 Follow Dr. Neuman's blog at fredricneumanmd.com/blog

 

Fredric Neuman, M.D. is the Director of the Anxiety and Phobia Center at White Plains Hospital.

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