What Are You Telling Yourself? (Part I)
I sat down with Johnny Strike, author, musician, former counselor, and founding member of San Francisco's earliest punk band Crime. He conducted a wide-ranging, in-depth interview with me in which we discussed self-esteem, addictions, procrastination, obesity, psychoanalysis, Albert Ellis, REBT/CBT, and more. I wish to share the results with my readers.
Johnny Strike: You have written that panic attacks are best dealt with by realizing that life is full of discomfort, and then convincing yourself of that fact by disputing the "unrealistic musts" they are thinking, but in severe panic attacks the person might not be in a frame of mind to intellectually look at their thinking like that. Wouldn't a better approach be to accept the fact that they are having an attack, and remind themselves that it's time limited, and not the end of the world, and then later work on the musts, and faulty thinking that could make the attacks even worse?
Michael Edelstein: The two are not mutually exclusive. Do both. Also daily write TMEs [Three Minute Exercises] on the problem. I'm not clear why working on musts and faulty thinking would make it worse.
JS: One may too stressed during the attack to find a paper and pencil to write out ABCs. It would seem to me that would be better prep or post work where as getting through the attack would be at the forefront, and repeating almost as a mantra: "This is time limited. This is time limited" could be more effective in the moment.
ME: I recommend whatever works best for any given individual. I suggest a wide variety of strategies. In general, as long as it's meaningful, the more reinforcement the better. The problem is people tend to tell themselves, "I'm too stressed to do it," then give up, thereby turning their misguided conviction into a self-fulfilling prophesy.
JS: How about popping a pill like Xanax to deal with anxiety attacks?
ME: It could be a temporary fix for some people, but usually does not change the underlying anxiety-creating philosophy. It highlights the difference between feeling better for the moment and getting better in the long-term. Clients sometimes request a quick fix. This is a misunderstanding of REBT. Rather, it's a life-long discipline.
Addictions and Procrastination
JS: I found your writings and techniques (disputing the musts) on dealing with those topics outstanding. My questions are:
1. What about the thinking that demands that one must not have musts, or that one must have them?
2. What do you mean by addiction? I may realize that smoking is not good, but I prefer to continue it anyway, let's say I cut down, and only smoke low tar, and feel it's an enhancement to my social life where with my other friends we get together after work for drinks and a smoke.
3. What about the contract idea especially to deal with procrastination?
ME: Excellent questions.
1. These are frequently the most pernicious kind of demands for one to have.
2. An addictive behavior as I define it involves any behavior you repeatedly engage in that blocks, sabotages, or interferes with your long-term goals. In the example you give, smoking is not necessarily an addiction according to this definition.
3. There are many possible strategies that could be effective in overcoming procrastination. Contracts is one. Experiment with many and use those that work the best for you.
JS: Many would argue with you that although it may all be your head, it could take time to realize that. For instance someone finding themselves a third through a box of chocolates before realizing they have failed in their goal. With a drug addict this reflective action could be so quick to seem involuntary.
Consider someone lighting a cigarette offered, and inhaling out of habit, then realizing the lapse, then shrugging it off since they're already smoking.
With aging there's the possibility of memory lapse. How does one problem solve that?
ME: The key involves preparing for these situations by daily practicing, practicing, practicing, cognitive, behavioral, and imaging strategies taught by REBT and CBT therapists.
JS: Today one hears the term self esteem used on a regular basis. it's become part of the language on talk shows and in everyday conversation. A common phrase is: He has low self-esteem, but you rarely if ever hear: He has high self-esteem, which is maybe a clue to what you have written and talked about, namely that the concept of self esteem is not a good one. Would you please elaborate some on your disagreement with popular culture's use and definition of this term.
ME: To esteem means to think highly of. Self-esteem means to think highly of oneself. Some individuals rate themselves as good people thereby giving themselves high self-esteem. However concluding you're a good person when you do well (and a bad person when you do poorly) is unempirical, illogical, and unpragmatic. There's no evidence to support it, it does not follow logically from the data, and it leads to poor results. The solution to the self-esteem problem lies in unconditional self-acceptance (USA), accepting oneself unconditionally as an imperfect human who acts imperfectly, never a god or a devil.
JS: Would you say that “self-esteem” is related to grandiose thinking, ego mania, and depression as well? Isn't it the case that PTSD (Post Traumatic Stress Disorder) is caused by having been the victim of traumatic events, not by thoughts or beliefs?
ME: 1. Yes, rating your total self highly, or high self esteem, is a type of grandiose thinking and can cause ego mania. Alternatively, low self-esteem can result in depression. The solution involves giving up all self-rating. You can work toward this end by recognizing you never can become a good human or a bad human. Rather, you're always an imperfect human who at times does well and at times does poorly. In Piagetian terms, we can call this perspective "Conservation of the Self." Since our emotions are caused by our thinking and since emotional stress is an emotion, this tells us PTSD is caused by our thinking.
The experience of the neurologist and psychiatrist Victor Frankl highlights this. In his book, Man's Search for Meaning, he relates how creating a meaning for himself during his Holocaust death camp suffering led him to ameliorate his own emotional stress and help his fellow victims with theirs. He called this "Logotherapy."
In addition, if we consider soldiers returning from war we recognize not all of them, perhaps a minority, have PTSD. If the risks of injury and death directly caused PTSD, then all veterans would be suffering from it.
JS: I know among your various projects you are working on a book about Sigmund Freud. I figure you are comparing his methods against Albert Ellis's. Three questions:
1. How far along are you, and is it being co-authored?
2. What do you see as the main shortcomings to Freud's theories and therapy?
3. I know that he inspired the Surrealist artists in Paris in the Twenties, mostly do to his work with dreams, and the unconscious. For me, anyone who inspired that movement has some value. Beyond this though do you find any other redeeming value?
ME: 1. The book, Psychotherapy Breakthrough, details the history of the psychotherapy movement, from Freud to Ellis. My co-authors are David Ramsay Steele and Richard Kujoth. It was published in August.
2. Freudian therapy is very superficial. Rather than helping the client overcome the core of his psychological disturbance, his irrational beliefs, it focuses on childhood memories, dreams, free association, and feelings.
3. Nothing substantive in the realm of psychotherapy.
JS: What about talk therapy? He is credited with developing this, and it is still part of many different therapeutic techniques.
ME: Good question. Talk therapy was around before Freud. Adolf Meyer, who developed psychobiology, was one of its noted early practitioners.
JS: And REBT was around with the Greek Stoics, but, I think we can safely say that he popularized it, as he did psychology itself.
ME: What he popularized was a toxic form of talk therapy. The world would have been better off without this.
JS: Albert Ellis finally called Freudian psychoanalysis "horse shit" but I find it interesting they he practiced it himself for six years. Ellis noted that most psychotherapists use some elements of unconscious thinking that Freud originally emphasized.
"One of the main things he did was point out the importance of unconscious thinking. Freud pointed out that when people are motivated to do things, that they unconsciously think, and even feel, certain things. We use that concept," Ellis said, adding, "Although Freud, as usual, ran it into the ground."
ME: Ellis seems to be using "unconscious" to mean tacit thoughts, rather than in the classical Freudian sense meaning thoughts that are repressed due to psychosexual conflicts threatening to the ego.
JS: Regardless, he gives him credit for it, at least in that interview.
JS: In your excellent interview on MentalHelp.net with David Van Nuys, Ph.D., you discussed psychoanalysis, and Van Nuys claimed that psychoanalytic thought and practice have evolved over the years and referred you to a paper by Dr. Jonathan Shedlera professor at the University of Colorado Medical School to support his position. Along with Shedler's paper on the "efficacy of psychodynamic therapies" based on a meta-analysis which he concludes that "psychodynamic therapies (are) as effective as CBT."
Have you followed up by listening to the interview Van Nuys conducted with him on Shrink Rap Radio? Or have you read Dr. Shedler's paper? If so what is your critique? Did you find any of it valid, or did you find it just more poppycock?
ME: I read The Efficacy of Psychodynamic Psychotherapy by Jonathan Shedler. In a sense, it's a meta-meta analysis in that it reports on a number of meta-analyses. He fails to describe the original studies in sufficient detail to evaluate their methodologies from his paper. He gives citations for some of these studies, but they're only available electronically to subscribers of the respective journals. Consequently, I was unable to read them and render an opinion.
In his detailed description of psychodynamic therapy, he fails to mention ascertaining the client's goals and working with the client to attain them. Moreover, he fails to include the use of homework or practice as an essential aspect of the therapeutic process. These appear to be essential aspects of successful psychotherapy, which leads me to remain skeptical of his conclusions.
(To be continued next week.)
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