STEPPING OUT OF THE BUBBLE

Make Way for a Different Kind of Thinking

2009-07-12T07:29:00.000-07:00

I distinctly recall when Nathan began seeing me for counseling. He was a skinny, sensitive kid with a big heart. At age 13, he struggled in the midst of a tumultuous custody battle that left emotional scars. My job was to prop him up - to give him hope that things would change for the better - and they did.

Nathan came back to see me three years after he had "graduated" from therapy. He brought his new guitar and treated me to few melodies in the privacy of my own office. He was serenading me - it was a gift for being there for him. However, Nathan's visit took on a more important purpose. He came to tell me, in so many words, how he had become a different kind of thinker - the type of young person who inevitably would change the very foundations upon how we view matter and energy and life itself. At age 16, Nathan had graduated from a college preparatory high school and made his way to a prestigious university to study nanotechnology.

As I intently listened, Nathan explained that nanotechnology will allow us to snap together the fundamental building blocks of nature more easily, more cost effectively, and in a way that is permitted through the laws of physics. Nanotechnology has the ability to transform our thinking about science, physical health and disease, emotional well-being, computer programming, and travel to outer space. Not only was Nathan "studying" this complex, molecular thinking, but he was actually conducting research with the world's greatest scientists in this technological field.

Like an H. G. Wells of his time, Nathan passionately projected what the world would look like in the next 15 years due to his work. His words seemed prophetic and powerful, and I sense that I was sitting before one of a new age of young people - the dreamers, the problem-solvers, the visionaries who would create a new way of thinking about thinking. These are not “egg-heads,” but balanced, well-rounded kids who have the capacity to not only reflect on problems but to communicate about how the world will dramatically change due to their influence.

Nathan represents an influx of thinkers among thinkers, who will quietly work behind the scenes to make things happen. These are not our future leaders or managers, but those who empty themselves of all internal clutter or preconceived notions about how the world works. By staying open to the truth, wherever they may find it, new, exciting discoveries will be made that will impact all aspects of the human condition.

Like Nathan, our future thinkers can recognize the qualities and significance of emptiness. They can handle the perplexing nature of uncertainty and ambiguity. They understand that there are multiple dimensions to any problem with conflicting and paradoxical meanings. They are willing to surrender conventional notions about how the world works in order to make room for the new. By cutting a path through the clutter and letting go of a traditional means of thinking, these talented young people will open themselves up to what Robert Schuller referred to as, "possibility thinking."
In the midst of all the incivility and strife that we are faced with, Nathan will make a difference. He has not forgotten what it was like to stand face to face at a young age with problems that were bigger than he was capable of solving. He will use that experience to empower and propel him in a direction to bring peace as he thinks about and humbly solves problems that raise hope and healing for all humanity.

James P. Krehbiel, Ed.S., LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. James is the featured Shrink Rap columnist for TheImproper.com, an upscale arts, entertainment and lifestyle web magazine. He has contracted with New Horizon Press to publish his latest work entitled, The Search for Adulthood: Saying Goodbye to the Magical Illusions of Childhood. James can be reached at www.krehbielcounseling.com.

2009-07-01T16:02:00.000-07:00

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From Alcoholic Enmeshment to Rational Recovery

2009-06-28T12:01:00.000-07:00

Todd came to see me at the encouragement of his mother. He "talked the right talk" about leaving his drugs and alcohol behind, although he had a long track record of failed attempts. Todd had been in and out of residential treatment programs without success. This young man looked to me and rational recovery as his last chance to live a lifestyle free of the ravages of addiction.

I pushed Todd to explain to me, in every conceivable manner, how "this time" things would be different from all of his other failed attempts at sobriety. In a straightforward, yet probing way, I took him apart in the process of working to hold him accountable for his wasted life. Fortunately, he didn't run away from therapy.

Todd came to see me every week as we combined my cognitive-behavioral treatment with a local outpatient rational recovery program. Since the efficacy of inpatient substance abuse treatment programs is marginal, I felt that this would be a more effective treatment approach. This two-pronged strategy appeared to be the perfect mix. Naltrexone, a medication employed to stop the urges and cravings of alcohol was used with my patient. The goal of treatment was to focus on his lifestyle of excessive drinking and to rationally, reconfigure patterns of behavior that were consistent with a lifestyle of sobriety.

Todd began drinking when he was eight years old. His father would take him on camping trips and would provide him with hard liquor during their journey. Todd recalled his father handing him small, open alcohol bottles for consumption which had been purchased from the airlines. Todd reminisced about how he would eventually end up vomiting during stops along the way to the camping sites. According to Todd, his father was too "wasted" to be of any assistance to him.

This father and son drinking dynamic went on throughout Todd's adolescence. Todd began being admitted to residential treatment programs by the time he was thirteen years old. Each time Todd was placed in a rehab program for drugs and alcohol, Todd's father would make a special effort to visit him during recovery. Ironically, he would wish his son well and then would depart. On one occasion, Todd remembered his father drinking and smoking pot with him in their car just prior to his being admitted.

I found it fascinating that Todd never thought about the peculiar, symbiotic, outrageous abusive nature of his father/son relationship until we began exploring it. Even then, Todd deflected the experience through anxious laughter. As I "turned up the heat" on the emotional impact of what he experienced, Todd's vision of his past became clearer. He began to understand the betrayal, shame and humiliation foisted upon him by his father’s alcoholic enmeshment. It was painful for Todd to learn to hold his father responsible for the hurt, disappointment and destructive behavior he created.

As we moved through therapy, Todd was afraid of his anger and where it would lead him. We addressed that fear along with ways of coping with his enfeebled, alcoholic father in the present. Todd set more appropriate boundaries related to any contact with his father, and on several occasions broached the subject of his father's past behavior to no effect.

Todd learned to accept the fact that his father would never change, and that he would need to grieve and release a history filled with horrible memories. Todd's rational recovery, based upon cognitive-behavioral therapy, is working. He has a positive support system, medication for his urges and cravings, and takes full responsibility for his recovery. Every day is a choice about whether to allow his father to continue to have power over his life or to choose to forgo a pattern of drinking that started many years ago during his father/son camping trips.

This narrative is a composite. It has been deliberately altered in order to protect an individual’s right to confidentiality and privacy.

Cognitive Therapy and Sleeplessness

2009-06-21T19:32:00.000-07:00

It appears that "as the world turns" many are having a difficult time falling asleep and/or staying asleep. Our fast-paced lifestyle can leave one feeling fatigued, apathetic and restless as a result of a cycle of sleep deprivation. Some turn to sleep medications as a way of rectifying the problem of insomnia. Others look for naturopathic remedies to provide respite from a sleepless night.

Certain chronic insomniac conditions that result from pain-related problems may warrant the use of sedating medications. Other cases, however, may respond to various non-medicinal treatments, including the use of cognitive-behavioral therapy.

Cognitive-behavioral therapy is at the forefront of treatment for various disorders, including depression, anxiety, pain management issues and insomnia. Insomnia may be caused by life stressors, physical illness, emotional discomfort, environmental factors, self-medicating or disruption in one's sleep pattern due to work-shift changes or jet lag.

CBT seeks to work with insomniacs through their thought processes, ways of viewing the world and underlying beliefs about sleep. Many adults become anxious about their lack of sleep. They may ruminate about the horrible things that they believe will happen to them if they fail to promptly fall asleep. I often tell patients, "Where is the evidence that not sleeping tonight will cause you undue harm? What's the worst thing that will happen?" Frequently, it is the anxiousness about not sleeping that sets up a self-defeating dynamic of frustration and restlessness.

CBT uses paradoxical intervention strategies for dealing with sleeplessness. I recommend that patients who experience insomnia stay awake as long as possible prior to going to bed. Individuals should be sufficiently fatigued and drowsy before lying down. The bed should always be used for sleep purposes and never used for reading, relaxing or ruminating. If the patient's sleep is interrupted, the sufferer should get out of bed and read, watch television, until sufficiently tired enough to resume sleep.

Often, people do not realize that the human body will automatically self-regulate. If one only gets three hours of sleep on a given night, the body will automatically compensate, eventually providing appropriate rest. It is the fear of not sleeping that sets up a negative dynamic for the insomniac. Individuals may set up a self-defeating cycle by remaining in bed as they ruminate about sleeplessness. Ironically, this process only compounds the problem by leading to further restlessness.

Learning to relax the body and mind is important to getting quality sleep. Learning mindfulness meditation helps the insomniac to calm the sympathetic nervous system, setting the stage for restful sleep.

What people do with their time prior to going to sleep is important. Playing stimulating music, working at the computer and using alcohol will negatively affect one's ability to sleep. Learning to let go of work-related stressors is imperative. Individuals who are "pusher-drivers" are more likely to carry their workday into the night.

Patients, who experience insomnia, generally suffer from the following self-defeating thoughts and assumptions:

• "If I don't sleep, something awful will happen to me."
• "I must sleep or else I won't be able to function anymore."
• "I'm afraid to go to sleep because something might happen to me."
• "If I don't fall asleep promptly, there must be a problem."
• "I have so much work to do that I don't have time to sleep."
• "I must stay in bed until I fall asleep."
• "Worrying about things helps me to control my life."
• "I must complete everything on my list, especially work tasks."
• "Being alone at night is a scary thing."

Assisting patients to reframe negative thinking is essential to treatment for insomnia. Anticipatory anxiety in the form of negative self-statements must be replaced with more adaptive ways of thinking about sleep. By employing strategies that emphasize the “reverse-effort” of not trying to fall asleep, patients learn to relax their bodies through passive volition and secure needed rest.

Cognitive Therapy's Application to Tinnitus

2009-03-16T16:28:00.000-07:00

Lisa was referred to me by a physician who specializes in treating ear disorders. The neurologist was familiar with the efficacy of cognitive-behavioral therapy and its application in treating pain-related syndromes. This patient was referred to me as a part of a multidisciplinary approach to managing tinnitus.

Tinnitus is a ringing, swishing or other type of noise that seems to originate in the ear or head. Nearly 36 million people suffer from this disorder. Many factors, such as certain medications, ear wax, fluid, infection or disease of the middle ear bones or eardrum can cause tinnitus. As with any pain syndrome or disturbance, emotional factors can exacerbate the disorder.

Lisa complained of a loud, swishing sound emanating from both ears. The disturbance was significant enough that it began affecting her ability to function in a meaningful manner. At home, while preparing dinner, she found herself shifting her head in an unusual position toward her right shoulder in a ritualistic attempt to minimize the annoying vestibular volume.

Her bodily compensation reminded me of a clutched position that battle-scarred soldiers assume in combat that represents a way of warding off impending doom. In reality, such posture actually symbolizes the heightened hypervigilance experienced by those who have been exposed to physical and emotional trauma.

It has been my experience that a pain syndrome often serves as a mysterious metaphor for the way we relate to the world. M. Scott Peck, author of the Road Less Traveled, used to talk about the nemesis of his neck pain. Although he sought surgery to rectify his condition, he viewed his problem as a more complex pattern. The origin of his neck stiffness transcended bones and tissue. Peck often said “he was afraid to stick his neck out." His malady was a metaphor for holding things in and avoiding conflict at all costs. Learning to assert himself paid dividends, and further minimized the significance of this problem.

As Lisa and I explored her problem, I began to see a thread that linked her nonsensical noise into a self-defeating cycle. "The volume was chronically turned up in Lisa’s life and it made her head spin." She often affirmed this impression through the narrative of her life’s experiences.

Lisa had always done what others required of her. Her earliest recollections of this behavior occurred when walking home from school on a rainy day with several friends. As a mean-spirited lark, her friends asked her to stick her feet into a large puddle of water soaking her shoes and socks. She obliged her friends so as not to disappoint them. She felt humiliated as her school-mates looked on and mocked her. From that moment forward, the power of pleasing others emerged as a benchmark for how she would conduct her life.

Alfred Adler used to say that our earliest childhood recollections embody a constellation of beliefs, thoughts and feelings that have the power to profoundly impact one’s future behavior. Lisa’s experience in a mud puddle would fuel her later behavior within adulthood.

Lisa worked as a full-time tutor. Her students loved her. One day, she taught ten students in a row, driving to and from each student's house. She then went home, did her chores and prepared her evening meal for her husband. It was typical for her to push to accomplish tasks for others without ever setting appropriate boundaries for herself. She never requested or required anything from others – finally she gave in to exhaustion.

As Lisa began to disclose more freely in therapy, her story of unyielding sacrifice for others at her own expense became more evident. All the money she earned went to subsidize her granddaughter, who refused to work. Lisa disclosed that her granddaughter had a $200 a month smoking habit. Although she was conflicted about supporting her granddaughter’s addiction, she paid her the money to cover the cost. Lisa’s showed regret rather than appropriate resentment for enabling her granddaughter’s behavior.

In order to decrease the background noise in Lisa’s life, we worked on the following issues:

• Balancing the need to please with a sense of personal protection

• Learning assertiveness skills

• Requesting and allowing others to care-take for her

• Letting go of the need for frenzied activity

• Listening to her body and honoring it by slowing down

• Learning to get un-trapped from the fear of abandonment

• Learning to never do for others what they can do for themselves

• Relaxing the sympathetic nervous system through exercise and meditation.

In order to address the above issues and decrease the volume of her tinnitus, I work with Lisa on her thoughts, distorted cognitions and underlying assumptions about life. I taught her to rationally respond to self-defeating thoughts and behaviors. Some of the types of thoughts we reframed were:

• "Where is it written that people can't get along without me?"

• "If I say no, and people don't like it, it's their problem."

• "It's okay to have abandonment feelings, just don't act on them by trying too hard.”

• "I need to focus in the moment, rather than stressing about things I can't control. If certain things don't get completed, it's not the end of the world."

• " I need to treat myself as if I were a dear friend.”

• "If I give in to others, I'll only resent it later.

• What's the hurry, anyway?"

As a result of the modifications in her thought-processes, Lisa began to make progress with her tinnitus and she learned that self-defeating thoughts were a metaphor for self-defeating assumptions which aggravated her ears. These were factors that complicated her condition by creating unnecessary stress.

[Note: This case is a composite drawn from my practice as a psychotherapist. It has been altered to protect the individual's right to confidentiality and privacy.]

The Magic Embedded in Life's Stories

2009-02-15T18:46:00.000-08:00

Recently, my wife took an introduction to genealogy course at our local library. She was interested in gathering more information about her family history. She found the class very useful in filling in some missing pieces about the story of her parents.

One way of generating genealogical information is to download census data, in this case dating back to the 1930’s. My wife was very excited about her discoveries and the process had piqued my interest. I wondered what I might find out about the life of my 93 year old mother.

I pulled up the fifteenth census of the United States, completed on April 17, 1930. My mother was raised in Richwood, West Virginia. She lived with her grandparents during her pre-adolescent years. She and her grandparents lived on Boggs Street with her grandfather working on a dairy farm.

Although I was aware that my mother lived in West Virginia and resided with her grandparents, some of the census information was new to me. When I mentioned that I discovered that Mother’s grandfather was a dairyman, she perked up and began telling me stories about how she helped out on the farm by feeding the animals and milking the cows. When I mentioned to my mother that she lived on Boggs Street, she drew a blank. However, hours later, she called me back with renewed excitement to share her story. The street was named after the Boggs family who were their only neighbors on top of a hill in rural Richwood.

Life is a tapestry of memories, some which unfortunately go unspoken. Stories define the nature of our life, and link us to our history and our future. Memories are made of the stuff that illuminate our legacy.

Family stories help people become three-dimensional. They make our loved ones more than what we see on the surface. They change our perception of significant others. Memories clarify the experiences of our families, making our loved ones appear fuller, richer, with more emotional depth.

Family memories provide everyone with recollections that are treasures that can be recaptured. They can be entertaining, informational and fill in missing pieces about the nature of our history. Sharing stories can be therapeutic for the story-teller, helping them get closure regarding prior life events.

The story-teller passes down to other family members’ information and experiences that provide links to those who came before us. As we intently listen, we are able to integrate information which broadens our heritage and identity. We feel more complete as we gain new knowledge about traditions, experiences, and values from those who shaped our family heritage.

Family members who share their stories enrich relationship connections. Story-telling is an emotional experience and creates an opportunity for healthy bonding to take place. We only truly know an individual based upon the degree of emotional expressiveness disclosed. Story-telling provides ample opportunity to make this process happen.

When our parents or other family members share their recollections, it provides us with clues to the social-cultural history that serves as a foundation for our family heritage. We also get a glimpse of what our loved ones were like during different periods of their life. We are able to get a sense of how our family experienced life when members were younger or lived in a different era.

The expression of memories provides us with the wisdom of our parents. Stories are a catalyst for pulling our family history together so that it makes sense to us. We become more personally integrated, authentic and complete, while we are enjoying the fun of listening to interesting experiences from the past.

The Mystery of Fibromyalgia and How Cognitive-Behavioral Therapy Can Help

2009-01-29T09:24:00.000-08:00

Fibromyalgia syndrome (FMS) is the medical terminology used to represent a complex clinical disorder of symptoms characterized by soft tissue pain, stiffness, and altered deep pain threshold with psychological fallout. It can mimic or accompany symptoms of joint injury, but it is not an arthritic or neurological condition. The disorder affects between 3 to 6 million people – or as many as one in 50 Americans. About 80 and 90 percent of those diagnosed with fibromyalgia are women.

There is usually an emotional overlay of depression and anxiety that affects the sufferer. There are numerous reasons why this is true. Many within the medical community have discounted fibromyalgia as a bona fide disease. Patients have been told that they are over-dramatizing their pain and that the stiffness or soreness has been psychologically induced. Others have been told that the condition was fabricated for attention or perceived by health providers as feigned helplessness. These assertions from medical experts make patients with FMS feel ignored, mistrusted, alone and without support. Patients often turn to self-blame, which fuels the pain cycle.

The pain and symptoms of fibromyalgia are real and have a definite physical basis.
There is no known cause for fibromyalgia. Some researchers have speculated that physical trauma or viral influences have triggered FMS syndrome in many patients. There are no known abnormalities in the muscle tissue of fibromyalgia patients that would account for the disease.

Current research has focused on regions of the FMS patient’s brain and the susceptibility of certain brain locations to pain sensitivity. The brain receives a pain signal from the muscles and stays in a state of alert. For unknown reasons, the brain fails to let go of the pain signal and sets up a chronic pattern or pain syndrome. The brain stays in a constant feedback loop, consisting of a system of amplified pain signals.

Recent brain scan research studies have shed new light on this disorder. Results published in the May 2008 edition of the Journal of American College of Rheumatology shows that neuroscientists have been able to conduct scanning technology to areas of the brain affected by fibromyalgia. Mild pressure on trigger points of the patient has produced measurable brain response in processing the sensation of pain. The elevated response of pain in FMS patient’s brain scans was significantly different from those in the control group of the study. This is one of several studies that validate the reality of fibromyalgia as a disorder affecting the brain's response to muscular and neuropathic pain. Hopefully, future studies will lead to new treatment options.

Currently, treatment options consist of the use of a multidisciplinary approach. Medication management, physical therapy, meditation, exercise, alternative therapies, and cognitive-behavioral therapy are useful. CBT is a valuable therapeutic treatment option for those suffering from pain syndromes. One of the byproducts of pain can be the escalation of anxiety and depression. Likewise, anxiety and depression can intensify the impact of pain and make it more debilitating.

Cognitive-behavioral therapy’s goal is to teach the FMS patient to embrace pain rather than fight it. Cognitive distortions, such as magnification and “catastrophizing” need to be addressed so that patients learn to de-escalate fueling the pain process. How one thinks about his pain affects its impact. One can learn to rationally respond to pain by saying:
"Although this problem is difficult, I can learn to manage it."
"What's the use of getting all upset about my pain, it won't help anyway."
"If I relax and walk into my pain, maybe all this will feel less troublesome."
"I'm not alone in this. I have the support of my family and friends."
"I'm not helpless, I have many strategies I can try to minimize the effect of my pain. Just keep moving!"

Cognitive-behavioral therapy can assist the fibromyalgia patient to identify stressful triggers that exacerbate pain. This may involve examining family struggles, exploring inner-conflict, and working with core, self-defeating assumptions that affect thinking and behavior. Teaching the patient mindfulness meditation as a way of relaxing the sympathetic nervous system is beneficial.

Through the use of CBT, a therapist can provide the fibromyalgia patient with structured homework assignments that will help pain sufferers to experiment with new behaviors such as increased involvement and activities. Motivating the client to set realistic goals for everyday functioning can be helpful. Encouraging a multidisciplinary approach involving exercise, physical therapy, rehabilitation and pain management are essential.

Fibromyalgia patients fear that their disorder will cause them to lose the ability to function at work and at home. Teaching patients to focus on what they can do rather than their limitations is important. There is a tendency for fibromyalgia patients to distort reality by focusing on negative perceptions to the exclusion of the positive. Helping the patient and family to accept physical limitations is a necessary component to successful treatment.

Fibromyalgia patients can easily get enmeshed in a cycle of pain and associated emotional symptoms. It is the goal of cognitive-behavioral therapy to assist the patient in coming to terms with his disorder and making plans to manage it. This is accomplished through acceptance and teaching the patient positive ways of thinking about his condition and multiple ways of treating it.

James P. Krehbiel, Ed.S., LPC, CCBT is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His book, Stepping Out of the Bubble is available at www.booklocker.com.

Are You Anxious About Your Anxiousness?

2009-01-11T13:19:00.000-08:00

Excessive anxiety is troublesome. For many, it can be an immobilizing experience. Anxiousness can be associated with social avoidance and withdrawal, can be a factor in relationship difficulties, can create painful symptoms, and trigger a need to rehash issues related to our past and future. Anxiety triggers the "fight or flight" response, ramping up our sympathetic nervous system.
The most successful treatment approach to dealing with anxiety is through the application of Cognitive therapy since anxiety is a reaction to our thinking, beliefs and underlying assumptions about life. It is usually not our primary anxiousness that creates our distress. It is our secondary thoughts and feelings - the "anxiety about our anxiety" that intensifies our symptoms.
Almost everyone experiences anxiety, but not everyone catastrophizes about it. Let's say you are taking a midterm exam in college. There are several ways you might respond when you open the test booklet and note that there are numerous questions that you are not prepared to answer. First, you might respond by saying, "wow, none of these answers look familiar. I don't remember studying for us- I'm going to flunk this test. If I fail it, there goes my grade for the semester. Wait until my parents find out, they will kill me!" Or and alternative, rational response might be, "Gee, I don't understand these first three questions - that's okay, I'll just take some deep breaths, relax and work on the questions that I am familiar with. Then I'll go back and tackle the ones I couldn't answer before."
An individual’s manner of self-talk determines the level of anxiety. When we "awfulize" about anxiety, it tends to intensify it. When we respond rationally to our anxiety, that diminishes its effect. Rationally responding to anxious thoughts is critical to minimizing its effect.
Many people tend to believe that their panic or general anxiety "appear out of the blue." They may feel confused and perplexed by the sudden emergence of their feelings. Cognitive therapists view anxious feelings as a byproduct of faulty thinking. There is no mystery to it. Teaching others to respond rationally to self-defeating talk is the primary goal of therapy.
Individuals who experience panic attacks are usually troubled by symptoms such as racing heart, sweating, fear of dying, hyperventilating and a need to escape social situations. Helping individuals to manage panic attacks takes understanding and patience. Assisting people to realize that their panic is time-limited is important. Since panic tends to take on a life of its own, it is important to address the secondary symptoms or the "panic over the panic." When people panic, they tend to magnify their symptoms through self-defeating thinking, perpetuating the attack. Teaching people to relax into their panic is necessary.
The following are some guidelines for those who experience anxiety and panic:
1. Anxiety is time-limited. It is comforting to know that it always diminishes in its impact over time.
2. Don't fight with your anxiety. It only makes things worse. Lean into your anxiety, embrace it, and it will subside.
3. Schedule a "worry time." Go into a quiet room, relax and try to expose yourself to your anxieties. Try to bring on your symptoms and you will find that it is difficult to do.
4. If you have a tendency to panic, create an exit strategy. Plan a way to remove yourself from anxious situations to bring relief.
5. Refocus your attention away from your anxiety. For example, when people experience panic attacks that involve a racing heart, I might encourage them to do jumping jacks to demonstrate that there is nothing physically causing their symptoms. This strategy actually lightens the situation and their symptoms.
6. If you are anxious, chunk things down into smaller parts. People tend to feel overwhelmed when they look at the entire picture. Rather than clean the entire house, pick a few specific tasks such as shredding a few unnecessary documents.
7. Stay in the present. Don't rehash your history or anticipate your future. Worrying about your future or history serves no useful purpose. You can't control it anyway.

Cognitive therapy emphasizes replacing self-defeating thinking with more rational ways are responding to stressors. Identifying goals of therapy, approaching them in a practical manner, and providing homework assignments are significant ingredients to addressing anxiety.

COGNITIVE THERAPY AND PAIN MANAGEMENT

2008-11-27T10:05:00.000-08:00

Those who work in the field of healthcare have known for some time that a connection exists between our underlying beliefs and thoughts and the functioning of our bodies. Dr. Herbert Benson, in his 1970’s landmark book, The Relaxation Response, articulated the concept that stressors can trigger a “fight or flight response”, an inner startle response that indicates we are about to experience an unpleasant event. Although there is a healthy fear that protects us from harms way, many times how one interprets stressful events and one’s ability to manage it, can affect the immune systems functional capacity. There is now sufficient research to validate Benson’s work, that relaxation techniques such a meditation, can have a direct link to minimizing the effect of a wide range of disorders such as high blood pressure, irritable bowel syndrome, back problems, neurological pain, and headache problems. Relaxation strategies calm the sympathetic nervous system, making it easier for the body to heal.
In Barbara Levine’s book, Your Body Believes Every Word You Say, she explores how our thoughts and underlying beliefs about our physical maladies affect our auto-immune system which regulates our ability to ward off illness, manage pain, and promote healing. In other words, legitimate pain from various illnesses and somatic complaints can be intensified by the kind of messages we tell ourselves. Spontaneous self-defeating thoughts such as, “What’s the use, my body will always betray me and never get better.” can reinforce the pain cycle of making things worse. People with such chronic self-defeating reactions have been shown to create inner chemical changes and constricted blood flow which further erodes the individual’s ability to manage pain. How we respond to our bodily disorders, in terms of core beliefs and inner dialogue, may affect the outcome of our health.
Some time ago, I attended a presentation by psychiatrist M. Scott Peck. He talked with mental health providers about his struggles with neck pain, a problem that had plagued him for years. An operation resolved some of his pain, but he felt that there might be some negative underlying belief that was also contributing to the problem. He ultimately concluded that he was a conflict-avoider, lacking the ability to appropriately assert himself, refusing to “stick his neck out.”
Physical illnesses can be intensified by self-defeating underlying thinking that is a metaphor for the chronic condition experienced. For example, people with back pain may at times lack the “backbone” to express their thoughts and feelings courageously. Individuals with gastrointestinal problems may not be unable to “stomach” certain intolerable thoughts and feelings. People with headache syndromes may experience beliefs and thoughts about events that make them want to say, “Life is making my head hurt.” Eating disordered people may experience core assumptions such as, “I’m so angry that I could just vomit, or if I monitor my weight and eating habits, at least it’s one area in my life that I can control!” People with neurological pain such as inner ear disorders may exacerbate their pain by experiencing thoughts of panic such as, “Oh my God, here it comes again, that nasty, annoying pain. I’ll never get over this because the volume in my life is turned up too high.”
Anxiety, panic, and depression are typical characteristics associated with physical pain. The more effectively one manages these symptoms, the less troublesome the pain may be. Learning to cope with anticipatory anxiety by rationally responding, “Ok, I know that this pain can be troublesome, but when it comes I will do my deep breathing and manage just fine!”, or dealing with panic, “When a wave of pain comes, I’ll just go with it. It’s not a big deal, my scary feeling are time-limited, they’ll be over soon”), and managing depression, “Just because I feel awful doesn’t mean I can’t do things to stay active and make me feel involved” are important ways of adaptively responding to pain.
The following ideas are some guidelines for managing pain more effectively:
· Try to get you pain in perspective. Make a realistic appraisal. “In the scheme of things, how bad is my condition?”
· Don’t fight with your symptoms, it only makes them worse. The more you accept your symptoms, the more they are likely to diminish.
· Use various activities to refocus away from your pain. Dwelling on pain makes it more painful. Stretching, music, swimming, meditation, and other activities are important.
· Seek a multidisciplinary approach to your problem, if necessary. Get a team of healthcare specialists, including a quality physician, psychotherapist, physical therapist, message therapist or other providers of pain management.
· Develop a solid support system of family and friends. Also, there are many support groups in our community for people suffering from a variety of physical ailments.
· Remember, that the things we tell ourselves have an impact on our physical and emotional well-being.
James P. Krehbiel is an author, freelance writer, and nationally certified cognitive-behavioral therapist in private practice in Scottsdale, Arizona. His personal growth book, Stepping Out of the Bubble is available at http://www.booklocker.com/. He can be reached through his website at jkboardroomsuites@yahoo.com.

Authenticity and the Gay Identity

2008-11-19T19:33:00.000-08:00

Many years ago, when I worked in education, I spent my summers directing outdoor park district activities for kids. The children would come from the neighborhood to play various games. One year I recall a teenage boy coming to the park with a desire to talk with me. He attended a youth group at his church (which was located nearby) and then would meander over to the park facility. At some point in our conversation, he told me that he was gay and that he felt ashamed as a result his church’s anti-gay sentiment. He felt very alone because he had told no one in his youth group of his sexual orientation. His parents were not informed, and would have been mortified had they known of his sexual identity. Each time he came to the park we would talk about his struggles with being gay. Because I had trained student leaders to work with the park kids, I was able to devote some attention to this troubled young man. This was my first exposure in conversing with an individual who professed to be gay. I learned a great deal about a segment of society that played out their lives in agonizing silence.

Over time, I learned that gay people, like other minorities, are used to being stereotyped. Those of us who are straight, perceive gays to be effeminate, flamboyant, impulsive and artsy. Most of the gay people I have met do not fit that pattern. They typically feel isolated because their behavioral patterns are actually heterosexual in nature with the exception of their sexual affinity toward others of the same sex.

With the advent of multicultural thinking, gays are beginning to feel more comfortable and accepted. Their level of confidence affects their relationships and style of relating to the world. The acknowledgement of being gay takes supreme courage. The odds have been stacked against those who choose to make their sexual orientation known. Many adults, now in midlife, are just beginning to acknowledge their true sexual identity. With such exploration comes the awareness that “I feel a stronger sexual connection with those of the same sex.” Such a realization may signal the emergence of terror – “I am not who I pretended to be.”

When you listen to the stories of those who are gay, you get a sense of the conflict and tension they have experienced in their struggle to be authentic. Most have known from an early age that they felt different about their sexual identity. In an attempt to conceal their feelings and behavior, many gays worked feverishly at removing any vestiges of gay traits from their behavior. This is exactly what African-Americans have done as they experienced the distain from those who embraced a Caucasian world-view.

Adolescence is a difficult time of turmoil for most youngsters. Add to that the issue of sexual identification and it certainly makes the process of navigating adolescence that much more strenuous. Many schools are afraid to acknowledge their gay students and provide little or no support for those in need. Ideological and political pressures play a role in keeping school administrators and school board members from stepping up to the plate in support for gay youth.

In my professional counseling practice, I have personally witnessed the anguish and conflict experienced by those individuals who have professed to be gay. I have also observed the courage that many patients have demonstrated in the process of emerging from their silence over their sexual orientation. Learning to be authentic is an important component of counseling and to honestly identify one’s sexual identity may be apart of that process.

Although there is little evidence to support its efficacy, many counselors surprisingly continue to espouse reparative treatment for gay clients. Counselors, who many times disguise their intentions, choose to subscribe to the archaic notion that sexual orientation is a learned pattern or choice rather than a lifelong identity. Reparative therapy views the gay individual as disordered and in need of transformation. Generally, counselors who conduct reparative therapy for gays look for deep-seated traumas as a causative factor in the “identity conflict” of those they serve.

Counselors who insist on touting reparative therapy for gays typically maintain their own biases regarding homosexuality. They carry these biases into treatment and negatively affect the self-worth and integrity of those they serve. Their insistence in curing gays creates a climate of self-doubt and defectiveness among those they treat.

Many in the religious community are unable to reconcile their beliefs and faith and are reluctant to identify with those who define themselves as homosexual. This fact causes many gays to reject their faith or live in a constant state of religious conflict. Years ago, a friend of mine decided to spend a weekend of solace at a religious retreat center. This was to be a time of isolation and reflection. However, her time quickly took on a new meaning. Gay men from churches throughout the country flew into this retreat center. Many of them were board members, elders, and pastors of their congregations. No one knew of their sexual orientation with the exception of the hundreds of Christian colleagues who met at this retreat center to worship together once a year. Every year, these men got together in the freedom of their real identity and worshiped God. They talked with my friend, expressing their sense of liberation and love for the God they embraced. My friend said it was a moving experience as she was asked to join them in their religious services which were filled with energy and passion.

Denial is a dangerous thing. Those who choose to ignore their true sense of self pay a price for their own personal betrayal. It takes courage to live with the way things really are. There are pitfalls along the way, but integrity calls for being true to who we are and who we have become. Those in the gay community have the right to define themselves in a way they desire. Unfortunately, for openly gay people, there are consequences for living with an identity they did not choose.

James P. Krehbiel, Ed.S, LPC is an author, freelance writer, and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His personal growth book, Stepping Out of the Bubble is available at www.booklocker.com. James can be reached at www.jkboardroomsuites@yahoo.com.

It's a Long Way from Richwood to the White House

2008-11-05T18:47:00.000-08:00

Several weeks before her death on July 26th of this year, my mother made an interesting discovery. Here was a 93 year old woman from Richwood, West Virginia, who clung tightly to her conservative Republican beliefs. But on this particular day, she smiled intently at me and proclaimed, "Barack Obama seems like such a nice young man." It was the first moment in my lifetime that my mother and I politically connected.

This country has been down a perilous path in the past eight years. We have struggled through the presidency of George W. Bush, who failed this nation with his lack of integrity, feeble domestic direction and disastrous foreign policy. With Bush at the helm, we fought the wrong war for the wrong reasons and are still paying the consequences in loss of lives and economic calamity.

We are in need of a new direction. Although John McCain stands out as a war hero, he has waged a campaign that is without substance. He has spent more time bashing his opponent than laying out clear plans to get the country moving again.

Barack Obama has the vision, intelligence and judgment to lead our country down a more positive path. His campaign has been steady, and his campaign organization has been stellar. He has been maligned by many, some on this site, who ironically use their Christian faith as the basis for divisive comments. Accordingly, he is the "Muslim," "the enlightened one," "the anti-Christ," "the radical," "the terrorist," and “a Hitler.” He was also deemed guilty by association, as if John McCain didn't have enough affiliations with troubled individuals himself.

Barack Obama's concepts and ideology mirror many valuable Judeo/Christian principles. He is not interested in continuing to feed the pocket-books of the wealthy. He personally identifies and has compassion for those of our comrades in need. He has one wife, one house and tattered shoes. He understands the needs of the middle class and the poor. By focusing on this country's crumbling infrastructure, he will get our people working again. His administration will create new jobs that will spur the economy. He understands that a "trickle down" economic policy does not work because the wealthy are tainted by their greed. He will work toward providing healthcare plans for all Americans. He will prioritize the budget and will eliminate wasteful governmental spending.

His foreign policy will be founded on the principles of diplomacy, not power and control. He will fight the right war in the proper place, on the border of Pakistan and Afghanistan. We will regain our respectful standing in the world through promoting understanding rather than division. His vice presidential selection, Joe Biden, is ready to step in on the international stage. We will regain our credibility at home and abroad as Obama seeks to call out and prosecute those in our government who have shredded the Constitution, needlessly tortured prisoners, demonstrated political collusion, and overstepped executive privilege.

Those Christians who would try to reduce this election to a referendum on abortion are mistaken. Most reasonable Americans do not "believe" in abortion. Rather, they embrace the sanctity of life, and believe that such a concept is much broader than any narrowly focused discussion regarding this complex moral dilemma.

This is the most exciting election I've ever witnessed. For the first time in history, an African-American candidate is positioned to become President of the United States. The first 16 presidents of this country could have owned Senator Obama as a slave! How far we have come as we look forward to a new day in American history. I pray for him and his family as he seeks to lead this country out of turmoil.

James P. Krehbiel, Ed.S., LPC, CCBT is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. He can be reached at (480) 664-6665.

McCain and the Mob Mentality

2008-10-12T10:31:00.000-07:00

Barack Obama has become a metaphor for those who are considered culturally different. Disturbingly, we have been down this road of hatred and divisiveness before. Who can forget the chilling memories of America's civil rights leaders being slain, segregation being fostered, synagogues being burned, black citizens being lynched, and law-abiding Muslims being shot and killed after 9/11.

This is the dark side of America that I'd rather forget, but once again has reared its ugly head through the campaign discourse of John McCain and Sarah Palin. McCain and Palin’s campaign rhetoric directed against Barack Obama has fueled the basest instincts of many misguided Americans.

McCain's effort to link Obama to a terrorist Muslim script is rooted in the most despicable form of hatred and bigotry. The fire has been stoked, and now his supporters are cheering McCain and Palin with chants of… "Obama is a terrorist, kill him!" Having crossed that ugly line, even the candidates themselves have been unable to stave off the damage they have wrought.

This pattern of inflaming the bigotry of the masses through divisiveness and venom is frighteningly reminiscent of the Nazi regime during World War II. Adolf Hitler and the German Nazis, under the elitism of white Anglo-Saxon Protestantism, sought and successfully slaughtered those who they perceived as ethnically and racially different. As Germany fell on hard economic times during the global depression, they looked for scapegoats to explain their financial decline. It wasn’t long ago that the Jews, those associated with Jews, Russians, the mentally ill, the physically disabled, artists, and the intelligentsia were sent to concentration camps and murdered. The mob mentality had worked and "cleansed" Germany of those who were perceived as funny looking and different.

John McCain and Sarah Palin have sought out the politics of personal destruction. They have willingly tried to demonize Barack Obama by painting him as an evil outsider who is a threat to the security of our democracy. Amazingly, some Christians have made this a personal vendetta by suggesting that Obama is the anti-Christ. On the other hand, other so-called God-fearing Christians have suggested that he portrays himself as a messianic figure.

The myth of moral superiority is that those who lay claim to know it all by smearing and hatemongering behavior, are the ones who need to "take the log out of their own eye" as Jesus suggested. As Sarah Palin lays claim to being the moral compass of the McCain campaign, she has opened herself to scrutiny as a result of unethically abusing her power as governor of Alaska.

When McCain finally called Obama "a decent" candidate, he was jeered by his own supporters. It is this vitriolic venom that should remind us all that this is a country filled with the beauty of diversity, and that we must never allow such mindless people to create another Holocaust, because we turned our back and ignored those who would perpetuate a lie. As we have seen in recent days on the campaign trail, the hate-filled, spiteful mobs are still there to remind us all that we must be vigilant. We must speak out against the threats and fears generated by those who have the power to create the conditions for another genocide.

Maintaining Sibling Relationships As We Lose Our Parents

2008-10-01T15:57:00.000-07:00

We of the baby-boomer generation are feeling the pressure as we provide care for our elderly parents. It is painful as we helplessly watch our loved one’s experience the impact of failing health. We feel powerless against the ravages of deteriorating health and mourn our losses as our parents begin the descent involving their incapacity to live independently. Children undergo the process of grieving as our parents move closer to the end of their lives. Family dynamics may shift.

The process of grieving hopefully may bring healing and closure to children who care-take for elderly parents. However, more typically, it takes its toll in creating upheaval and conflict among the children. As elderly parents come to the end of their lives, the grieving process may serve as a catalyst which affects core issues and dynamics among the surviving children. If there are unresolved issues harbored by any family member, they will invariably surface during this time of distress. Grieving and loss have a way of opening the door for unfinished psychological business that has been “swept under the rug.” One can only hide the pain for so long and then inevitably the truth, wrapped in emotional baggage, will make itself known.

The children of an aging parent are forced to deal with a myriad of new decisions and problems. However, legal, financial, and questions related a parent’s possessions tend to be the focal point for conflict among siblings during the process of parental decline. Children, who face these issues with their unresolved baggage, create tension for the entire family system. Hopefully, parents help minimize the impact of sibling conflict by structuring their will and financial matters effectively.

Quibbling over finances or belongings may represent the way in which children play out their unresolved conflicts toward the elderly parent and their interaction with each other. They may feud over jewelry and other personal possessions belonging to the parent, leaving the elderly parent feeling resentful or guilt-ridden. The turmoil may exacerbate the parent’s declining health. Misunderstandings may exist over who gets what and when. Interpersonal conflict emerges when the grieving process serves as a metaphor for unfinished family business. Although most parents dread the prospects, it is not unusual for children to break communication with each other after the death of their parent.

Because feelings are more intense during the declining health of an elderly parent, the children are more prone to become reactive. Reactivity leads to anxiety, and anxiety promotes misunderstanding and defensive communication. Like the advent of premarital counseling, perhaps there should be therapy for children who are trying to navigate the process of caretaking for an elderly parent in deteriorating health.

What are some of the ways that children can cope more effectively while caretaking for an elderly parent and avoid the traps that cause interpersonal damage?

Make sure that there are legal documents in place, including a will, durable power of attorney, and a trust. They should be updated, particularly if there is any transition from state to state.
Make sure that your parent specifies, outside of the will, items to be distributed equitably to all family members.
Children of the elderly need to work on responding, by promoting understanding, rather than reacting with defensiveness and resentment.
Children should seek professional counseling assistance when they are unable to manage their personal grief and it begins to affect their functioning as well as other family members.
Learn to keep things in perspective. Money and things are not worth severing relationships and causing hurt feelings within the family. Our legacy and our families should be based on the quality of our relationships.

Caretaking for the elderly is a difficult process. It takes patience, wisdom, and the ability to sort out issues related to our parents and siblings. We must take the high road consisting of integrity when dealing with our family members. There are not guarantees that they will do the same. Nevertheless, we must vow to make peace with our past, care for our parents, and let go of our loved ones in a way that will bring peace and healing to our life. In doing so, we will never have regrets.

CHUCKLING YOUR WAY THROUGH THE GOLDEN YEARS

2008-07-03T20:54:00.000-07:00

No matter what the experts say, aging is difficult. It takes a fair amount of luck, good genes, family support and activity to make this journey work. There is one added quality that really lightens the load as the elderly are faced with their "golden years," and that is the capacity to laugh at oneself and life.

As the aches and pains start mounting, and the aged begin to feel alone in their plight, humor is a powerful potion for sustaining an attitude for success. Life becomes a chain of mountains to climb, and the hiking is much easier if the elderly navigate their journey by poking fun at a world filled with challenges. Seniors must learn to float downstream, buoyed by the water as they pass by the twigs, branches and rocks along the current of life.

When it comes to humor, the late George Carlin would have been proud of my mother. At 93 years old, she can take a life event and turn it into an amazing, dramatic story filled with adventure and lessons to be learned. Recently, she had a stint in the hospital due to atrial fibrillation, an indicator of congestive heart failure. Although my mom's heart is pushing enough blood, the upper chamber is showing signs of wear and tear.

When she was released for home from the hospital, my mother graduated from two pills to an assortment of blood thinners as her cardiologist sought to regulate her heart-beat. She stayed in a nursing care facility for awhile and then was sent back to her independent living apartment on a trial basis. Several days later at 5 a.m., she fell in her bathroom and landed on her hip. She had the presence of mind to crawl to the pull-cord to get the attention of the nursing-care staff. They promptly arrived, called me and contacted the paramedics for another round to the emergency room.

When I got to the ER, she dejectedly said, "Son, I'm sorry I messed up." "Did you use your walker to get to the bathroom?" I replied. "No, it was filled with all kinds of papers," she sheepishly disclosed and continued with, "but it was VERY CLOSE to the bathroom,” as if that mattered. They x-rayed her hip and she had fractured it - her femur needed fixing. When she got up to room 2107, the staff moved her onto her hospital bed. An internist promptly visited her and she inquired, "What time is it Doc?" "It’s 8 a.m. young lady. Why do you ask?" “I need to get out of here in an hour. I've got to go to the beauty shop. I can't lay here looking like this. By the way, how do you say your last name?" The doctor spoke slowly…"G-H-I-A-M-A-D-I …GHIAMADI,” he said. "Oh my, that must have been a serious problem for you when you were in grade school," she retorted.

For the next few days, the cardiologists monitored my mom’s vitals trying to get her ready to handle surgery. My wife commented to my mother about the excellent nursing care she was receiving. "You're getting so much attention, Oma." "Yes, and I might even get a tiara at the end of the day if I play my cards right,” she replied.

Several days later, surgery was "all systems go." The launch had been delayed several times, but now we were doing the countdown. Exasperated, my mother put the nursing team on alert. "Let's get this show on the road. Just make sure they "cut" the right leg off," she jokingly said. As they wheeled her down to surgery, she kept it up, "Where are you taking me? It looks like we’re headed for the parking lot. Hey, don't let ‘em stick a knife in me if I'm not ripe enough!"

When we got to the pre-op area, a nurse met us there. When the nurse bent over to take my mother's necklace off, my mother was amused. Hey, I guarantee you it's been a long time since anyone's looked down that area." When the nurse finished chuckling, she asked my mother the critical question. "Which leg is being operated on today?" Mom was playing it coy. "I really don't know," my mother replied. "Is it the left one Gladys?" the nurse said. "I think it is right; I mean, I think it is right that it's the left one … is that right?" The morphine didn't seem to affect her wit. It reminded me of Abbott and Costello, but this one was a monologue.

She took the liberty of putting her surgical cap on before the anesthesiologist came to give her the "juice." The orthopedic surgeon strolled in and asked my mother if she had any questions. "I only have one question for you. Are you REALLY old enough? My daughter tells me you were born in 1970. Is that right?"

The anesthesiologist entered and told my mother that her heart could handle the surgery and he proceeded to inject her in the arm so she could take a nap. "The surgeon looked so young. How old are you?" she asked. The boyish doctor said, "How old do you think I am?" "I think you're about 62," my mom replied. He grimaced and left for a minute and when he came back my mother had adjusted her assessment. "It's in my best interest to say that I'm sorry. With your cap on I thought you were older. You really must be around 45. You see, my son is in his early 60s, and I like him a lot." As I gave her a peck on the cheek, she was off to surgery and as she turned her head I heard her say to me, "Good luck on your new book. I hope it's a success."

I never had a doubt that my mother would make it through surgery. She had successfully created an atmosphere that put everyone in her sphere of influence at ease. She chuckled her way through a revolting predicament and brought everyone with her into her humorous inner world. As my mother always believed, she was making funnies, the tried and true method of traveling through the golden years.

WHY SCOTT MCLELLAN CAME CLEAN

2008-06-05T18:50:00.000-07:00

Most people, familiar with the workings of the George W. Bush White House are not surprised by the revelations of Scott McClellan in his riveting new book entitled, What Happened. His account punctuates the deceit and deception orchestrated by an administration that lied about the run-up to the war in Iraq and the deliberate leaking of intelligence information.

The most pointed question is, why did Mr. McClellan choose to reveal his story? After all, providing the propaganda spin for the White House in no way left him accountable to share his narrative upon leaving Washington D.C. McClellan describes his experience as press secretary as being in a bubble. Within this bubble, he passed along convoluted political spin while remaining in a protracted campaign mode.

As I mention in my book, Stepping Out of the Bubble, staying in the bubble represents the comfort zone, a place where we avoid the challenges and paradoxes of healthy living. The bubble protects us from having to confront reality. It is the place where we minimize and distort the full impact of real-life experience. The bubble is like an insulated cult - it protects us from the truth.

Like a polygamist leaving the sect, McClellan's departure from political life led him to encounter the realities of civilian life as his political perspective subtly began to shift. McClellan was forced to grapple with a huge dose of reality when he testified before a grand jury in the Plame investigation on February 6, 2004. His deposition and grand jury testimony could not have been a comfortable experience. He must have reflected on his prior disclosure in a press conference when he said "the president has made it clear that he wants to get to the bottom of this matter (Plame case), and that anyone who has information that relates to this that can help the prosecutors move forward and get to the bottom of it should provide information to the prosecutors."

I believe that testifying about these Plame-related matters may have forced McClellan to step out of the bubble about what he knew regarding the president's and his subordinate’s role in leaking intelligence information. Once McClellan had been debriefed by the grand jury, he must have experienced immense internal conflict. I believe that he must have felt enormous shame and betrayal and was primed for further disclosure.

I believe that Scott McClellan told his story because he is an intelligent, honorable person who could no longer live with the burden of a lie. If he maintained the lie, he would lose himself. He told the truth, not for monetary gain, but because he was conflicted and wanted to rid himself of the weight of scandalous propaganda and behaviors that he validated as press secretary for the president. The shame of it all caught up to him and his disclosure is a way for him to acknowledge the scripted verse (referenced in his book) on the University of Texas tower which says "Ye shall know the truth and the truth shall set you free."

James P. Krehbiel, Ed.S., LPC, CCBT is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His book, Stepping Out of the Bubble is available at Amazon.com. James is the Shrink Rap columnist for TheImproper.com, an online site in NYC. He can be reached at www.krehbielcounseling.com.

HOW ABUSED WOMEN CAN BREAK THE CYCLE

2008-05-24T20:48:00.000-07:00

Self-destructive Cycle of Victimhood Starts in Childhood

Women, who have a history of mistreatment in relationships, tend to place themselves back into relationships with men that foster further abuse. Often, after the damage, women appear to be mystified as to why they set themselves up. They are easily lulled back into situations that potentially blindside them to personal attacks and betrayal.

Origins in Childhood

So what is the trigger that causes women to repeatedly choose to put themselves in harm’s way? There is a fascinating dynamic that originates when women are victimized by a troubled childhood; in adulthood, they tend to fluctuate between shame-based feelings and a sense of vulnerability to control. Women, who experience an absence of parental validation from childhood, will seek affection and attention at all costs. They will move through every stop sign imaginable in their effort to get "right" what went wrong during their difficult past.

A lack of validation from childhood leads a woman to be vulnerable to emotional hurt which includes self-doubt, shame and blame. This mix of feelings fuels the pattern by attracting men who invade their personal space. The same useless interpersonal dance gets replayed over and over again. Putting themselves back in the fray is a women's way of trying to fix that which remains unfixable - the domination of controlling men.

It’s Never Too Late to Embrace Positive Change

As they reel from additional assaults, these women eventually retreat into their private, emotional world. Then the cycle resumes. Rejection and self-blame lead to anxiety, followed by the quest for validation from those who can't give it. These ladies believe that if they try hard enough, they can fix any damaged relationship. Their illusion about the way things "should be" clouds their judgment and leaves them susceptible to further abuse. How do women break this cycle?

· Let go of the dance and embrace the shame and fear.
· Acknowledge self-blame and discover that the relationship wreckage never was about you.
· Learn to experience the kind of constructive anger that says, "I deserve better."
· Fight the urge to get in harm's way with those who would "flip things" by creating conflict. Stay above the fray.
· Rationally respond to self-blame and vulnerability with positive self-talk.
· Set appropriate boundaries that detach you from partners who might choose to exploit you through intimidation and fear.
· Surround yourself with those who are validating and drop male friends who try to manipulate you as a way of bolstering their own ego.
· Create new, positive goals, relationships and activities.

Women who desire to leave behind their childhood pain must learn to shut down the pattern of being exploited by those who seek to continue the cycle of abuse. Women who have been abused, can learn to take a step back, refusing to “take the bait” while letting go of the patterns that previously put them at risk. Only then can they overcome the emotional trauma of their childhood and get themselves unhooked from the men that repeat it.

MUSINGS ON BEING A CONSERV-ATIVE

2008-04-23T17:10:00.001-07:00

Running for political office has never been a wish that I aspired to pursue. God forbid that I would consider that with all the corruption and mud-slinging that goes on, reminiscent of this election cycle. However, I feel the need to go on record, and confess that I am a compassionate conservative - a progressive sort of conservative. So let me explain…

In my opinion, a true conservative is one who is dedicated to being cautious by nature and in principle. I consider myself a fiscal conservative because I balance my check-book and only spend what is within my means. I don't live extravagantly and have no credit card debt. I don't drive fancy cars and buy over-priced items. Contrary to this country I love, I balance my budget to the glee of my wife. I believe in "paying as you go” for social programs. This concept has worked marvelously for the Illinois Tollway and I believe that once again it should be adopted as a conservative governmental standard.

I believe that if we prioritized better, those who financially suffer could get relief. I am conservatively cautious about going to war. As we know, our current war is costing the taxpayers a lot of money, and I have concerns about why we went into Iraq (not Afghanistan) in the first place. I also wonder why we are still there. Can you imagine what we could do with trillions of dollars to build our country's infrastructure and assist in helping the poor and needy? Our national debt is skyrocketing, and this liberal policy goes against the conservative ideals of balancing the budget.

Conservatism is also about protecting things like the environment. I prefer to call it "creation care." When it comes to global warming, conservatism is at a crossroads. More and more business leaders, evangelical Christians and other progressive conservatives are calling for action to reduce the risks connected to man-made climate change. Unfortunately, more reactionary conservatives continue to attack those who act to reduce emissions, and belittle those who are concerned about our planet. One would assume that environmentalism would make conservatives enthusiastic. The root of conservative and conservatism is directly related to the word conservationism. So why is it that reactionary conservatives such as Ann Coulter, Dick Cheney, James Dobson and Jonah Goldberg are the loudest voices advocating recklessness? What is conservative about “sticking up your nose” at the preponderance of mainstream scientific evidence?

As a conservative, I believe in moral integrity and family values. I don't like politicians who lie and makes it very difficult to decide who to vote for in the upcoming political election. I don't like congressmen, governors, mayors and presidents who lie about their sex lives when it affects the American public. I am also morally outraged by those who use their political power to lie, stonewall and cover-up their egregious mistakes and crimes.

If I were a progressive conservative Christian preacher, anybody could come to my church as long as they left their guns at home. I would welcome the sick, the needy, the gays, the Muslims and atheists. I would preach a Gospel based upon the principles of love, compassion, tolerance and encouragement. There would be no divisiveness in my message. In the pulpit, I would not deliver hatemongering, bigoted snippets like Reverend White, Parsley and Hagee. I would not act morally superior, but show respect for all faith traditions realizing they all share kernels of truths that bind people together. However, I would exercise my right to share truth and faith as I see it (the Gospel) and hope that others would sense the same yearning that I experience for knowing God in a more intimate way. In my church, if a young girl was pregnant, I would welcome her with open arms so that she didn't feel the need to slither away and impulsively terminate her pregnancy - that's pro-life in action.

As a progressive conservative, I feel a need to show by my behavior that I truly believe what I say. I can usually reconcile my beliefs with my experience. However, there’s a disconnect between progressive conservatives and their public voices. True conservatives are not opportunists who play to the crowd and in the process misrepresent others who are more tolerant. I am a progressive conservative who wants nothing to do with those who grandstand by smearing others who share different values, lifestyles and faith traditions. I am not driven by the fear of “rubbing elbows” with those who share a different worldview. I want to be a unifier, not a divider. I hope that this country gets back to sharing my ideal for fiscal responsibility, compassion, tolerance and unity. This is my passionate plea for America.

WHAT DO I KNOW FOR SURE ANYWAY?

2008-03-24T18:49:00.000-07:00

The older I get, the less I seem to know for sure. It's not that I lack wisdom, but life is not a clear-cut, fixed matter, but an ever-changing, fluid experience. Each moment is new and is filled with the wonder and mystery of the unknown.

As a child, life appeared certain. I lived in a comfort zone which protected me from the reality of a world complete with ambiguity, paradox and difficult challenges. As I became older, reality uprooted the foundation of my world. I could no longer hide behind my black and white thinking that served me well as a youngster.

As an adult, I learned to embrace the insecurity that comes with the unpredictable nature of life. According to Alan Watts, holding onto security is like trying to grab water into your hands - it is elusive. Holding too tightly onto matters brings to mind "the law of reverse effort." Hanging on is more likely to make us feel out of control.

Although the very fabric of my life has been shaken, the good news is that things appear adventurous. Every day is a new journey, with excitement as I travel into the unknown. I am on a wild, crazy ride that leads me to conclude, "What do I know for sure, anyway?"

Consider this. One traveler gets on a plane with a destination for home. She is excited about seeing her family. However, the plane goes down in the Everglades of Florida and all passengers are lost. A friend of hers makes a last-minute change in her flight plans, deciding to stay in Miami for another day. She wakes up in the morning and is confronted with the horrible news. Why did she survive, while her friend did not? Some would like to provide us with the comfort of their philosophical or religious explanations. In my opinion, they are not good enough.

A child is raised in a home filled with parental abuse. As he enters into adulthood, he struggles to "find himself" and eventually ends up being a successful partner, father and businessman. His brother grows up in the same environment, and moves into adulthood lashing out at the world, blaming others for his failure to function and achieve. Is there an answer to this dilemma?

I have a disorder called fibromyalgia. Some doctors think it's "in my head." All I know is that I chronically ache all over with trigger points on muscles that hurt on contact. It is painful when my skin is touched. Does anyone know why this happens? There are clues, but no definitive answers and no clear-cut solutions to fix the problem. Women tend to suffer from it more than men. I'm not sure why that's the case and neither are the doctors.

More kids these days are suffering from autistic spectrum disorders. It appears to be a neurologically-based problem which affects children's ability to communicate and establish appropriate social relationships with age-mates. These children appear rigid and controlling in their behaviors and latch onto a topic that they perseverate about. Nutritional clues to this syndrome have not materialized as causes, so we are left with an uncertainty as to why autism occurs and why it is increasing in frequency. There are no easy answers.

Consider this. There are individuals and groups who feel that they know it all. They tend to have all the right answers, and can back their ideas up with "talking points," biblical interpretations, and personal experience. For these people, life appears easier because there are no gray areas or ambiguities in life. They boss-manage and tell others how to believe.

Individuals who always think they are right are frightening to me. Hitler claimed he was right and look what happened as evil impacted the lives of millions. David Koresh believed he was right and what a mess he made. For those who profess to be right, there are no options to their way of thinking. Just recently, I read a politically motivated article in which the author ended with, "Jesus Christ endorses this message." I believe that using religion in this way is disingenuous and blasphemous - but, what do I know?

I wish life was as simple as many make it out to be. I would feel less strife. However, it would not be authentic. It would leave me living in a bubble away from the complex realities of life. The simplicity would also take the adventure and wonder out of living with uncertainty. I do not know why certain things happen the way they do. I can live with that. After all, what do I know for sure anyway?

James P. Krehbiel is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His personal growth book Stepping Out of the Bubble is available at www.booklocker.com. James can be reached at www.krehbielcounseling.com.

COGNITIVE-BEHAVIORAL THERAPY AND WEIGHT-LOSS

2008-01-18T20:29:00.000-08:00

The weight-loss industry is alive and well. If one is overweight, the choices of diets, nutritional supplements, herbal remedies, exercise programs, support groups, and motivational programs are endless. If devouring a carton of ice cream doesn’t stress you out, ruminating about one’s weight-reducing options can sufficiently reduce one to tears.

If there is a quick fix to maintaining the loss of weight, I have yet to see it. There are plenty of ways to lose weight, but what about the process of keeping it off? Often people bounce around from one dietary plan to another as their weight fluctuates during their quest for the perfect plan. They may deny the reality that there is no panacea for proper weight maintenance. It is a multi-faceted process.

Often, individuals become obsessive with the weight-loss pattern. Weight-loss and weight maintenance can become a ritualistic, compulsive cycle. Charlie Whitfield, author and addictions expert calls the pattern the “repetition cycle.” Anxiety and depression mount, followed by the urge to eat, leading to self-indulgence, and ending with symptoms of self-blame and guilt. Then the cycle of abuse repeats itself. Paradoxically, those who follow an addictive quest to lose weight may actually end up sabotaging their own goals.

From childhood, we are conditioned to believe that the only way we can change is when we are coerced. Therefore, we learn to mistrust our instincts and believe that if we give ourselves enough rope, we’ll hang ourselves. Without exploring the psychological issues that may be triggering weight problems, most people will be doomed to repeat a pattern of self-defeating behavior. We must understand that we are more than the pleasure center of our brain. We are much more than the darkest side of our soul. Many may say that if I am not intolerant of my mistakes, how will I learn to motivate myself to change? However, real change only occurs when we learn to respect and value who we are with all of our faults.

Because of its value in dealing with an individuals thinking, distortions, and beliefs, cognitive therapy is the most effective therapeutic treatment for those who seek to lose and maintain weight. Cognitive therapy helps people make rational assessments of their weight, and assists people in responding with self-affirmation to their maladaptive thinking about eating and body perception. Whatever one’s demons happen to be, people need to move forward and treat themselves as if they deserve the best things to happen in their life.

Self-defeating thinking and behavior tend to perpetuate the cycle of unhealthy eating. No amount of exercise or nutritional support will address the need for individuals to learn to rationally respond to their maladaptive eating patterns. Unhealthy eaters are typically overwhelmed by self-blame. A downward spiral is set in motion by the way in which the person views himself. Unhealthy eaters will label themselves as being “fat” (whether they are or not), and will chastise themselves for not making progress in losing weight. Viewing oneself as an “overweight louse” is not an effective way of motivating oneself for change. In fact, browbeating oneself for being less than perfect only intensifies the cycle of unhealthy eating abuse. Self-blame is a form of tyranny which keeps one stuck in the midst of the problem.

Cognitive therapy teaches the unhealthy eater to quit the self-blame, realistically assess the problem, and to set practical goals for change. The therapist may say, “Does eating too much make you a horrible person? In the scheme of things, how awful was it that you ate that extra helping of cake?” Realistic appraisal follows, “what do you think you can do next time to make sure that you don’t overdo it?”

Cognitive therapists also assess body misperception. Many people who eat in an unhealthy fashion may tell others that they are fat. Labeling oneself in a negative manner is one of many cognitive distortions that hinder weight-loss progress. In many cases, the individual’s concept of their weight may be exaggerated. The therapist may say, “Does calling oneself morbidly obese change anything? Or where’s the evidence that you are as overweight as you think you are?”

Most unhealthy eaters experience thwarted anger. Rather than direct their resentment at the source of their difficulties, they self-sabotage by internalizing their anger and directing it toward themselves through unhealthy eating. They may feel frustrated by the conditional nature of a relationship, may have a family member who humiliated them about their weight, or experienced rejection through social betrayal. As confidence was stripped away, they developed a negative concept of self which fueled their unhealthy eating pattern. The self-blaming message is usually, “I guess I really am a slob, so the best I can do is to continue to prove it to myself.”

Unhealthy eaters can untwist their maladaptive thinking and meet their weight goals by:

Learning to rationally respond to negative thinking. For example, instead of saying, “I’ll never meet my weight goals, I’m just worthless,” one might say, “Just relax and be patient, Rome wasn’t built in a day.”
Identify cognitive distortions such as castastrophizing, labeling, personalizing, and black and white thinking. An example might be, “If I can’t lose 5 lbs. this week I might as well give up” (black/white thinking).
Instead of being unkind to yourself, talk to yourself the same compassionate way you would to a dear friend who is experiencing the same weight problem.
Instead of assuming your negative thoughts are accurate, examine the evidence that supports your conclusions. “If I don’t lose 15 lbs., will people really think I am hopelessly obese?”
Instead of taking full responsibility for your weight problem, you can assess the many factors that may have contributed to it and address those issues with the support of others.
Set a realistic agenda. Ask yourself, “What would it be worth to me to stop my unhealthy eating? How hard am I willing to work on a rational solution?”
Evaluate weight maintenance progress based upon the process – the effort you put in – rather than the outcome. Your efforts are within your control, but the outcome may not.
Substitute language that is less emotionally loaded. “I shouldn’t have eaten that extra helping” can be redefined as, “It would have been preferable if I hadn’t eaten more.”

Often, people will expose themselves to a diet that will dramatically assist them in losing excessive weight only to have the weight return. Instead of “quick fix” diets, setting a realistic agenda for weight-loss is a more rational, thoughtful approach. A slow, gradual loss of weight helps us to more easily adjust to the psychological ramifications of body perception change. Weight-loss goals need to be established because we prefer the change, not because others want it for us. Feeling coerced to change, or sensing that others acceptance of us is conditional upon weight-loss will lead to resentment and a feeling of helplessness in our quest to change. Instead, we must vow to learn the difference between self-indulgence and self-respect and work to put self-kindness into our everyday experience and choose our relationships based upon these positive qualities.

James P. Krehbiel, Ed.S., LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. He is the author of Stepping Out of the Bubble, the story of courage and risk taken by those who seek to better their lives. James can be reached at www.krehbielcounseling.com.

HOW TO RESPOND TO TRAGEDY

2008-01-04T19:22:00.000-08:00

Rabbi Harold Kushner, the author of When Bad Things Happen to Good People, wrote about his response to personal tragedy. His son Aaron had premature aging, and eventually died from this disease. The pain from the Rabbi’s loss provoked a crisis of faith. Kushner wrote his book for those "who have been hurt by life," to assist them in finding a faith that provides reasonable answers to aid them in coping with their suffering. Kushner explores the random nature of life and how certain spiritual explanations for tragedy left him feeling empty.

Recently, I made a trip to visit a friend who has terminal cancer. This was no easy task. I knew that it would be our last visit. I struggled over the issue of what things I wanted to explore to make sure that the time we spent together was uplifting for both of us. I was apprehensive about "saying the right things," but as I drove to her house I kept reminding myself to "just let things be the way they are." It was a time of closure and healing for both of us.

All of us are confronted with times of suffering. It is an inevitable part of the human condition. We are abused by a partner, we lose a job, we are betrayed by bandits who rob our homes, we experience the death of loved ones and we struggle with serious illness. No reasons adequately explain our hurt and disappointment. We are left with our grief.

Often, family and friends make honest attempts to respond to our trauma, but they may make matters worse through insensitive comments. In the name of God, they may make comments that leave us feeling annoyed and misunderstood - the very thing we do not need. Here are some of the unhelpful comments that I am referring to:

God will never ask more of us than we can endure.
Try not to think about it.
God is trying to teach you a lesson.
Don't let it get you down.
Everything that happens in life happens for a purpose.
God has singled you out because he recognizes your strength.
Getting upset about it doesn't do any good.
If you are not healing from your affliction, you lack faith in God.
Just remember, other people have it worse than you.

Trying to figure out why misfortune happens to us is fruitless. Some things appear to happen for no reason. As Kushner indicates, although there is ample evidence of God's handiwork among us, people are unable to accept random acts that occur within the universe. This leaves us feeling deprived of structure and security. I believe it’s not our searching for the reason for affliction that's important, it is our reaction to. This is where our faith in God becomes important. When one is "down and out" here is what you can to say to people:

Tell me how you feel about what happened?
That must feel awful.
It's not your fault that this happened.
Tell me how I can help you?
Would you like to talk more about it?
I am sorry that happened to you.
I'll keep in touch more often.
I'll pray for you and your family.
I'll be there for you.

We need to learn to be more sensitive to those who are suffering. As a partner or friend, our role is not to fix matters, but to learn to become a good listener. We must listen without trying to provide reasons and explanations that are not helpful. As I said, we must "just be there and let things be the way they are."

James P. Krehbiel, Ed.S., LPC, is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His book, Stepping Out of the Bubble is available at www.booklocker.com. James can be reached at www.krehbielcounseling.com.

IS JESUS A REPUBLICAN?

2007-12-08T14:40:00.000-08:00

As I ponder decisions on an everyday basis, I ask the question, “What would Jesus do under similar circumstances?” Often, it is difficult to decipher the right answer that would lead me down the path of personal piety.

Recently, I had a dream which had a dramatic impact on my way of looking at the world. During the dream, God clearly conversed with me in an audible tone. I recall what He said because it startled me to the point of waking me out of a deep sleep. When I was finally more lucid, I recall Jesus saying to me – “I am a right-wing Republican, and you have been remiss in failing to follow in my footsteps!”

I immediately sensed that His statement would have the affect of turning my world upside down. I got up, took a shower, had breakfast and contemplated what I should do in response to this perplexing news. Immediately my mind flashed to Pat Robertson, the preacher from The 700 Club who miraculously leg-pressed 2000lbs. If anyone could confirm the veracity of my synchronistic, spiritual experience it would Reverend Robertson. It was Pat Robertson, along with Oral Roberts, Jerry Falwell and others who had ample experience with this issue of divine intervention. So I contacted Pat Robertson to make sure that I was not delusional. Pat emailed me back providing me with confirmation that I was clearly hearing the voice of God.

Trusting Pat’s wisdom regarding my pipeline to the Almighty, I realized that indeed Jesus had talked to me and was staking His claim as a bonifide right-wing Republican. My mind then aimlessly wandered to another thought. What changes was I supposed to make in response to this dramatic disclosure? In order to follow in His footsteps, what issue did I need to proclaim with evangelical fervor? Numerous ideas flooded my mind. If I was to be God’s vessel, I needed to:

Dissociate myself from any vestiges of Hollywood. Burn all of my CD’s with the exception of my Bon Jovi collection.
Renounce global warming since it is the brain-child of internet guru Albert Gore.
No longer watch The Oprah Show.
Practice the word abomination. Write it ten times in a sentence for a week.
Learn to think black and white without being wishy-washy.
Believe in my beliefs even if they contradict my experience.
Embrace the euphemism of pro-life even though it is inconsistent with the eyes of despair and death from pre-emptive war.
Believe that the United States is the only country that receives God’s special blessing and favor.
Profess that the axis of evil only exists in the hearts and minds of other countries, never our own.
Believe that some sins are worse than others, especially the Big Three.
Renounce the concept of separation of church and state because our country was founded on Christian principles. Faith-based initiatives should receive tax breaks even if they are exclusionary.
Keep the government out of dictating whatever people want to do even if it hurts themselves or others.

As I pondered my new list of proclamations, I felt a sense of relief. All of my new “talking points” were simple and understandable. God had delivered His message. Jesus was as right-wing Republican and He had given me a new set of principles to follow. No longer a “bleeding heart liberal,” I made my way out into the community to share my new perspective.

James P. Krehbiel, Ed.S. is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His personal growth book, Stepping Out of the Bubble is available at www.amazon.com. James can be reached at www.leavingthebubble.blogspot.com. or www.krehbielcounseling.com.

ARE YOU PREACHING TO THE CHOIR?

2007-11-29T20:04:00.000-08:00

Today I read an article by an atheist, which demonstrated more common sense, moral integrity and civility than many within the Christian community. As a Christian, are you preaching to the choir?

Recently, I have read the "talking points" from Christian writers (receiving kudos, by the way) that focus on the denial of global warming, liberal political bashing, the hating nature of God, the "abomination" of homosexuality, and the anti-God movement in the schools. Writers of a similar mentality rally around these folks and pronounce their "Amen’s."

I believe that one of the purposes of writing is to reach a wider general audience, particularly as a Christian writer. As a Christian writer, are you careful and responsible to write only information that is original to you? One can certainly maintain integrity, make a clear statement and accomplish this goal. However, I believe there is a “disconnect” between many Christian writers and the general public. They lack integrity and are preaching to the choir.

Cognitive dissonance is a term which describes the tension that results from a set of beliefs that can’t be fully reconciled with experience. My father believed that African Americans were second class citizens, and yet he treated all people with grace and respect, especially those less fortunate. The distinction between his beliefs and experience was disturbing to me.

Years ago, I befriended a senior pastor of a mega-church in the Chicago area. We went to breakfast together and I served as a needed sounding-board for him. His daughter, who was rebellious, got pregnant when she was 15 years old. He sent her away to live out of state with relatives during the pregnancy and after the delivery of the child. As far as I'm aware, apart from family members, I was the only soul that knew of this man's dilemma.

I asked him why he sent his daughter away. I found his response alarming. He said that he was embarrassed, and that he wanted to protect his daughter from the shame of the congregation! Conservative Christian "beliefs" don't always match experience – this is cognitive dissonance. Oh, we love to go on about "saving babies," but who really wants to care for them, or at least not judge the parent who has had the child out of wedlock? Christians are great in talking about prevention, but not good at teaching responsible sexual behavior and supporting those who have made life-altering mistakes. We must “walk the talk.”

I am a lucky man. This morning I walked out to my backyard. My house is nestled near the foothills of our beautiful mountains. I was disheartened as I observed the haze and smog that clouded my vision of this gorgeous site. My experience tells me that something is horribly wrong. I don't need check my beliefs or Bible to understand this fact. Nevertheless, God has asked me to be a good steward of my body as well as the planet.

Evangelical Christians all over the globe are now on board with "thinking green." Christians have a choice. They can hang on to their “beliefs” and watch the planet continue to deteriorate, or they can follow their common sense. Contrary to some Christian’s beliefs, the concept of global warming is not a liberal conspiracy trumped up by those in the Democratic Party.

Many in the Christian community are unable to reconcile their beliefs and experience as they are reluctant to identify with those who define themselves as gay. This avoidance and judgmental behavior causes many gays to reject their faith or live in a constant state of religious turmoil. A friend of mine decided to spend a weekend of solace at a religious retreat center. It was meant to be a time of isolation and reflection. However, her visit quickly took on a new meaning. Gay men from churches throughout the country flew into this retreat center. Many of them were board members, elders and pastors of their Christian congregations! No one knew of their sexual orientation with the exception of the hundreds of their Christian colleagues who met at this retreat center to worship together each year. These men got together in the freedom of their real identity and worshiped God. They talked with my friend, expressing their sense of liberation and love for the God they embraced. My friend said it was a moving experience, and she was asked to join them in their religious services, which were filled with energy and passion.

As a Christian, when is the last time that you talked to someone who professed to be gay or have you avoided this group because of your belief system? Should the neo-conservative Dick Cheney judge his daughter because she professes to be gay? Can you imagine the conflict he must feel as a father and conservative politician? One’s beliefs cannot always be reconciled with experience. This fact makes life more challenging, confusing and complex. You can’t simplify your experience no matter what you believe.

One of the “talking points” in Christian circles is family values. Many have James Dobson, from Focus on the Family, as their mouthpiece. As a Christian, do you merely believe in family values or do you really embrace them? As Christians, do you support those who have been the victim of family hurt, or do you reinforce those who believe in spirituality and family values but justify their prior experience?

Beliefs and dogma will only carry us so far. As James Fowler, author and theologian states, “faith is an unreserved opening to the truth, wherever it may be found” (paraphrased). Learning to check our beliefs against our experience is essential to a mature faith. Christians need to reevaluate their thinking and quit preaching to the choir. Many potential converts to Christianity are being turned off by the inconsistent and thoughtless manner of those who believe they are expressing the Gospel. Are you preaching to the choir?

James P. Krehbiel, Ed.S., LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist in private practice in Scottsdale, Arizona. His book, Stepping Out of the Bubble is available at www.booklocker.com. James can be reached at www.krehbielcounseling.com.

What ABOUT Family Values?

2007-11-08T13:40:00.000-08:00

The concept of "family values" has become a catch-phrase. It has been used by many politicians to promote their agenda, particularly among those who consider themselves politically conservative. However, the term has lost its meaning in the process of being politicized.

Currently, the religious right is looking intently at presidential candidates, making sure that their version of family values is embraced by specific nominees. If the politician doesn't align himself with their brand of family values, all bets are off. At this point, no candidate appears to be pleasing the religious right. So calls have gone out for a third-party prospect for president.

In order to truly understand family values, we need to isolate it from the political and religious pandering. Family values are about the support, nurturing and compassion that individual family members demonstrate toward one another. We see it every day in its simplicity.

Family values starts with partners who cherish each other and are committed to their mate’s spiritual and psychological well-being. These are couples who respect, value and trust each other implicitly. A partner does not need to perform to get a sense of approval from their loved one.

If children are involved, these couples develop a consensus on how their children are to be raised. They establish clear, understandable rules which are reasonable. They are extremely connected to their children and share their life through play, instruction, discipline and involvement in their children's activities. Couples cherish every moment with the kids because they realize that someday their children will pull away and move on. Good parents don't resent this detachment, but view it as a form of self-determination. It is a “feather in their cap.”

Even after children have transitioned to adulthood, we stay connected and open to providing support. If we are fortunate enough to have grandchildren, we relish the opportunity to welcome them to the family nest. We support our children in their parenting and look forward to the time when our grandchildren spend time with us under our support and care. We consider it a blessing to have another opportunity to love and cherish our little ones.

The most important value we can teach our family is civility. Civility is learned behavior in which we treat others with kindness and respect. We take special care to treat those less fortunate than us with compassion and support. We seek to understand those who share different perspectives and in a non-evaluative manner explore those distinctions.

Family unity is not a political or religious concept but rather a primal instinct. In all cultures, there is a natural desire to protect and nurture one’s flock. There's nothing new about family values. In our global community, taking care of those we love is all the more important. By compassionate family companionship, we are able to shelter our family from the alienation that is characteristic of today's society.

James P. Krehbiel, Ed.S., LPC, CCBT is an author, freelance writer and cognitive-behavioral therapist practicing in Scottsdale, Arizona. His personal growth book, Stepping Out of the Bubble is available at www.booklocker.com. James can be reached at www.krehbielcounseling.com.

COGNITIVE THERAPY'S TREATMENT OF ANOREXIA NERVOSA

2007-10-25T19:50:00.000-07:00

Anorexia is a troublesome disorder characterized by an obsession with weight and food. With a target group consisting primarily of adolescent girls (80-90%), the anorexic will crave food, but will refuse to eat or retain it because of an overwhelming fear of weight gain. The individual may stop eating almost entirely, and will deny that her behavior is abnormal and that health is deteriorating. Typically, the anorexic will say that “she feels fat,” even when she is obviously underweight.

The behavior of the anorexic may be characterized by a pattern of social withdrawal, rigorous exercise, and ritualistic eating habits. The emotional profile of the anorexic is marked by a pattern of depression, fear of obesity, and loss of self-confidence. Physical symptoms include a loss of menstruation and a weight loss of up to 20-25% of body mass. According to diagnostic criteria, a female patient is clinically suffering from anorexia nervosa when body weight has fallen to 15% below normal and she has not menstruated for at least three months. The same body weight criteria apply to male patients.

Anorexic teenagers are generally unwilling to receive treatment, resisting any attempts at counseling. Those who reluctantly seek treatment begin the process from an adversarial perspective. Developing a collaborative relationship with an anorexic patient is no easy task. It is critical that the therapist develop a warm, friendly, honest and accepting relationship with the anorexic. The quality of the therapeutic relationship will be a factor in determining the individual’s willingness to deal with the terrifying aspects of eating and weight gain.

The relationship provides a means for examining cognitive distortions and maladaptive underlying assumptions that the anorexic applies to her internal world. It is critical that the counselor accepts the individual’s beliefs about body perception as genuine for her. Any attempt to refute, challenge, or devalue the person for holding erroneous assumptions about weight and body misperception is counterproductive. Anorexic teens are used to hearing from significant others that their beliefs are illogical and irrational.

It is the goal of the therapist to enter into a mutual fact-finding process with the anorexic client. By accepting the patient’s belief system as genuine for her, it is possible to introduce doubt about the anorexic’s basic cognitive assumptions. The individual may be encouraged to reexamine core assumptions about the value of thinness. Several lines of inquiry might be, “Is it practical for you to embrace this idea?” or “How does losing weight fit in with other values that you cherish?” Emphasizing that treatment will follow an experimental model is an important notion. The therapist’s approach with the anorexic might be, “Let’s try this out and see what happens.”

Therapy with the anorexic involves challenging faulty thinking and beliefs. For example, if the patient expresses apprehension around the issue of losing competence if she gains weights, the therapist can help her develop a working definition of competency that will establish a concept of whether or not it is influenced by weight changes. Such questions such as, “Would you appreciate your friend more if she weighed less than you?” may help cut into the double standard established by the anorexic patient.

Questioning the anorexic about what would happen if their worst expectations came to pass may minimize the imagined effects of the event. The person who demands “thinness” is obviously anxious when she considers herself “fat.” The counselor may inquire, “What’s the most horrible thing that could happen if you were to gain weight?”

Cognitive distortions are numerous in the anorexic and must be gently challenged. Distortions such as dichotomous thinking, (“If I gain weight, I’ll be considered obese.”), overgeneralizations, (“I will never get any better and my eating will never improve.”), magnification, (“Gaining any weight will be more than I can take!”) must be directly, but gently confronted in counseling. The anorexic is encouraged to design experiments to test the validity of specific irrational thoughts. For example, the anorexic individual may be encouraged to interview her friends for preferences in physical appearance, checking out how often people select a friend based exclusively on the merit of weight.

Body-size misperception is a significant feature of the anorexic disorder. The individual may be asked to reinterpret what she sees. Such counter-arguments may involve the use of reattribution techniques such as, “When I try to estimate my own dimensions, I am like a color-blind individual attempting to create my own wardrobe. I will rely on other’s objectivity to assess my actual body size.”

With the anorexic, maintaining a multidimensional approach to treatment is necessary, focusing on information processing, cognitions, and other strategies such as:
Dealing with family issues. Some therapist’s believe that the anorexic disorder actually acts as a stabilizing force for the family.
Dealing with personal goals and ambitions of the anorexic.
Focusing on issues of control, perfectionism, assertiveness and autonomy.
Dealing with social adjustment issues.
Assisting with problem-solving and coping skills.

Dealing with the anorexic patient is demanding and requires flexibility and creativity as necessary ingredients if the therapeutic process is to be successful. Many anorexic clients struggle with their body misperception issues throughout their life and may need to revisit the counseling process during times of high stress.

James P. Krehbiel, Ed.S., LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His book, personal growth book, Stepping Out of the Bubble is available at www.booklocker.com. He can be reached at www.krehbielcounseling.com.

THE EMERGING POPULARITY OF COGNITIVE-BEHAVIORAL THERAPY

2007-10-10T10:23:00.000-07:00

Cognitive-behavioral therapy is currently receiving a significant degree of attention as the treatment of choice for individuals needing assistance with a variety of psychological disorders. It is a structured, pragmatic approach to dealing with problems and is appealing to those seeking therapeutic treatment. People in need of counseling are seeking out clinicians who have specialized training in CBT. Understanding the reason for this current trend in popularity of cognitive-behavioral therapy can be found in the unique characteristics which are pivotal to this modality of treatment. There is a simplicity and yet effectiveness in the model which characterizes the concepts of CBT.

Cognitive-behavioral therapy facilitates a collaborative relationship between the patient and therapist. Together, patient and counselor develop a trusting relationship and mutually discuss the presenting problems to be prioritized and explored in therapy. In CBT, the most pressing issue troubling the patient typically becomes the initial focus of treatment. As a result, the patient tends to feel relieved and encouraged that the primary problem that brought him to therapy is immediately being acknowledged and addressed.

Problems are tackled head-on in a very practical manner. The patient is coached on the ABC’s of cognitive-behavioral therapy. The therapist explains the connection between thoughts and beliefs and their impact on behavior. How the patient thinks about problems determines the way in which the individual responds to various issues. It’s the manner of thinking about life’s issues that steers the patient’s way of behaving.

Let’s assume that you work in an office and for an entire week a co-worker has walked past you without acknowledging your presence. Each day you go back to your cubicle and wonder why this colleague is treating you so unjustly. You build up thoughts about her being condescending and snobbish and begin questioning what you might be doing to annoy her. Anger begins to emerge and your start thinking, “How dare she treat me this way!” Eventually, you settle down and start to rationally consider the problem. You think, “This is stupid, why don’t I go visit her at her office and see what’s going on in her life that might be affecting this situation. You enter her office and begin starting a conversation. In the midst of your discussion, she reveals that her son is suffering from depression and needs to see a counselor. Your colleague is disturbed about the situation and confides in you that she has been on edge with everyone at the office. She asks you if you know of a qualified therapist. You give her some ideas and before you leave, she gets up from her chair and gives you a firm hug. This incident demonstrates how our thinking can be faulty and can be based upon some erroneous assumptions.

CBT is effective because it teaches the patient to modify patterns of thinking which affect behavior. CBT is a straight-forward therapy which is designed to alert the patient to self-defeating ways of thinking. Locating distorted or maladaptive thinking is accomplished through an exploratory process which is dependent upon a solid patient/counselor therapeutic alliance.

Cognitive-behavioral therapy focuses on the patient’s negative self-talk, and offers practical suggestions on how to untwist one’s thinking to make it more adaptive. The CBT therapist assists the client in thinking more rationally by examining the individual’s spontaneous thoughts, observing ways in which they may distort reality, and ferreting out underlying assumptions or beliefs that affect ways of thinking and behaving.

Spontaneous thoughts are the nonsensical things that we tell ourselves when we are under stress – “I’ll never get a date, who would ever want me!” Cognitive distortions are the lenses out of which we perceive reality – “You always make me feel like a loser” (either or thinking). Underlying assumptions are the “hot buttons” which crystallize as a way of coping and getting our needs met during childhood – “I must avoid conflict at all costs; I hate disapproval and getting my feelings hurt.”

Cognitive-behavioral therapy seeks to refute the nonsensical things we tell ourselves and assists us in developing more rational ways of responding to our maladaptive thought processes. Since homework is an integral part of therapy, patients will be encouraged to complete exercises designed to change negative thinking. One concrete procedure helps the client to identify current troubling events, negative self-talk, and ways of rationally responding to situations sited. The individual logs difficult situations, identifies self-defeating thinking and refutes the negative thought processes with more rationally, adaptive way of responding to events. During each therapy session, the log sheet is reviewed for patient progress.

With CBT, clients are in control of their own progress. They are aware of the process that is necessary for change, and diligently work at modifying faulty thought patterns. Therapeutic progress is easily monitored through self-inventories and patient feedback. Time is always left at the end of sessions to review the benefits or pitfalls of the counseling sessions. Clients are asked to assess the effectiveness of their counselor’s treatment process.

Patients often ask, “How long will this counseling treatment take?” Although each case is unique, six to eight sessions are generally sufficient to teach clients strategies for reshaping their thinking. CBT is a time-limited, user-friendly, practical process for helping individuals to assess their negative thinking and making needed transformation in the way they respond to themselves and others. Individuals with anxiety, addictive patterns and depressive disorders are particularly well suited to benefiting from this from of treatment. The good news is that many behavioral health disorders can be treated successfully through cognitive-behavioral therapy. NACBT or The National Association of Cognitive-Behavioral Therapy is a good resource for locating counselors who are sufficiently trained, certified, and specialize in this treatment approach.

James P. Krehbiel, Ed.S, LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His personal growth book, Stepping Out of the Bubble is available at www.amazon.com. James can be reached at www.krehbielcounseling.com.