Thursday, November 27, 2008

COGNITIVE THERAPY AND PAIN MANAGEMENT

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.

Wednesday, November 19, 2008

Authenticity and the Gay Identity

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.

Wednesday, November 05, 2008

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

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.

Sunday, October 12, 2008

McCain and the Mob Mentality

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.

Wednesday, October 01, 2008

Maintaining Sibling Relationships As We Lose Our Parents

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.

Thursday, July 03, 2008

CHUCKLING YOUR WAY THROUGH THE GOLDEN YEARS

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.

Thursday, June 05, 2008

WHY SCOTT MCLELLAN CAME CLEAN

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.

Saturday, May 24, 2008

HOW ABUSED WOMEN CAN BREAK THE CYCLE

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.

Wednesday, April 23, 2008

MUSINGS ON BEING A CONSERV-ATIVE

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.

Monday, March 24, 2008

WHAT DO I KNOW FOR SURE ANYWAY?

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.

Friday, January 18, 2008

COGNITIVE-BEHAVIORAL THERAPY AND WEIGHT-LOSS

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.

Friday, January 04, 2008

HOW TO RESPOND TO TRAGEDY

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.