Blog – Everything is About Therapy

Emotion regulation simply refers to how people (both intentionally and automatically) manage their emotions. This is a hot topic in the field of psychotherapy because if you have good emotional regulation, then you’ll be resilient and have good mental health, but if you have poor emotional regulation (also known as dysregulation) then generally speaking, you will have problems. There are different problems people can have in regulating their emotions, but we can loosely break them into two types: emotional underregulation and emotional overregulation (also known as overcontrol).

When emotional underregulation causes problems, they are usually obvious and dramatic, such as crying spells, flying into rages, impulsive behavior, etc. Emotional overcontrol, on the other hand, is often less obvious because it is frequently condoned and encouraged by our culture, especially for men. Emotional overcontrol can look like detachment, hyper-intellectualism, having a “stiff upper lip,” or your friend who tells you about the horrific thing that happened to her but follows it immediately with “but it’s fine.” Problems caused by emotional overcontrol can look much more subtle than those caused by undercontrol, but can include loneliness, subtle depression, free-floating anxiety, somatic symptoms, a vague sense of boredom or lack of excitement about life, and trouble with close relationships.

Disney’s Frozen is a perfect metaphor for emotional overcontrol, how it develops, and how it causes problems. For those of you who have been living in a cave, in this movie, Elsa has special powers related to snow and ice. However, one day, while playing, she accidentally hits her sister in the heart with an ice bolt. In the aftermath, she is told that her powers are dangerous and she must hide them. “Conceal, don’t feel” she is told, and she is even given gloves to help her keep her powers under check. This is very similar to how emotional overcontrol can develop. Somehow, usually in childhood, we get the message that one or more of our emotions are dangerous to those around us who can’t handle them or could be hurt by them (anger is a frequent one here), or are otherwise bad or shameful and must be hidden (sadness and vulnerability often fall in this category, especially for men). So we gradually learn ways to distance from our feelings and hide them from others. Over time, these ways of insulating others and ourselves from our feelings become ingrained and automatic. In Frozen, Elsa’s attempts to hide her powers cause a problem by distancing her from her sister, who begs Elsa to play together with her like they used to. In the same way, overcontrolling our emotions leaves us (and those around us) lonely because it’s impossible to share our whole selves. It also leaves us without our full passion, capacity, and feeling of inner wholeness.

The song Let It Go is the moment where Elsa decides to reclaim her power and stop holding it in. Later in the movie, she learns that she doesn’t have to go off on her own to do this, but can use her powers in relationship with others and for the benefit of others. In a similar way, for those of us who suffer from emotional overcontrol, it can take a while to re-learn how to own all of our feelings and how to use them responsibly in our relationships to both stand up for ourselves and increase our closeness and enjoyment with others. This process, of course, is an area where therapy can help us a lot. Like Elsa, we don’t have to accept a life of hiding, nor do we need to exile ourselves in order to fully be ourselves. We can have the best of both worlds and be able to experience all of our emotions in connection with others, yet in a responsible way where we still have a measure of control.

How many times have you dipped your toe into cold pool water, only to have your friend (already in the water) say “it’s nice once you get used to it?” The water may actually be cold or maybe not so much, but it almost always feels colder at first than it does later after your body acclimates to it. The way you get used to the temperature of the water is similar to the concept of desensitization in psychology. We can have a lot of anxiety about certain things, but after we are exposed to them over a period of time in a controlled way, anxiety is replaced by feelings of mastery.

Many types of therapy make use of desensitization. Types of therapy such as Prolonged Exposure Therapy (PET) treat phobias by exposing people to feared stimuli, for example snakes or elevators. PET and other types of therapy including EMDR can treat post traumatic stress disorder (PTSD) by exposing people to their memories of traumatic events. Exposure and Response Prevention treats OCD by exposing people to thoughts and sensations which disturb them, while preventing them from engaging in compulsions they usually use to manage their discomfort. A few types of therapy (including ISTDP, which I practice), are structured to reduce anxiety associated with emotional experience and emotional closeness, using systematic exposure.

Exposure to feared and avoided stimuli, memories, emotions, and behaviors is actually one of the most powerful healing factors in effective therapy. However, it’s one of the hardest areas to motivate clients. Why? Because just like getting in the pool, it’s uncomfortable at first! Since therapists can’t splash you and drag you in like your friend at the pool, we have to build your motivation to get in based on how nice it will feel to swim (be free of symptoms) once you get used to the water (are done with the desensitization process).

Every once in a while, my clients come to session saying that they have nothing to talk about because “everything is going well.” This usually means either that a major crisis happened in the last week that they don’t want to talk about, or else, that things genuinely have gone OK over the last week and so they don’t want to kill their mood by talking about any of their difficulties. I get it, since I have done the same thing myself as a client, but it’s also my job as their therapist to point out how their behavior helps or hurts their progress in therapy. To help them understand why everything going well isn’t a reason not to talk about anything, I oftentimes will tell them the following story:

Once upon a time, there was a man who lived in a house with lots of big holes in the roof. Every time it rained, water would come pouring in and drench all of the furniture. One sunny day, the man was sitting on his front porch when a woman who happened to be a roofer walked past and noticed the holes in his roof. “I see your roof is pretty leaky,” she said, “Would you like me to help you fix it?” The man shrugged, smiled, and replied, “No thanks, because today it isn’t raining!”

I almost always get a laugh of recognition when I tell this story. It’s very easy to see why it’s necessary to repair a roof before it rains, but it’s much harder to see the need to work on our emotional vulnerabilities and problems before life stressors come up and cause a crisis. Oftentimes, when nothing is happening to trigger symptoms, we can imagine that our problems are already gone, until the next thing happens. Then it’s already Thursday and we are melting down, but we have to wait until our next session which isn’t until Tuesday!

Proactively addressing problems is critical part in living a successful life (and is also one of the famous Seven Habits of Highly Effective People) but it takes discipline. Going to therapy at all is a great way of being proactive, and once we are there, we can be certain that there will ALWAYS be something worth talking about, assuming we are willing to talk about what we usually want to avoid. Then we can start repairing our emotional roof before life throws any more storms at us!

How is therapy like working out? Well, we all know that there are lots of right ways to exercise! And many of us know that there are lots of right ways to do therapy, too. But as this video shows, there are also lots of ways to fail at exercising. And as it turns out, there are some ways of doing therapy that don’t work very well, either!

If you join a fitness class, you may quickly learn some new skills, like how to execute a burpee. But the main task of getting fit is a slower process of capacity-building. By gradually lifting heavier weights over time, or slowly working up your aerobic activity over time, you can increase your strength and endurance. Therapy can be similar. You might learn some skills very fast in therapy, like how to use deep breathing or how to dispute an irrational thought. But oftentimes, the more important work of therapy involves a slower process of capacity-building. In therapy though, instead of improving the functioning of our muscles, heart, lungs, etc., we are actually improving the functioning of our central nervous systems! We are always building the capacities to self-reflect, self-regulate, relate well with others, and experience strong and conflicted emotions without getting too overwhelmed.

As this video shows, one way to fail at fitness is to work above your level, so you fall over and get pinned under the weights or go flying off the treadmill. Many times the same kind of mistake can happen in therapy. Maybe you decide you want to talk about your worst trauma right away, and spend the session sobbing uncontrollably or overwhelmed with anxiety, then you go home and have a migraine for the rest of the day or engage in your worst coping habits. Afterwards, you might decide you never want to come back to therapy again.

On the other end of the spectrum, if you join the gym in order to get fit, you probably would not sit around on some of the equipment, talk about how the equipment is used or could be used, lift one dumbbell a couple of times, then go home and expect to get stronger. Amazingly though, many people do practically the same thing in therapy for years at a time! They want help with managing their emotions, but instead of lifting the weights (actually experiencing their emotions at increasing dosages so they can build the capacity to handle them), they talk about their problems in a way that totally avoids actually stirring up their feelings. Or they say they want to overcome their fears, but they don’t engage in the work of actually facing what they are afraid of in order to accomplish that.

A good therapist is like a good personal trainer. They know how to help you build your capacity by starting at a level you can manage and gradually increasing from there. They won’t push you to a point where you get too overwhelmed and regret it later, nor will they encourage you to stay too comfortable so that you never work hard enough to see any progress. Of course, both good trainers and good therapists value your feedback when working together, so if you realize your therapy has been overwhelming you or not challenging you enough, it’s probably time to say something about it.

I have been on hiatus recently with this page because I was busy with moving and other life events. Among other life events, I got a speeding ticket and ended up taking a defensive driving course. Fortunately, the class inspired me for this post!

The defensive driving course talked about the importance of wearing a seatbelt. Otherwise, in a crash, you could go flying through the windshield and end up who knows where outside the car. A seatbelt keeps you tethered inside the car. While you could still be hurt in a crash, staying inside the car is your best chance for survival. I started thinking about how realistic beliefs are like seatbelts, because they keep us safely tethered to reality. Although reality can be harsh and painful, staying in contact with reality whenever possible is still much safer than the alternative!

Imagine you are driving along in your car and get into an accident. You go flying through the windshield, sailing through the air, and eventually hit the pavement. If you end up cracking your skull open, you might blame the road for being there, but it’s not the road’s fault. If you had been wearing your seatbelt, you would never have been in a position to be on a collision course with it.

Similarly, it’s not reality’s fault when reality collides with our false beliefs. One famous therapist who pointed this out was Albert Ellis, who created Rational Emotive Behavior Therapy (REBT). Ellis said that we tend to make ourselves miserable through our own irrational beliefs. For example, he talked about “dogmatic demands,” in which we think things “should” or “ought” to be different from how they are. For example, I can keep myself miserable for years thinking my family “ought to” treat me differently, but I will just keep on having a painful collision between this belief and the fact that they don’t! Whereas, if I started with a more realistic belief, such as “I want my family to treat me differently,” it would be more clear that it’s up to me to either change what I can change or accept what I can’t. To give a more extreme example, let’s think about recent mass shooters who believed things such as: women must give me love and/or sex; if they don’t then I am justified in killing in revenge. A belief this detached from reality won’t just keep you unhappy, it can land you dead or in prison for the rest of your life.

Albert Ellis also pointed out that when our irrational beliefs conflict with reality, we can end up condemning and devaluing ourselves, others, or other aspects of life. For example, if I believe I must always be successful in my work, I can tell myself I’m a worthless therapist if I fail to help one of my clients. This is like failing to wear a seatbelt, flying out of the car, smashing into an underpass, and then calling my rib cage worthless for not holding up under the impact. I’m never worthless for not living up to my own demands; if my expectations of myself had been realistic, I wouldn’t have had to be in conflict with them. Ellis said that to be emotionally healthy, we should accept ourselves and others as we are rather than negatively rating ourselves and others based on our irrational beliefs.

People (and defensive driving classes) might seem annoying when they keep reminding you to wear your seatbelt, but they are trying to look out for your safety. Likewise, therapists can seem really annoying when they try to remind us to keep our beliefs in line with reality, but they are also looking out for us by doing that! When driving on the road of life, it’s good to remember to fasten our reality belt!

Last night I went to see Won’t You Be My Neighbor, the new documentary about Fred Rogers, which by the way was excellent. At some point in the film, they mentioned something I have heard before, which was that many people have accused Mr. Rogers of creating a generation of narcissists by telling all children that they are special just the way they are. I’m tempted to simply laugh at that kind of allegation, but I think this is an opportunity to clarify an area of real confusion for some people, which is the difference between healthy self-worth and toxic narcissism.

When you look at the whole context of everything Fred Rogers said, and how he lived his life, it becomes very clear what he was trying to tell kids by saying that they are special. He was affirming the uniqueness, worth, and dignity of every person. He was saying that every person is equally special because everyone has unique gifts to bring to others, and that all people are equally lovable and entitled to basic kindness and respect. These beliefs are very supportive of having a healthy sense of self-worth that helps people to respect others, uphold fairness, and contribute to society.

Let’s compare this to some lyrics from Kanye West’s song, I Am a God:
I am a God
Hurry up with my damn massage
Hurry up with my damn ménage
Get the Porsche out the damn garage
I am a God

If you look at this and Kanye’s others songs, along with his actions, it’s clear that he believes he is special, but in a completely different way than how Fred Rogers used that word. Kanye doesn’t mean, “I am special and because of that I have unique gifts to bring to all of the other equally special people in the world.” He means, “I am more special than other people, and am therefore entitled to special treatment.” Of course, the important difference here has nothing to do with the musical style; lots of rappers have promoted love and respect, and Kanye West is far from the only highly-visible person displaying narcissistic traits. The point of using him as an example is just that his lyrics in this song are so blatant as to make the point very obvious.

Hopefully the contrast here makes it clear that self-worth and entitlement (an aspect of toxic narcissism) are so far from being the same that they are actually polar opposites. One promotes generosity, while the other promotes greed. One promotes love and respect for others, while the other promotes contempt for others. One embeds us in a dense web of mutuality with others, while the other one places us alone on a pedestal. So let’s not be too confused by the fact that the word “special” can mean very different things to different people, and make the mistake of blaming an epidemic of narcissism on someone who had nothing to do with it.

Just to make this even clearer:

Self-worth:
-Emphasizes universal worthiness of all people
-Promotes generosity and contribution
-Based on love and respect
-Is compatible with realistic appraisal of people’s strengths and weaknesses
-Values differences

Narcissism/Entitlement:
-Emphasizes comparisons; some people are seen as worthier than others
-Promotes entitlement, demandingness, and sometimes violence
-Based on contempt and disdain
-Necessitates unrealistic idealization and devaluation of people and/or groups
-Devalues difference – only one “right” way to be

To relate this back to therapy, healthy self-worth is the foundation of all healthy people, relationships, and communities, while entitlement and toxic narcissism can easily destroy people, relationships, and communities. Unfortunately, when people get too deeply embedded in toxic narcissism, they usually don’t want therapy for it, no matter how much it may be ruining their lives, because they believe they are perfect and that other people are the problem. Obviously, therapy can’t help people who don’t want therapy, but fortunately, it can help the rest of us. After all, all of us, in smaller ways, have put ourselves on a pedestal at some point. And almost all of us, at some point, have also enacted the opposite role by devaluing ourselves and putting others on the pedestal instead. If we are not too far gone to be able to see this as a problem, then therapy can help us to let ourselves and others off of their pedestals and relate instead from a secure foundation of respect and worthiness.