Common Problems that Lead to Therapy: Part I (symptom disorders)

by Dr. Rob Burkham

The purpose of pain in our life is to promote healing and growth. The psychological pain of sadness, grief, fear, depression, or anger serves the same purpose that physical pain does. Both physical and psychological distress warn us that something is wrong and we need to do something different.

I once read a newspaper story about a young girl who suffered from a rare neurological disorder which made it impossible for her to feel physical pain. Her health was always in danger because she would do risky things which would cause her serious injury but she wouldn't know it. She had broken nearly every bone in her body through reckless behavior because she did not know she was hurting herself.

Psychological Pain = Time to Change

When you are in pain psychologically, it is a message to you that you need to make some changes in your life to alleviate the pain and keep you from generating more pain. Your pain is a gift to you (yeah, some gift!) to push you to make a better life for yourself and to stop injuring yourself. Therapy can help guide you not just to feel better, but to understand how you can change things so that your life will not generate so much pain. The problems you bring to therapy present you with opportunities to grow and make positive changes in your life.

Depression

Depression is often said to be caused by a chemical imbalance in the brain, and that is a partial truth in most cases.

Depression is also caused by a pessimistic way of thinking about one's self and one's life which keeps depressed people feeling bad about themselves, inferior to others, unassertive with others and helpless to make any changes.

Anti-depressants have helped millions of people and have been a lifesaver for many, but therapies that focus on changing the way you think and the way you relate to others have been shown to be highly effective at getting people out of depression and helping them to stay out. These therapies, called "cognitive-behavioral", can be very helpful by themselves or in conjunction with anti-depressant medication.

Many times, depressed people are in vicious circles in which their negative thinking leads to ways of relating to others which strengthen their negative beliefs. Here's a common vicious circle: · I believe that I am inferior to others so I don't stand up for myself. · Because I don't stand up for myself, I get taken advantage of by others. · When I get taken advantage of, I feel inferior to others. · When I feel inferior, I don't stand up for myself. And so on.

Breaking this kind of self-reinforcing cycle can be a very important part of effective treatment of depression. If you learn to think more positively about yourself and you learn to be more assertive with others, you will be stronger and more in charge of your life and therefore less depressed.

Anxiety Disorders

Like depression, anxiety disorders (these include obsessive-compulsive disorder, generalized anxiety disorder, social anxiety disorder and phobias) are seen by many as primarily a problem with brain chemistry, another partial truth. While medications can be helpful for many, there are powerful psychological therapies which focus on changing how you think and what you do in the present. They use principles from cognitive and behavioral psychology to help you gain control over your fears.

For many types of problems other than anxiety disorders, the specific techniques used by a therapist are not particularly important to the outcome of therapy. Many different techniques are effective with many different types of problems.

However, research seems to support the idea that with anxiety problems, specific techniques matter a great deal. If a therapist is using a general, unfocused talking therapy and is not using specific techniques to help you relax, combat your fears with alternative thoughts, and gradually expose you to what you fear in order to overcome that fear, you may not be getting the most effective treatment for your problems.

I have found that when people have reduced their anxiety problems enough so that their symptoms are not interfering with their life, they may need to work on problems that were fueling their anxiety or were covered up by their anxiety. For example, a couple's marriage may be focused on one of the partners' anxiety problems, keeping them from having a fully satisfying and mutual relationship.

The partner without the anxiety may be spending a great deal of energy taking care of their mate and can become very frustrated. The person with the anxiety may feel inferior and dependent. When the anxiety is not long present, the couple may need some help to have a relationship without the anxiety.

Post-Traumatic Stress Disorder

People can get traumatized by many things and can have a hard time "getting over" those traumas. People can be hurt by being in combat, being in a bad car accident, being sexually assaulted, or being physically assaulted. For years after these events, people can continue to have fears of situations which are similar to the situations in which they were traumatized. They can have intrusive flashbacks and nightmares about them and avoid places or relationships which would bring back the memories of these incidents. This is post-traumatic stress disorder.

To be helped in therapy requires a willingness to gradually face these past events and reduce the fear that is so closely tied to those events. Change comes when the client emotionally knows that these are past events which do not need to exert their power over their present lives. It helps to have a compassionate and patient therapist who can guide you through talking about the past trauma, feeling some of the feelings again in the context of a safe relationship, and losing some of the fear. It also helps to have supportive family and friends who can accept your pain and encourage you because you are valuable to them.

About the Author

Robert Burkham, Ph.D. is a clinical psychologist with 25 years of experience doing psychotherapy and 20 years of experience supervising other therapists. He has been a licensed psychologist in the state of Wisconsin since 1982 (License #991) and has practiced in Appleton, Wisconsin for 20 years. He is a member of both the American Psychological Association and the Wisconsin Psychological Association

The Therapy Triangle Robert Burkham, Ph.D. http://www.therapytriangle.com