Monthly Archives: May 2015

Cognitive Pearl #084 Sivan 13, 5775 May 31, 15 Poetry & Cognition





My previous post touched on the integration of poetry and artistic expression into our work as healers, teachers, and professionals of every stripe. Of course it is absolute hubris to think that art needs some sort of ‘scientific validation’ or in the lexicon of contemporary Orthodox Judaism, a ‘teudat kashrut’; humanity has soared out of its most horrible depths on the wings of poetry and art well before a bunch of psychological hotshots started poking around with brain scans and computers.

As a yeshiva bochur however poetry has a unique place beyond other artistic forms. In spite of the often maligning characterizations of the yeshiva bochur, what outsiders often don’t appreciate about us is our love of precision. Whether we’re arguing over who bears responsibility for a wayward ox or the correct amount of cayenne pepper in a cholent, we will go to the mat to get to the truth. We want our ideas, to be clean, concise, and free of dross.

So it shouldn’t surprise anyone that poetry’s exacting demands of beat, rhythm, meter, rhyme and structure should mean so much to this yeshiva bochur. The ethereal ideas of great poetry brings me into communion with what really truly is; nothing less and nothing more. In the poem lies the essential truth, a truth so miniaturized, rarified, and refined that it can take me by the hand and schlep me with my big American ego into its beauty.

With that in mind, I share one of my favorite poems about how we can heal each other. It’s written by Hafez, a Persian mystic, who appeared to have appreciated the terrible loneliness that still challenges us to this day. 

With That Moon Language

Admit something: 

Everyone you see, you say to them,

“Love me.”

Of course you do not do this out loud;


Someone would call the cops.

Still though, think about this,

This great pull in us

To connect.

Why not become the one

Who lives with a full moon in each eye

That is always saying,

 With that sweet moon language,

What every other eye in this world

Is dying to


Cognitive Pearl #083 Sivan 10, 5775 May 28, 15

greatest fear









Over the years the New York Times, a newspaper celebrated by intelligentsia the world over, has introduced a surprisingly intelligent discussion about mental health and psychotherapy. So it was fascinating to read of a case vignette in which poetry was a central prop in the dynamic between healer and client. You can read the article here.

To be sure, the management of the case was problematic. The comments, when you look past the snideness and the rage so common to comment sections, raise some very valid questions. While there is no doubt that the client’s poetry and the discussions that revolved around it played a major role in this case, it’s seems that the central axis here was the client’s wounded narcissism and the therapist’s valiant and impotent efforts to ‘domesticate it’.

What this write up triggered for me was a reflection on the integration of artistic expression into treatment. I am not by any means an art therapist. However I’ve long believed that one enormous value of artistic expression is that it allows us to become rulers and gods of the crazy universes that we inhabit. For one beautiful expressive moment we ‘own’ whatever threatens to destroy us or we hold the reins of an otherwise fleeting mysterious dream. Whether it’s our own creations or the visions and words of others, we are no longer unwanted visitors in this world; we are the kings and queens. 

And what could be better than that?


Cognitive Pearl #082 Sivan 4, 5775 May 22, 15


With Shavuot upon us, two ideas have been rolling around my head, ideas that I think are super important in our work as healers and teachers.

The first  idea is about trying new things, making mistakes, and then picking up the pieces to make an even more beautiful masterpiece. The Torah is shockingly candid about mistakes. While the purveyors of super-hero fiction (and many so-called Gedolim biographies) would like us to believe that heroes are flawless, the Torah gives us permission to embrace the reality of our imperfect-perfect existence and to dance with it. Even Hashem, with all of His abilities, could not stop us from messing up just 40 days after the greatest moment in human history. We made a Golden Calf, an epic mess which we’re still cleaning up to this day.


Yet Hashem didn’t throw in the towel. He gave us and Him another chance to make it work. And it did. Just look at how far we’ve come.

The second idea is a bit more ‘cognitivy’. In my spare time I’ve been reading a lot about non-symbolic cognition. Think of how a dog might view the meat counter in a supermarket. He sees (or smells) the meat but little else. Unless there’s a predator present, everything but the meat is invisible to him because it has no symbolic value. At least to a dog. Among our species, non-symbolic cognition is a hallmark of clinical depression; the severely depressed individual looks at a world of grey, flatness, and lacking any symbolic contours. While we see energy, beauty, and opportunity he sees blankness.

What’s this got to do with Shavuot? Well we’re told that Hashem forced the Torah on us through brute coercion. The Midrash uses the phrase, ‘He held a the mountain like a barrel over them’.

This first iteration didn’t work out as planned; we relapsed into our idolatrous roots. The reason that I think we failed is that we were unable to see what we were being given; it was invisible to us. The glory of the Mitzvot had no symbolic gravitas to us.


We were still thinking in ‘Egyptian’, with its pyramidical distributions of power, and soul crushing ideology of meaningless dispensable cogs in someone else’s dreams. Hashem’s idea of unbounded spirit, unchained from the gravity of materialism seemed ridiculously invisible. To paraphrase the words of Eric Fromm, we tried to escape from our own freedom.

The take away is that not only did the Jewish people need to be deprogrammed so that they could fully embrace the Mitzvot, our clients do as well. While we don’t have any mountains to hold over their heads, we can use our creativity, example, and our skillfulness to evoke the dormant human spirit. 

Chag Samayach everyone!

Cognitive Pearl #081 Sivan 2, 5775 May 20, 15

sleeping baby

 In my previous post, I spoke of a client who falling soundly asleep, is awoken by the thoughts making a racket in her mind. She’s unable to fall asleep again because of her stressed out mind and the activating signals which it broadcasts to the body.

In the following session, I suggested that she keep a journal handy. Should this episode occur again, she could use the time to ‘unload’ or ‘download’ her troubles into the journal. What was recorded could then be used for further reflection during the waking hours of the day. Or she could use the awake time to organize her thoughts so that they wouldn’t be running around her head causing all sorts of havoc. Predicting that some of the thoughts would be anxious and distorted in nature, I reviewed the procedures for doing a dysfunctional thought record with her.

Along with prescribing of a journal and a dysfunctional thought record, the client and I discussed ways to prepare her body to return to sleep. In this particular case, chamomile tea and some relaxing music turned the trick. Other clients have found relief in listening to guided imagery, taking a bath with a few drops of lavender oil added, offering a prayer, doing some light housework (I find doing the dishes to be incredibly relaxing at 3am in the morning), or through diaphragmatic breathing. 

In this specific client’s case however there were other comorbid psychological barriers which made the return to regular sleep more difficult. In other words, things were not that simple. The triggering event of the insomnia evoked many of the insecurities which had plagued her previously. Yet, these easy interventions helped restore the balm of sleep, something that helped the client deal with the crushing circumstances of her life. These interventions allowed us to keep the emotional work in the treatment room without spilling into the bedroom. 

Cognitive Pearl #080 Sivan 2, 5775 May 20, 15


As a cognitive therapist, helping relieve insomnia requires getting into the thoughts and beliefs that otherwise make sleep impossible. Mind and body are connected; what the mind thinks it ‘translates’ into physical reactions. The body is a captive eavesdropper on the thoughts, worries, regrets, and impulses that criss-cross the mind.

An example:

Last week a client made an important decision which would have great influence on her future. Without going into the details if this decision fell in between ‘what-to-order-for-dessert’ (trivial) and ‘who-to-marry’ (super not trivial), this particular decision would fall closer to the who to marry direction. Not surprisingly she complained of sleep difficulties. In this specific case, she was able to fall asleep literally when her head hit the pillow but awakened two hours later and then not be able to fall asleep again.

It didn’t take a rocket scientist or advanced, experienced cognitive therapist to understand why this was: her mind, after a two hour nap, began percolating with activity. The body, ever ready to help out, heard the mind, and threw some coals on the fire. By coals on the fire, I mean acetylcholine, the neurotransmitter of physical activity. It also stopped dumping adenosine, the neurotransmitter of sleepiness, into the blood stream. The result was a body ready to go and buy a dress (oops! I’ve said too much already!). 

What we did about however was pretty cool. More on that later. 

פנינה קוגנוטיבית #079 אייר כ׳ח, תשעה 17/5/15

We dont escape

בעשר שנים אחרונים נשמע בארץ, במיוחד בכנסים מקצועיים, על טיפול דיאלקטי התנהגותי (.D.B.T). אני גם תרמתי לתודעה זה דרך הרצאות שהצגתי במסגרות שונות. אחרי כמעט 20 שנים מאז שהשתתפתי מסלול הכשרה הראשונה שמרשה לינהן ניהלה בחוף המזרח של ארה׳ב עלו לי הרבה מחשבות, רעיונות, שאלות, וביקורות על שיטה זה. לא שאני פוסל אותה; להפך, בעיני ראיתי איך שהוא יכול להושיט יד לחבר’ה שטיפולים שונים כמו טיפול בפרמכיולוגיה וטיפול בשיחות נכשלו לספק מענה ׳מספיק׳. לדעתי, ובמיוחד פה בארץ עם מנטליות שונה ועם רגישויות ופתיחות תרבותית שונה מארה׳ב אנו חייבים לחשוב פעם שנייה ושלישית על איך אנו ממשיגים ומלמדים את המודל ואת הכישורים של .D.B.T. ולכן ראיתי לנכון להתיחס לדיונים אלו בפוסטים הבאים. אשמח לקבל את משובכם.

לצורך חזרה על קצת מהתשתית מהמודל של .D.B.T, אנו מניחים שחוסר כשרונות חשובות גורמות לאי יכולות לקליינטים לתפקד באופן יעיל ממול לאתגרים הנורמטיביים של החיים. בגלל חסורונות אלה, קליינטים מוצאים מענים ׳יקרים׳ והרסניים בפתולוגיות שונות כמו מניפיולציות שונות, התמכריות, פגיעה עצמים כמנגנון הרגעת עצמית, אובדנות ועוד. כישורי .D.B.T משלימים את הפערים ביכולת הקליינט. הכישורים הרבים מחולקים לארבע קטגרויות: 

כישורי יחסים בינאישייםכישורי מנוחת הנפש (Mindfulness)

כישורי הרגעת עצמית (Emotional regulation)

כישורי התמודדות בניסיונות (לחצים)

הנה תרשים עזרה שאני מחלק לקליינטים שלי:

היהלום של כישורי DBT

Cognitive Pearl #078 Iyar 25, 5775 May 14, 15

Its not the circumstances

 Reflecting on the common physical causes for insomnia which I encounter with my clients, they all share one common root: disregard for connection between mind and body. It seems that we all live without regard to the body which so cares for us.

So for instance, the amount of artificial light which we fill our living spaces can have cumulative devastating impact on our health (this was brought home to me by some frightening data about breast cancer and light pollution which you can read about here). Yet as much as we read about how important it is to ease the body towards sleep by decreasing exposure to light, we keep the lights on and use our phones, computers, and tablets to stimulate ourselves late into the night. 

I mention this disconnection here because for most of our clients, insomnia is another manifestation of their negative relationship with their bodies. While deeply delving into this relationship is not always required, it’s important to at least raise the issue. 

Cognitive Pearl #077 Iyar 24, 5775 May 13, 15

You either walk inside your story














In every area of clinical practice of cognitive therapy, psychoeducation is critical. Useful, relevant, and accurate information changes lives. This is especially so in the treatment of insomnia and all sleep difficulties. Seeking relief have most likely become so frustrated with themselves that they’ve overlooked many of the basic rules of sleep.

So we start from the beginning. 

We speak about the importance of sleep. We speak about the benefits of sleep. We speak about the conditions that make sleep possible. We speak about ways to create a sleep conducive environment. We speak about sleep supporting life style changes. 

As a matter of practice, I generally give my clients some simple literature about sleep hygiene.  Sleep Hygiene Tips is a form which I came across sum time ago. It’s clearly and engaging. Most of my clients however suffer from comorbid depression or anxiety or bipolar disorder or post traumatic stress disorder (or all of the above). For them I prepared the Zzzzz Sleep Help sheet. 

While psychoeducation alone won’t relieve your clients’ insomnia, it will get them started on redesigning their lives for their own benefit. Furthermore, psychoeducation also acts as a catalyst to get at the deeper issues that might otherwise not be found. 

Cognitive Pearl #076 Iyar 23, 5775 May 12, 15

Between Stimulous & Response










The integration of cognitive behavior therapy into the treatment of insomnia has received lots of coverage in the general press as well as in the professional literature. The results reported have been positive regardless if the client was suffering from comorbid depression, anxiety, or addictive disorder or if sleep medication was also used.

The model that I’ll be sharing in coming posts is taken from the protocol developed by the United States Department Of Veterans Affairs. They have an immense amount of experience treating veterans, their families, and their communities for a variety of comorbid disorders. 

The protocol has three components. They are:

Psychoeducation about sleep, insomnia, and the conditions that interfere with sleep.

Treatment of environmental, psychological, and physical factors that get in the way of sleep.

Monitoring and follow up of those in treatment.

In following posts, we’ll briefly review what you need to know about sleep (psychoeducation). Then we’ll get into stimulus control, quieting the mind, and relaxation techniques. 


Cognitive Pearl #075 Iyar 22, 5775 May 11, 15










In the world of cognitive therapy, upgrading is fundamental. With that in mind, (hopefully!) with today’s post, you’ll notice improvements which will make the content even more exciting and useful. Let me know what you think!

Today’s Tachlis Takeaway: many sleep problems can be helped with the methods of cognitive therapy.

When we think of sleep, we may often think of a necessary evil which we must ‘put up with’. Just look at the coffee section of my local supermarket: there’s a solid eight meters of valuable shelf space devoted to a bitter beverage whose most important redeeming quality is that it can keep us awake. Looking back on my forty year love affair with coffee, I’ve got some serious doubts that I would have been able to start and complete even one degree without the steady drip of stimulants into my veins.

Sleep however gets a bum rap. It’s quite telling that the Bible tells us that Adam was asleep when he was matched up with Eve. Marriage, the most important event in a human’s life; and here a central protagonist was out cold. But it’s not just the Bible that tells us something about sleep; modern science continues to inform us of the many, many blessings of sleep.  Or, r’l, the terrible ills that can befall the human mind and body when we don’t sleep enough.

Where we psychotherapists come in is that many of the barriers to the blessings of restful sleep respond to the skills which we offer. In the coming posts we’ll consider some of cognitive therapy techniques which can help our clients (and ourselves) to sleep and to heal.