Tag Archives: social connectedness

Cognitive Pearls #091 Listening, Healing, And Really Helping

white flowers on chizkiyahu hamelech











Having observed how differently our clients behaved outside, in a non-clinical environment we resolved to consider how we, as well intentioned therapists, were failing them. Instead of helping them deal with the real challenges that they faced, we, unwittingly, compelled them to comply with a helpless, pathologized role.

So we went back to the drawing board. That always begins with questions: What did these clients really need? What could we, in our roles as psychiatrists and social workers, do to meet those needs?

We began to listen much more closely to what the clients had to say. By ‘say’ we kept in mind that verbal communication could not be the only bridge to understanding. We needed to listen deeply, looking for subtle nuances and clues, abandoning our preconceived notions. When possible, we turned to people in their living and work environment to help us understand our clients’ needs, We spoke with parents and siblings. We spoke with supervisors at the stores where they worked.

A great deal of information emerged. We learned, for instance, that these young people wanted to have relationships that were deeper than the ‘special needs’ label that earned them politeness but little else. We learned that their families, as loving and supportive as they were, kept them in boxes intended to keep them safe but unable to explore, improvise, and find some mastery and joy in the rich world that they lived in.

So what did we do?

Stay tuned!

Cognitive Pearl #089 Sivan 27, 5775 June 12, 15 Old Navy & Miracles Part I

brighter than bright







Complete recovery from schizophrenia is sadly the exception rather than the rule. Whether it’s due to severity of the pathophysiology or a combination of other factors, people suffering from schizophrenia usually become chronically impaired. Their functional abilities decline. Their medications, as wonderful as they are, leave them stuporous and undermine their health. They become ‘locked’ into a state which defines what they can do and what they can’t do.

Miracles still happen, though! When given useful psychotherapy, support, and opportunities, people can enjoy life a bit more. They can become more active in their families and communities. They can find new zest in life, moving from mere, colorless existence to raucous, joyous living.

This was driven home to me many years ago when I coordinated an aftercare group for adults who had been considered to be hopelessly locked into their psychiatric disability. This group was developed in response to a wonderful initiative taken by the Old Navy & Gap clothing stores. The owners of the chain had instituted a policy that all of their stores were required to employ a significant percentage of adults with severe psychiatric illness and disability.

In order to support that initiative the company expanded its mental health insurance coverage and also worked with local plinics to support their workers. My hospital was located in the same area where Old Navy had ten stores; and that’s how our group came to be.

Sitting down together in those first months however was a bit difficult. Members were shy, much like one might expect out of someone diagnosed with paranoid schizophrenia.

Until the coffe maker broke.

To be continued…

Cognitive Pearl #073 Iyar 17, 5775 May 6, 15

Most people take the limits of their vision









Robotic doctors. Robotic surgeons. Robotic Nurses.

How about robotic psychotherapists?


For those who are worried about our long term career prospects, there’s some good news. Despite many elaborate efforts to program a computer ‘to do’ psychotherapy, unless there’s some dramatic change in our humanity, a caring, loving, real human healer will never go out of style.

The reason for my optimism?

Oxytocin and the essential nature of human attachment.

And here’s the explanation: way back in Genesis we are told that ‘it is not good for Man to be alone’ (2:18). This Biblical observation isn’t simply about the need for companionship for safety and reproduction and other technical needs. This observation is about a core of human need: we need companionship to be human.

This observation came home to me as I read of a Japanese study on dogs and oxytocin featured in the New York Times (you can read it here). Researchers found that as a dog looks into the eyes of a human, oxytocin levels in both dog and human rise. (Oxytocin is the the most well known neurochemical of attachment.) The longer the gaze, the more then oxytocin levels rose, bonding the two together in trust and in the camaraderie known to those of us dog owners. 

To be sure, it’s not just dogs that evoke this oxytocin response. Far more dramatic is the shared neurochemistry formed between mommy and baby as each lovingly gazes into each other eyes in that most elemental of human bonding behaviors. What this finding however highlights is that human trust can only be evoked in the dyadic feedback loop between carbon based life forms. That dear friends can only happen in between a loving, accepting healer and his or her client. 

Robots therefore need not apply. 

Happy Lag BaOmer everyone!!

Cognitive Pearl #071 Iyar 15, 5775 4 May, 15

Be Somebody














During this Jubilee year, you shall return, each man to his property.

From this week’s portion, Behar. VaYikra 25:13

It is human nature that we collect stuff. Bags and bags of stuff, both literal and metaphorical. Books, clothes, tools, identities, debts, hurts, and resentments are just a few that crowd my home and my head. People tell us to ‘let it go’ but that’s hard. Life gets weighted down, almost impossible to navigate. We keep on doing things, not because they’re smart, but simply because of inertia and the deep attachment to symbols of the one truly universal illusion of humanity: the past. 

The Mitzvah Of Jubilee is the antidote to our despair. 

Human societies stratify themselves along the lines of ‘have’ and ‘have not’. Those who have (and you fill in the blanks: land, tenure, money, looks, yichus, job, whatever) get to rule over those who don’t have. Stratifications are quite stable; they’re multigenerational. The rich stay rich and the poor stay poor. 

This is an arrangement that, despite the few good things that can emerge from it, is terrible for humanity. Human growth requires upheaval. We are all most alive when we are improvising, changing in a dynamic environment. 

The Jubiliee and the social engineering implied by it liberates us. It breaks the economic stranglehold of social class giving the have nots a new chance and the haves peace of mind. Returning to our property is not only about returning to our ancestral land; it’s about returning to our basic selves, that pristine moment before we were kidnapped by social class and indoctrination. In so doing it compels each of us to clean out our lives, to rid ourselves of our baggage, to reclaim the only transcendent truth: we are what we are.

Because who we are is the only property that is truly ours. 

Cognitive Pearl #070 Iyar 12, 5775 1 May, 15

We rise by lifting others




In considering the depth of cognitive treatment I take the approach that above all, my efforts must ultimately lead to positive social reintegration. Humans are a social animal; we can do amazing things when we’re attached to others. From a cognitive therapy perspective, social connectedness forms the bridge that allows the transfer of new ideas between people. These are the ideas that save our lives. 

Consider depression. Or schizophrenia. Both share features in common: thought disturbance and  emotional disconnection are the most visible. When most of us think of schizophrenia, delusions and hallucinations come to mind. Or when we think of depression we think of the immobilizing heaviness of self hatred and despair. Yet in both cases, social disconnectness is the most important determinant of outcome. That connectedness provides the leverage to keep the client connected to reflection, reality testing, and the magic of community. 

So tachlis, as a cognitive therapist, my treatment plan and its length, intensity, and depth is designed around getting the client back in touch with others. 

After all, life is with people. 

More on this next week.

Shabbat Shalom!