Category Archives: ALL

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

jealousy

 

 

 

 

 

 

 

 

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. 

 

Cognitive Pearl #074 Iyar 18, 5775 May 7, 15

Lag BoOmer BonFire

 

 

The dizzying smoke of a million bonfires lingers in the air of Jerusalem. For some Lag BaOmer was a magical evening; for others it was a night of noise, irritation, closed windows, and coughing.

Isn’t that a fitting epitaph for Rabbi Shimon Bar Yochai (you can read more about him and Lag BaOmer here)? An all eclipsing hero to some; a dangerous and tiresome rebel to others.

Counting myself among the former, Lag BaOmer is a quintessential cognitive therapy holiday. Granted that such a statement seems counter-intuitive; after all, cognitive therapy advocates empiricism (the school of philosophy which holds that only that which can be seen can be truly understood) and Lag Baomer is a celebration of the mystical, of the unseen, of the unknowable mystery of the Universe.

For me however empiricism has it limits just like every body of human knowledge. Everything, perhaps with the exception of death, is subject to the law articulated so poetically by another fantastical character of much more recent vintage, Forrest Gump, ‘it happens’. As much as we strut about with our data, statistics, predictions, and all the other synonyms for human hubris we just don’t know.

Lag BaOmer and its mystical traditions remind me that no matter how clever we get, humanity will never fully know the whole score. As close as we get to figuring it all out, the loving Designer of all stays just beyond our grasp. He sprinkles beauty as a leads us deeper and deeper into the cosmos. 

So what then is the place of cognitive therapy when each of us is immersed in a universe so much out of our control?

There are of course many reasons to do what we can to make our lives better. For me, cognitive therapy has offered one unparalleled gift and for this it is supremely relevant. That is is the pure pleasure of clear thought and the joyous life that results. Once I get all of the traps and tricks of misery-making-embodied-pseudo-thinking out of my head the sky turns blue, the universe opens itself, and I’m swept into the mystery of it all.

So pass me a marshmallow and throw another log on the fire. 

Bar Yochai, the holiest oil has anointed you; you’ve ascended to the loftiest of levels; glory encompasses you. 

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?

Yikes!

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 #072 Iyar 16, 5775 5 May, 15

A terribly tortured client complained about her feelings. Not a specific feeling. She simply hated the whole idea of feelings; they were inconvenient; bothersome. Not surprisingly, she was suicidally depressed, full of self hatred, and utterly confused by why she was so miserable.

There’s good news. She’s doing great now; cognitive therapy has helped her far more than all of the hospitalizations and medications. She’s come to understand that feelings are wonderful teachers and friends. Instead of repressing them she lives her life joyfully by respecting the wisdom they offer.

Her story comes to mind as I reflect on my trip (told in a previous post) to Meron. Instead of taking our car, I decided on public transportation (it was actually really nice!!). One major difference between going in a private car and public bus is that on a bus there are no bathroom breaks. Otherwise, the driver would be forced to pull over every second; tachlis, a three hour trip would take three days. So instead we must all ‘hold it in’, cutting ourselves from our the messages that our bodies tell us.

The same is true of the family which my client comes from. Many children. Harried parents. A culture which indoctrinates towards sameness and ostracizes difference. In a world like that who has time for feelings? Who has time for inconvenient truths spoken by the heart. ‘Onward!!’, she was told again. Onward towards where? To a place whose entry fee was the cruelest kind of amputation: the person from herself.

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!

Cognitive Pearl #069 Iyar 11, 5775 20 April, 15

What You Say 

 

 

 

 

 

A bit of a digression.

As I write these post I’m on my way to Meron, the location of the grave of Rabbi Shimon Bar Yochai (you can read about him here). Hoping to skip the crowds next week (it’ll be Lag BaOmer which you can read about here), I decided to make my pilgrimage a week early. While this isn’t the place for a discussion of the mystical dimensions of this pilgrimage (and visits to the burial sites of other saints and sages) it is an opportunity to touch on culture and cognition.

Culture is universal. Wherever you find two humans you’ll find culture. Manifestations of culture are nearly infinite. My pilgrimage to the grave of a culturally designated saint is not unique; people the world over visit similar sites. And there are many other kinds of cultural pilgrimages too: cinco de mayo in Spain and Saint Patrick’s Day in Ireland come to mind. Sporting events are also cultural pilgrimages. As are festivals and annual gatherings.

So the question we need to ask is what is all of this culture about? Why do humans have his need to abandon all sense and sensibility, their jobs, their families, and the opprobrium of their normal lives and go nuts?

For me the answer begins with something I heard from Dan Siegal, a developmental psychiatrist, in an interview a few years back on Shrink Rap Radio (an excellent resource which you can find out more about here). Siegal was speaking about the mind as a process (as opposed to a thing) which regulates the flow of information within the organism and with other organisms. At one point he said something that still makes my ears ring:

Yes, I study the way energy and information flow is shared in relationships across generations. That’s what culture is!

The implications of that idea is that culture is what one generation tells another. Culture teaches ideas (we call that indoctrination) that are central to the continuation of that culture. So while pilgrimages to holy sites of every ilk fulfill our needs for belonging, entertainment, and so much more, they are primarily about absorbing the ideals of those who came before us.

And as cognitive therapists who assert that the ideas that we hold are what makes us or break us, our clients’ culture is enormously relevant.

Cognitive Pearl #068 Iyar 10, 5775 29 April, 15

one kind word

 

 

 

 

 

 

 

 

 

 

 

 

In a previous post, I suggested that the breadth of cognitive treatment depends on the severity and chronicity of the disorder. In other words, the worse the disorder and the longer it’s influence on functioning the ‘more’ treatment required. 

That seems straightforward, right?

It is but it needs to be broken down so that we understand three dimensions: 

What is meant by severity.

What is meant by chronic.

What is the difference between ‘more cognitive therapy’ and ‘less cognitive therapy’. In other words, we want to understand how cognitive therapy alleviates the conditions that it aims to treat. 

Let’s start with severity. As a convenient place let’s consider the global assessment of functioning of the DSM (you can see it here). The authors of the DSM direct us to consider the occupational, social, and psychological impact of the disorder in determining severity. This seems to be an eminently practical method (until one considers the ideological underpinnings of this approach but that’s for another time).

As a cognitive therapist however I find social functioning to be the most relevant for the simple reason that one’s ability to be part of a social fabric is a far more important indicator of health than occupational and psychological abilities. As I’ve stated in previous posts, psychological health and illness is far more influenced by our social connectedness than the neurotransmitters floating around our brains or the autonomous ideas held in our heads.

From this point of view, my work with clients is oriented towards this social connectedness above all else. From my experience, when people are more connected to others who positively influence their activities, ideas, and feelings they easily shed the dysfunctions of illness. And when their social connectedness is so sparse that they are allowed to ‘marinate’ in their own darkness they just get worse and worse. 

Chalilah. 

To be continued. 

 

 

Cognitive Pearl #067 Iyar 9, 5775 April 28, 15

Seth Godin Draw A Map

 

 

 

 

 

 

 

 

 

In the world of psychotherapy, everything is up for debate. When we speak of chronic disease or disease severity there are a million and one opinions.

Take chronicity for example: we tend to think of chronic illness as an affliction that doesn’t go away. A minor cold has a beginning point and an end point. Schizophrenia on the other end doesn’t seem to have either; the DSM speaks of the prodromal phase, a descent into illness that is almost only identifiable retrospectively.

And it never goes away.

Or so it seems.

In Israel and in the United States, those with schizophrenia are considered as disabled for life by Bituach Leumi and the Social Security Administration. However more and more reports of full recovery are emerging. Furthermore, as technology rapidly reshapes society, the definition of disability itself has become a moving target. New occupational opportunities have allowed many formerly disabled people to enter the workplace.

This says nothing of the ideological underpinning of occupational limitation as disability. As a Jew, scarred by the obscenity of Arbeit Macht Frei (‘Labor Makes Freedom’, the sign greeting the Jews and other undesirables as they entered the Nazi death camps) the connection between productivity and human worth is frightening.

This riff however does nothing to clarify the issue I raised in my previous post: how does the cognitive therapist determine the depth of treatment. And that dear reader is where I’ll pick up next. 

Cognitive Pearl #066 Iyar 8, 5775 April 27, 15

The words You Speak Become The House You Live In

Most of us think of cognitive therapy as a way of understanding and relieving depression, anxiety, and whatever else we use it for by focusing on the thoughts that underlie the disorders.

That is all true.

Yet, for me at least, cognitive therapy is about approaching the processing system that is the human mind. Whether it’s depression, joy, psychosis, impulsivity, concentration, love, pain, and all the rest, (and there’s a whole lot more!) the mind takes in information, processes it, and then uses those processes to guide how it navigates its existence. Cognitive therapy seeks to alter cognitive processes by illuminating them and by upgrading them.

The end result is a better life. 

While some mistakenly claim that cognitive therapy is superficial, it isn’t at all. It’s just that we cognitive therapists have found that not every single cognitive process needs to be illuminated and upgraded to make things better. Generally speaking, chronicity and severity are the best guides to how much we need on the table. 

More on that in the next post.