A reflection at the nexus of Yom HaZicharon and the death of Rabbi Dr. Aharon Lichtenstein. 

The human response to suffering is to break down. We fall apart. We crumble to pieces. Witness the reaction of Iyov to the news that his world had been destroyed:

And Iyov got up and tore his coat and he plucked the hair of his head and he fell upon the ground (Iyov 1:20).

But more than breaking our person, suffering blows up the ideas that we had of the world. Like an exploded balloon, our comfort in the world is blown apart. Witness the descent of Iyov into the madness of grief and confusion. It makes us crazy, this suffering. Nothing makes sense. How could it?

And then we try to find a new normal. For some, it becomes easier to see the pieces as separate, detached from each other. We choose sides. We hurry into identities and ideologies and then pull them tight around ourselves. ‘At least we know what we are’, we tell ourselves. The world becomes smaller and predictable. Or so we hope. 

There are those however who refuse to give up on the human destiny, to see the universe in all of it’s complexities and heart breaking beauty. Rav Lichtenstein was such a person. A sometimes student of his, I was always impressed by the depth and breadth of his ideas. Not that I always understood them but that’s my bad; not his. He thought nothing of introducing Chaucer or someone else into a lecture on Teshuva (Repentance) on or in a riff on chazaka (ownership). Not because he wished to make a statement but simply because Chaucer said it better. The Lubavitcher Rebbe a’h once said that those who keep their religious books separate from the secular books don’t understand either. Rav Lichtenstein got that; he saw a world as one. 

יהי זכרו ברוך

The Pattern Interrupt Schedule is easily tailored to specific needs. When I work with depressed clients, we will agree that at each interval they will perform some behavior. Changing scenery comes to mind: the client gets up from wherever he is sitting and goes outdoors for some fresh air, takes a bathroom break, chats with a colleague or any other opposite action. For those suffering from anxiety, they can do a few rounds of diaphragmatic breathing, light yoga, journaling, prayer, or any other grounding behavior that suits them. The idea is to punctuate the automaticity and monotony of the inner states of misery. 

Last week, I introduced the rational response form. The ‘idea’ behind it is that the form triggers the client’s critical thinking abilities. With that upgrade in thinking he, with some help from his cognitive therapist, comes up with concrete ways to act on these new ideas. 

This brings me to the pattern interrupt form, a skill sheet intended to punctuate the smothering gravity of depression. The form also has the effect of triggering mental rehearsal for the purpose of developing new habits. 

Some explanation:

The mental experience of depression and any form of suffering is profoundly different from the mental experience of the peak states of joy, bliss, and flow. Without treading into the gory details of unsymbolized thought, time distortion, and all the rest of the dysfunctional inner dimensions of depression, suffice it to say that the experience is an unpleasant monotony of despair, collapsing into itself. This nauseating swirl of chaos needs punctuation; pattern interrupt is one effective way to do just that. By breaking up the client’s day with helpful tasks, he can challenge the hopelessness and chaos of his inner world. 

This may sound a bit off topic but we need to talk about this Schlissel Challa business. It’s a lot more connected to cognitive therapy than meets the eye. (For those who want more information on this custom click here and here.) We rationalists tend to look down on such ‘segulot’, lucky charms, and amulets. This negativity however is so misplaced! In fact, it usually backfires in the worst ways because in its hubris, it fails to recognize that the rational and the scientific all have their limits. Arthur Schopehnauer told us that ‘Every man takes the limits of his own field of vision for the limits of the world’. (Actually it was God who told Job the same thing but Schopenhauer sounds better.) Or as Taleb reminds us again and again, we are easily and dangerously seduced into the falling hook, line, and sinker for the vivid, failing to consider the undetectables. Segulot remind us that as much as we think we’ve figured the world out, there is still so much that we don’t know and can’t know. And that’s great news especially for us joy freaks! It means that we’re surrounded by mystery; it means that life will never be boring. 

That’s it for now. I’ve gotta go stick a key in the challah. 

Shabbat Shalom to all! 

Clients almost universally complain of feeling stuck. They know that change is needed but are frustrated by barriers both known and unknown. The work of cognitive therapy is to reveal those barriers in order to challenge the cognitions, or beliefs, that support them. While much of the foundational work is done during sessions, in order for clients to utilize these understandings, a rational response form can help.

You can see an example of a Rational Response Form here.

In my practice, as we dismantle the thoughts and inner processes or hot thoughts, we list each of them on a form. We then go to work disputing these hot thoughts, writing the disputations down on the form. Then we come up with opposite actions, behaviors intended to neutralize the embodied heaviness of the hot thoughts. The client then goes home with the forms and is sent on ‘mission possibles’ to perform the opposite actions. 

The use of homework assignments is rooted in cognitive therapy’s assumption that people learn through doing. With new learning comes new understandings; with new understandings come new possibilities. This assumption is true whether we are speaking of clients immobilized by the symptoms of depression, the gamut of anxiety disorders, personality disorders, or any other form of mental disorder. If the human mind is involved in the ‘problem’ then cognitive therapy asserts that an ‘upgrade of thought’ yields a better situation.

While most of us are familiar with many excellent collections of prepared homework assignments (here are some of my favorites), better yet are assignments that are developed in collaboration with the client. For example, I encourage all of my clients to monitor their moods (English), not all connect with a standard mood monitoring form. So we figure out what works: a couple of clients use phone apps; one prefers the use of a diary. Still others email me running narratives of their emotional ups and downs (we’ll leave the issue of email for another time). More important than the details, it’s the collaboration around getting cognitive therapy into their lives that helps them. In coming posts I’ll show some of the assignments that I’ve put together with my clients to meet their needs. 

My latest book, Take My Hand A Guide To Jewish Mindfulness is now available in book stores. Warm, simple, real, and friendly Take My Hand will bring the ideas of mindfulness down to Earth. For those in Jerusalem, Take My Hand can be found at Havruta and at other book stores specializing in English Judaica. For those who would like to purchase the book directly, send me an email or call me. 

Blessings and blessings to all!

After a wonderful Pesach hiatus, it’s time to get back to work! 

Looking over my previous posts, it seems that many are devoted, at least indirectly, to the relationship between the cognitive therapist and the client. That relationship is one characterized by mutual discovery: as cognitive therapists we strive to enter the matrix of the client’s thoughts, to see the world as he sees it, and then to invite him to reconstruct his ideas. In new ideas lay the potential for new ways of thinking, living, and relating. 

Cognitive therapy however strives to extend the therapeutic relationship into the client’s life. This is primarily done through homework assignments and skills building. In the coming posts, we’ll consider some of these assignments and skills. Many of them will be drawn from the exciting world of dialectical behavioral therapy (DBT), as well as the wonderful writings of one of the most prolific exponents of cognitive therapy, Mathew McKay. 

A few nights ago, we began our seder with a question: why is this night different than all other nights?

It’s fascinating to observe that out of all the questions that the seder could have begun with, the Rabbis saw fit to begin with a question about deviations. After all, ‘mah nishtana’ is a question that flows from an observation of difference from a norm.

Perhaps the Rabbis, intent on designing a seder centered around educating our children, understood that pattern recognition is one of the earliest cognitive skills evident in the developing child. Pattern recognition has been observed in infants as young as four months (although if you ask me, my children had their mother and father figured out from the get go). For the Rabbis, this pattern recognition could be leveraged for new learnings;  by tickling a child’s sense of order, he or she child will perk up and learn new ideas.

For me however, as a cognitive therapist who spends his days and nights helping people find their ways out their own personal Egypt, ‘mah nishtana’ is a powerful tool. Our clients are too often so numb to the misery that they fail to notice how it affects them and how to get out of it. When we start questioning the ‘normal’, we jar our clients to begin thinking again about their lives and the stories which have imprisoned them in it. 

And that’s the first step towards freedom.

Chag Samayach to all!