1 NPI REFLECTS Volume 12: Issue 2 SUMMER 2022 What is NPI? The Nashville Psychotherapy Institute or NPI is a 501(c)(6) non profit, professional organization. Founded in 1985, NPI now boasts 300+ www.NashvillePsychotherapyInstitute.orgmembers. Inside this issue: A note from the Chair Linda Manning 2 Jules Seeman Fall Workshop “How DBT Handles Resistance” 4 Ketamine Assisted Psychotherapy Tom Neilson 6 Supervision Rebecca Pearce 7 Board Member Spotlight Tiffany Davis 9 A Review of I Don’t Want to Talk About It:... Philip Chanin 10 Pandora’s Box Linda Odom 12 Continuing Education Calendar of Events 13
Theological Trauma
By Richard Gorman, Jr. MA,
you start,
The Slow Disintegration of
M.Div., M.Ed. LPC MHSP (temp).
(Continued on page 5)
During a session one day a client disclosed that “one of the first bible verses I ever learned was ‘the heart is wicked and evil and you can’t trust it.’ I must’ve been 4 or 5 years old. I mean, if that’s where I’m not sure where you go from there?” Indeed. This client’s memorization of an ancient phrase from the Old Testament prophet Jeremiah helped me better understand her decades long battles with depression, anxiety, shame and self contempt all characteristics of theological trauma. So, what is Theological Trauma. . .and who are you to say anything about Religiousit?
trauma carries uniquely complex effects. I consider “theological trauma” to be a specific subset of spiritual trauma. Theological trauma is distinct because it resides in the belief system of a spiritual community. The effects of theological trauma tend to creep slowly into the deep recesses of one’s psychology entrenching itself over time and eventually forming significant aspect of internal working model the primary lens by which a person understands themselves, relationships, the world and even God. Unfortunately, the devastating effects of theological trauma tend to be realized long after the damage has been done. Before I go any further, let me share a bit about myself: I was a seminary trained Christian pastor for close to 20 years. I still consider my Christian spirituality fundamental to my identity. During my years in pastoral ministry I walked alongside adults working through the debilitating and persistent effects of self contempt due to theological trauma. In my experience the doctrinal tenet that contributes most devastatingly to theological trauma is a construct known as “total depravity.”
You know your lives are as intricately interwoven as nerve cells in the mind of a great being. . . . Out of that vast net you cannot fall. . . . No stupidity or failure or cowardice can ever sever you from that living web. For that is what you are . . . rest in that knowing. Rest in the Great Peace. . . . Out of it we can act, we can dare anything . . . and let every encounter be a homecoming to our true nature.
Invest in Joy and Rest. The psychologist Rick Hansen points out that our brains are like Velcro for bad news and like Teflon for good news. With so much bad news around, we can counteract this tendency by choosing to pay special attention to the good, the joyful, the awe inspiring. This practice can take many forms! My colleague and friend Kenneth Robinson always reminds me to get into my body dancing, swimming, walking, practicing yoga or tai chi. I remind myself to pay attention to my senses watching a sunset, digging hands in the dirt, listening to bird song in the morning and evening, smelling a magnolia blossom. I love hanging out with babies and toddlers and pets. I am awed by these pictures of our universe produced by the Webb telescope (https:// www.nasa.gov/webbfirstimages). I encourage you to watch this lovely video on nature, beauty, and gratitude (https://www.ted.com/talks/louie_schwartzberg_nature_beauty_gratitude?language=en). I am learning to set and keep boundaries so that there is time for rest and leisure and restoration.
Linda Manning, PhD
certainly living in stressful times. Every day seems to bring more bad news. As I said at the beginning of our July NPI meeting, it has been a particularly rough few months. We are continuously faced with climate catastrophe’s, mass shootings, war in Ukraine, January 6 Committee hearings, Supreme Court decisions, and extreme political division. Whatever your personal position on each of these things, seismic shifts are occurring. I know for myself, and from my conversations with clients and colleagues, that it can feel like the world is falling apart. And we, as psychotherapists are holding space for it all. So, I am struggling. I sometimes get overwhelmed and discouraged. I notice waves of different feelings grief, rage, despair, terror. How about you?
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I have a confession to make. I have been struggling lately. And I wonder if you have Wetoo.are
A few things have helped me. I offer them up, not as solutions for everyone, but to start a conversation. As Chair of the Board, my theme for the year has focused on Community and the Common Good. I hope to join you in a conversation about how we, as a community, can help each other.
Meditating. Meditation is always a go to for me. The Practice, of course, but also the perspective that it offers. I need this gentle inner work on a consistent basis. I love this quote from Joanna Macy, who invites us to meditate on our “intimate coexistence.”
Showing Up. Richard Rohr offers this notion, “the best criticism of the bad is the practice of the better.” He finds his inspiration in St. Francis of Assisi. Joan Halifax, another meditation teacher that I love, talks about the importance of simply “showing up” in our attempt to practice the better. For me “showing up” has meant a range of activities from public protest to research into what we as psychotherapists need to know about the impact of the Dobbs decision on our professional practice (https://nashvillepsychotherapyinstitute.org/resources/covid 19 resources/). More will be added soon! Doing something helps me. Vulnerability and Sharing. As psychotherapists, we value vulnerability and open sharing of difficulty for our clients. I need to remember that this works for me too. I am so very fortunate to be a member of an NPI Circle that has been meeting monthly for twelve years. I have been a member of this Circle for close to ten of those twelve years. This wonderful group of loving, empathic, wise individuals provides a safe space for vulnerability. At our latest meeting, I shared just how much I am struggling. Circle process invites members to simply listen. No attempt at “fixing” required. My dear friends and colleagues made space for me to speak and be heard. I went into the meeting feeling heavy and despairing. I left feeling heard, held, and lighter. I am so very grateful. If any of you would like to learn how to start and facilitate an NPI Circle, please let me know (doclgm70@gmail.com).
(continued on page 3) From the Chair...
Jan Richardson
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I invite you to take anything from this list that serves you. I invite you to add to the list, for yourself and for all of us. We are a community of helpers. We hold space for so many. May we also attend to our own needs. In that way, we can continue, as Jan Richardson says “to bear the light.”
Blessed are you who bear the light in unbearable times, who testify to its endurance amid the unendurable, who bear witness to its persistence when everything seems in
From the Chair (continued from page 2) Care for the Caregivers. Join us on Thursday, August 25th, from 6 to 8 pm. (This is a revised date). This will be a hybrid event available in person at Glendale United Methodist Church (thank you to Glendale and Brentwood Counseling!) or online via Zoom. This is a free offering from your Board. It will be a time to be together, listen to live music, practice compassion, share conversation, and enjoy community. More information to come but please SAVE THE DATE and add it to your calendar now!
Blessedandshadowgrief.areyouinwhomthelightlives,inwhom the brightness blazes your heart a chapel, an altar where in the deepest night can be seen the fire that shines forth in you in unaccountable faith, in stubborn hope, in love that illumines every broken thing it finds.
Blessed Are You Who Bear the Light
Continuing Education: CE credit for this event is co sponsored by NPI and the Institute for Continuing Education. Application has been made for 6.00 contact hours and full attendance will be required.
Learning objectives:
How DBT Handles Resistance
REGISTER ONLINE NOW $189 members/$219 non members Student Discounts & Member Scholarships Available www.NashvillePsychotherapyInstitute.org Jules Seeman Fall Workshop Saturday, October 22, 2022 9:00 am - 4:00 pm Cumberland Heights Campus 8283 River Road Pike Nashville, TN 37209 Sponsored in part by generous donations from
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Special Guest Presenter: Stephanie Vaughn, Psy.D. Clinical Psychologist HSP
Dialectical Behavioral Therapy (DBT) has earned a reputation for successfully treating clients who engage in, what has traditionally been referred to as, “resistant” behavior. This training will highlight DBT’s unique approach to addressing difficult client behaviors and will teach specific strategies any therapist may use to overcome barriers to progress. Attendees will learn through a combination of didactic material, role plays, short videos, and experiential activities in order to expand their options for how to respond to challenging client behaviors.
1. Describe the concept of “resistance” using DBT terminology
3. Explain how taking a dialectical stance can assist when addressing therapeutic ruptures
4. Use DBT stylistic strategies to improve therapy outcomes
Dr. Stephanie Vaughn is a Licensed Clinical Psychologist practicing in Tennessee, Massachusetts, and Florida who also maintains an Authority to Practice Interjurisdictional Telepsychology (APIT) granted from the PSYPACT Commission. Her main role is the CEO and owner of PSYCHē, PLLC, a national group practice pairing independent expert clinicians with PSYCHē clients. She is a Linehan Board Certified DBT Clinician™, a national speaker for Premier Education Solutions Inc. (PESI), and an Affiliate and Associate faculty member for Vanderbilt University's Psychiatry and Psychology programs, respectively. She has presented for multiple professional organizations and universities, hosts a podcast with therapy tips and opinions, “PSYCHē Says,” and has authored a variety of DBT materials produced by Psychotherapy Academy.
2. Identify strategies for responding to Therapy Interfering Behaviors (TIB)
Psychologist Susan David argues that Emotions, from blinding rage to wide eyed love, are the body’s immediate physical responses to important signals from the outside world. When our senses pick up information signs of danger, hints of romantic interest, clues that we’re being accepted or rejected by our peers we physically adjust to these incoming messages. . .[our emotions] help us not only to survive, but also flourish.1 A communal arrangement where emotions are systematically shut down can set up a context for emotional manipulation, physical exploitation and abuse.
Living in a state of disintegration, our adult clients who have been steeped in this doctrine often have an incredibly difficult time feeling and identifying emotions. Many meet the criteria for alexithymia. One of the primary points of engagement with clients is to help clients feel and name their emotions and identify the messages they carry, to value their emotions instead of fear them.
Susan David goes on to argue rightly that though emotions serve us they can be fleeting and unreliable. They should be evaluated for the messages they carry but they should not be denied. As a wise mentor of mine says: “Our feelings are great servants but horrible masters.” How can we help our clients?
5 Theological Trauma (Continued from page 1)
Oh, the irony… It seems ironic that the healing of theological trauma requires work of integration. After all, at one point in the New Testament story of Jesus he is asked what ideas and actions are the most important? He answers, first, “to love God with your mind, heart, soul and strength.” As I see it, Jesus is providing an image of an integrated human being: Mind=cognitive, heart=emotional, soul=identity and strength=actions.” He does not deny or shut down emotions. Next, he says that we are to “love our neighbors as ourselves.” Riddled with shame and self contempt, many of our clients find it impossible to love themselves and, therefore, are hindered in their attempts to love others well.
As therapists we have an incredible opportunity to help our clients experience wholeness, integration and recapture their ability to love well. One of the hopes I carry for my clients who suffer the effects of theological trauma is that they would fully experience the medieval saint Julian of Norwich’s powerful maxim: “We are not just made by God, we are made of God. All of us are uniquely divine.”
“Total. . .huh!!??”
Though there is a long and complex historical development of this doctrine (as well as significant variations), the basic idea of ‘total depravity’ is that human beings at their essence are fundamentally bad The deepest part of us is ‘sinful’ and, therefore, unworthy of love. Totally depraved, human beings are constitutionally incapable of doing or being anything good. There is nothing of value that we bring to the table. If you’re not familiar with this concept it can be a lot to take in. One way I put this in perspective is to consider what I would think (or do) if I overheard a parent engaging their child in this way. They might say something like: “Look, kid. This is hard to say. But the most essential and deepest parts of you are fundamentally bad. In fact, there is nothing good about you. The only reason that I am willing to have anything to do with you is, well, because I am so good. So you better be thankful.”
1 David, S. (2016). Emotional Agility: Get unstuck, embrace change and thrive in work and life. Avery.
Yes, this doctrine can be as bad as it sounds. Remarkably, this doctrine is alive and well in many evangelical and reformed church communities. Admittedly, the ways that church communities handle this doctrine fall along a wide spectrum. Some are ‘softer’ and more nuanced while others are more explicit and heavy handed. Additionally, not everyone steeped in this doctrine suffer obvious ill effects. Many are able to integrate it and carry on. But many are left deeply damaged. How does the doctrine of ‘total depravity’ do damage? This doctrine holds that, due to our depravity, it is impossible to trust our emotions, feelings or experiences our feelings ‘lie’ and deceive. So, if not our emotions, then what can be trusted? It is often taught that, in place of feelings, one can trust cognitive concepts about God that happen to be filtered through pastors and church authorities. In this context individuals often begin to experience a steady and systematic disintegration of mind from body, emotions and experiences. This steady disintegration is devastating primarily because emotions serve to inform us, protect us and direct us to what we value most.
The primary dilemma that we face is how we can help clients proceed along the journey from disintegration to integration?
The Default Mode Network (DMN). Ketamine, like psilocybin and other classic psychedelics, quiets the brain’s default mode network (DMN). The DMN is a network of brain structures that help the brain operate in an efficient manner, by working mostly on habit. By quieting the DMN, ketamine helps people break old habits and get out of mental ruts. Disrupting rigid patterns. Many mental disorders, including depression, anxiety disorders, and addictions, are characterized by excessive rigidity (or excessive order) in thinking, feeling and behavior. Examples include the tendency of depressed people to get stuck in rumination about the past or about how inadequate they feel, the tendency of anxious people to obsessively worry about the future, and the tendency of those with addictions to ruminate about their next fix. Ketamine appears to interrupt these rigid patterns, introducing creative dis order, allowing the individual to develop new, healthier ways of thinking, feeling, and behaving.
KAP, in contrast to ketamine infusions, pays attention to important psychological factors in the client’s healing. It aims to optimize treatment by carefully preparing the client, offering a pleasant and supportive environment for treatment, integrating the insights of the ketamine experience, and using all the available tools of psychotherapy. During KAP, the client always has a therapist present, which is often not the case for people receiving ketamine infusions. The presence and the support of the therapist helps reduce any anxiety and fear and makes the experience more comfortable. How Does it Work?
page 7)
Increased Compassion and Empathy. At lower doses, ketamine operates as an empathogen: it can facilitate greater compassion and empathy. This helps in developing self compassion, which is a powerful antidote to the self critical thinking common in depression. It can also help in the development of greater compassion and empathy for others, which can facilitate couples’ therapy. (Continued on
SeveralKetaminepractitioners in the Nashville area are offering ketamine intravenous infusions, which have been shown to be an effective treatment for treatment resistant depression and Post Traumatic Stress Disorder. Daniel Barton, M.D. has been an innovator in the field, and others have followed his lead. However, few practitioners are combining ketamine with psychotherapy in middle Tennessee. Ketamine Assisted Psychotherapy (KAP) is a promising, integrative approach to treatment that aims to combine the best of the therapeutic power of ketamine and talk therapy.
Psychedelic Assisted Psychotherapy is all over the news these days. Following the success of Michael Pollan’s book and recent Netflix series, How to Change Your Mind, there is much excitement over the healing potential of psilocybin, MDMA, LSD, and other psychedelics. Psilocybin Assisted Psychotherapy and MDMA Assisted Psychotherapy have been so effective in the research to date that they have been granted breakthrough therapy status by the Food and Drug Administration. Breakthrough therapy designation is a way to expedite the development and review of new drugs when preliminary research indicates that the drug may demonstrate substantial improvement over available therapies. There is only one problem with this rosy picture: these medicines have not yet been granted FDA approval, and they are not available to the public outside of research studies. However, one psychedelic medicine, ketamine, is available for treatment now. Ketamine is not a classic psychedelic like psilocybin or LSD; it is a dissociative anesthetic that has psychedelic properties at lower doses.
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KAP is a remarkable, integrative approach to psychotherapy that combines the effectiveness of psychotherapy with the latest in neuroscience and psychopharmacology. Here is a summary of several mechanisms that appear to play a role in the effectiveness of KAP.
Ketamine Assisted Psychotherapy: An Integrative Approach to Treatment by Tom Neilson, Psy.D.
SUPERVISION,
Tom Neilson, Psy.D. is a clinical psychologist in private practice in Nashville, TN. He has worked in the community mental health field, has been training director of an APA accredited internship program for psychologists, and has been in private practice for 25 years. His doctoral degree is from Florida Institute of Technology. Tom graduated from California Institute of Integral Studies’ Certificate Program in Psychedelic Assisted Research and Psychotherapy in 2021, and he has received specific training in ketamine assisted psychotherapy at Polaris Insight Center. He is currently chair elect of NPI. by Rebecca Pearce
(Ketamine, Continued from page 6) Neuroplasticity. Ketamine is also a neuroplastic agent; it causes the growth of new neurons and new synaptic connections via the release of a protein called brain derived neurotropic factor. This allows a re wiring of the brain which also facilitates the development of new, healthier ways of thinking feeling, and behaving.
Anti Inflammatory Effects. Recent research suggests that chronic, low level inflammation from childhood stress, chronic stress, infections, gut bacteria, autoimmune disorders, and other sources can cause depression. Depression is increasingly understood as a disorder of inflammation in the brain. Ketamine has anti inflammatory properties that treat the chronic inflammation associated with depression. Psychotherapy. In Ketamine Assisted Psychotherapy, a therapist works with the client in developing new and healthier habits of thinking, feeling, and behaving. The therapist uses all the tools of psychotherapy to assist the client’s growth and change. Treatment approaches including Mindfulness, Internal Family Systems (IFS) and Acceptance and Commitment Therapy (ACT) are commonly used. There is a remarkable synergy in this integration of psychotherapy and cutting edge neuroscience. Peak or Mystical Experiences. It is common for clients to have positive peak experiences during KAP, such as feeling one with everything, discovering deep compassion and love for self and others, or having an experience of the presence of the divine. These experiences tend to be profound and are often cited as one of the most important and meaningful experiences that clients have in their lives. Roland Griffiths, Ph.D., a professor and researcher at Johns Hopkins School of Medicine, suggests that these peak experiences can cause “inverse PTSD.” By this he means that these experiences are so positive and affirming that they have a healing and restorative effect, leading to a richer and happier life, which is the opposite of what happens when a serious trauma causes Post Traumatic Stress Disorder.
Tiffany Davis
Board Member Spotlight
I joined NPI in 2007. I had worked at a community mental health agency to start my career and had been there 11 years when I somewhat abruptly jumped into private practice. There was an opportunity in Mt. Juliet with a former colleague who had some office space. So, I did not think completely through this move, but became a reverse commuter and gave it a go. Mt. Juliet was a nice community in which to build a practice, and I do see children, adolescents and adults so I was quickly pretty full. A colleague encouraged me to join NPI and met me at a luncheon to introduce me to her colleagues. I started to attend the monthly luncheons. I usually exited a little early to get back across east to see clients in the afternoon, but I found it important to build that anchoring community. The luncheon topics were varied, of course. Some were excellent, and some were not so great, but that was not the point for me; the point was participation. It is a little bit like church I am not so concerned with the sermon (don’t tell my pastor), but more focused on being there each week and participating in the faith NPIcommunity.hasbecome for me exactly that: a professional community from which to learn, connect, enrich, gain and give support, and to just be. I have attended several of the seasonal workshops, often impressed with the national presenters. I have yet to attend the NPI connection retreat but have intended to the last two years (derailed by Covid). Hopefully in 2023 that event returns. I was asked to join the board several years ago, but at the time had an extensive commitment to another organization in the community, so I could not fulfill the request. Several years later, a colleague nominated me and I completed the application. My board experience started in 2021, smack dab in Covid so nearly a year of board meetings on Zoom was somewhat frustrating (although, NPI did a super job transitioning to online formats throughout the pandemic) I had been looking forward to connecting with new (for me) NPI ers. It was good to finally get a few in person events going again and return to in person Board meetings. I am on the membership committee and hope to help more with planning socials, recruiting new members, visiting university programs. In essence, I am a worker bee, which brings me back to my first paragraph, as I emphasize the value of showing up.
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Tiffany Davis, LCSW
In 2019, I moved my practice to Nashville and continue to see children, adolescents and adults. I also do some Collaborative Divorce work. I am grateful to be back in town and closer to NPI luncheons and events. I encourage young clinicians/people new to the field/people new to town to come check out NPI and become a part of this community. NPI’s presence is a gift to us all.
I was asked to participate in the Board Member Spotlight and received several templates as a model of what I needed to write. I read over the templates, comparing myself to others, and thought, well, dang I haven’t done that much in NPI. Hmm Instead of being at a loss, and penning a very short spotlight, I will instead ponder a Woody Allen quote my Dad once sent me about success. “80 % of success is showing up” (Woody Allen is probably not the person you want to quote in a psychotherapy publication, but bear with me here). Handwritten next to the printed quote was a note from my Dad: “you always show up, so I have no worries for you”.
Terry Real makes a clear distinction between overt and covert depression. He writes: “While many of the men I treat report the classic symptoms of overt depression feelings of hopelessness, helplessness, and despair many more experience depression as a state of numbness…This experience of depression is not about feeling bad so much as about losing the capacity to feel at all.” (p. 55). He says that depression in men is likely to be “mild, elusive, and chronic.” (p. 33)
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“Treating covert depression is like peeling back the layers of an onion. Underneath the covertly depressed man’s addictive defenses lies the pain of a faulty relationship to himself. And at the core of this self disorder lies the unresolved pain of childhood trauma. Healing from depression unpeels these three layers in three phases: sobriety, relational maturity, and trauma release.” (p. 279)
(Continued on page 9)
Assistant Clinical Professor, Department of Psychiatry at Vanderbilt University Medical Center www.drphilchanin.com ~ philchanin@gmail.com
By Philip Chanin, Ed.D, ABPP, CGP Board Certified Clinical Psychologist
I am as compelled by this book today as I was when I first read it 25 years ago. And I have witnessed the profound impact it has had on probably hundreds of male patients (and many of their partners) to whom I have introduced it, in the years since then. Terry Real’s concepts, such as “covert depression,” “performance based self esteem” and “relational heroism” have been immensely important in my work with men and with couples.
“Like Dante and Virgil, standing together on the broad plain of Hell, looking down into the concentric circles of the Inferno, Jeffrey Robinson and I perch on the rim of his personal wasteland. We speak, almost abstractly, like two merchants weighing an object for purchase, of the pros and cons of his possible descent, the hardest work of his life. Jeffrey and I are at one of the critical junctures in healing the depressed man’s relationship to himself the moment he decides to stop his flight and face his own condition. Once a man resolves to take up his hero’s journey, real therapy can begin. Our descent occurs in three phases. First, the addictive defenses must stop. Then, the dysfunctional patterns in the man’s relationship to himself must be attended to. Finally, buried early trauma must reemerge and, as much as possible, be released.” (pp. 269 270)
“Depression is not really a feeling; it is a condition of numbness, of nonfeeling. In my work with depressed men, I differentiate between states and feelings. States are global, diffuse, impersonal. One’s relationship to a state is passive, disembodied. A state of depression just drops over someone, like bad weather Feelings, in contrast to states, are specific, anchored in the body of one’s experience. Depression is a state. Sadness and anger are feelings. Anxiety is a state. Fear is a feeling. Intoxication is a state. Happiness is a feeling. One feels about something. Feelings are embedded in relationships; thus, when one feels something about a relationship, one can take relieving action. Emotions are signals that emerge from the context of our interactions. The cure for states is feelings…unlike states, which tend to congeal, feelings will run their course in due time…Feelings are not endless, but our numbing attempts to avoid them can last a lifetime.” (pp. 285 286)
The Best Self Help Book for Men Ever Written: A Review of I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression by Terrence Real
A number of years ago I offered a men’s therapy group with the title “I Don’t Want to Talk About It: Addiction, Depression, and the Loss of the Relational in Men’s Lives.” I began my flyer for the group with the following quote from this book: “…for many depressed men, recovery is linked to opposing the force of disconnection, and reentering the world of the relational often kicking and screaming. A man cannot recover from…depression and remain simultaneously numb at the same time; he cannot be related and walled off simultaneously; he cannot be intimate with others before establishing intimate terms with his own heart. (pp 158 159)
Real has done work with Carol Gilligan at Harvard into the profound role that typical male socialization has upon men and men’s relationships. He writes “Hidden depression drives several of the problems we think of as typically male: physical illness, alcohol and drug abuse, domestic violence, failures in intimacy, self sabotage in business.” (p. 22). He adds, “Men die early because they do not take care of themselves. Men wait longer to acknowledge they are sick, take longer to get help, and once they get treatment do not comply with it as well as women do.” (p. 37)
“Depression is an obsessive disorder. A depressed person is endlessly caught in the chains of his rehearsed inadequacies.” (p. 225)
“In our society, most males have difficulty not just in expressing, but even in identifying their feelings. The psychiatric term for this impairment is alexithymia, and psychologist Ron Levant estimates that close to eighty percent of men in our society have a mild to severe form of it.” (p. 146)
Real draws upon the work of others in the field of addictions, including “Edward Khantzian, the father of the self medication hypothesis, (who) speaks of addictions as attempts to ‘correct’ for flaws in the user’s ego capacities…Khantzian and others currently writing on the psychology of addiction speak of substance abuse as a desperate strategy for dealing with self “dysregulation.’ Khantzian’s research on both alcoholics and drug abusers led him to focus on four cardinal areas of dysregulation: difficulty in maintaining healthy self esteem; difficulty in regulating one’s feelings; difficulty in exercising self care; and difficulty in sustaining connection to others The damage to self that Khantzian describes can be summed up as damage in relatedness.” (p. 276)
One of Terry Real’s most useful concepts in my work with men and with couples is “relational heroism.” He writes, “Relational heroism occurs when every muscle and nerve in one’s body pulls one toward reenacting one’s usual dysfunctional pattern, but through sheer force of discipline or grace, one lifts oneself off the well worn track toward behaviors that are more vulnerable, more cherishing, more mature…Each time Jeffrey Robinson feels the physical flood of agitation, depression, and shame sweep over his body, but does not run he has learned to give himself the functional parenting he never received. Such moments lie at the heart of the recovery process. Jeffrey once teased me that our therapy felt like couples counseling between himself and himself.” (p.277)
As you have probably experienced in these quotations from Terry Real, he is an extraordinary writer who gives powerful vignettes of the exchanges that take place between him and the men that he works with in psychotherapy. In his writing, he also draws upon relevant literature as well, as seen in his reference to Dante Alighieri’s Divine Comedy in the opening quote in this review.
“Whenever a man turns to an external prop for self esteem regulation, he is involved in the defensive structures of covert depression. Narcissus at the well (transfixed by his image) is an addict. For simplicity’s sake, I label dependency on any self esteem ‘dialysis machine’ as addictive dependency…Just about anything can be used as an addictive defense spending, food, work, achievement, exercise, computer games The cure for the addictive defenses is simple in theory, miserable to experience. All one need do to stop such defenses is decide to stop them then, with ample support, withstand the withdrawal.” (pp. 270 271)
Real takes a tremendously helpful stance on the distinctions between “healthy self esteem” and the “performance based self esteem” upon which most men depend. He adds, “Covert depression is at its core a disorder of self esteem. Healthy self esteem is essentially internal. It is the capacity to cherish oneself in the face of one’s own imperfections, not because of what one has or what one does.” (p. 44). Real continues, “What we offer boys in our culture is highly conditional, performance based esteem, not an essential sense of worth that comes from within. One cannot earn healthy self esteem. One has it. Performance based esteem augments an insufficient, internal sense of worth by the measuring of one’s accomplishments against those of others and coming out on top.” (p. 182) He says, “It is hard for many successful men to see the harmful effects of compulsive work until the relational bill comes due.” (p. 47)
The poem “Healing,” by D.H. Lawrence is another example: I am not a mechanism, an assembly of various sections. And it is not because the mechanism is working wrongly, that I am ill. I am ill because of wounds to the soul, to the deep emotional self and the wounds take a long, long time, only time can help and patience, and a certain difficult repentance, long, difficult repentance, realization of life’s mistake, and the freeing oneself from the endless repetition of the mistake which mankind at large has chosen to sanctify.” (p. 226 227)
Real, like Alice Miller in her book The Drama of the Gifted Child, explores the profound interplay of shame and grandiosity. Real writes, “A common compensation for shame, of feeling less than, is a subtle or flagrant flight into grandiosity, of feeling better than…The ‘narcissistic defense’ of using grandiosity to ward off shame.” (p. 55). He adds, “Grandiose behavior is a defense against images of the self as worthless and inferior The flight from shame to grandiosity lies at the heart of covert male depression.” (p. 56)
I have found Terry Reals words and concepts so helpful that I often reach for this book during a psychotherapy session and share these ideas with my patients. I have read several passages in this book so many times that I have memorized them and can quote them without even opening the book! Here is one of those concepts:
11 (Secret Legacy of Male Depression, Continued from page 8)
Real closes this particular chapter in the book saying, “A man who is willing to drop down as far and work as hard as young Billy did is after bigger game than relief from an illness. A man willing to permanently alter the terms of his internal dialogue to transmute the dynamic of wounded boy and harsh boy, feminine and masculine, shame and grandiosity, inside himself seeks nothing less than a transformation in the way that he lives, the values he lives by. Such a journey goes beyond recovery. It is alchemy. It is a quest.” (p. 227)
BOX By Linda Odom, PhD Our debt is coming due. Pandora’s Box is rattling. And its opening is imminent. Our Karma is relentless. It will not wait forever. If you put your ear to the box, You can hear the enslaved souls wailing. And you can hear the Native American souls drumming, drumming, drumming Drowning out our denial. We want so desperately to forget, But genocide cannot be forgotten. It can be buried. It can be walked over. But the shame eats at us from within. We try so hard to give it away… We violently project it onto others. Not MY shame, but YOURS! We split into the good guys and the bad. We point our fingers at one another everywhere but at ourselves. This solution is about to pass away. The shame is coming home. Our debt is coming due.
12 PANDORA’S
13 Nashville Psychotherapy Institute P. O. Box 158626 Nashville, TN www.NashvillePsychotherapyInstitute.orgnpinashville@gmail.com37215 NEWSLETTER CREDITS Editor: Emily Ector Volman, LPC, NCC Layout & Design: Melissa Vickroy, MS Printing: ISSUU online publishing **Editor’s Note: The content and opinions expressed within this newsletter do not necessarily reflect the views of nor are they endorsed by the Nashville Psychotherapy Institute, the Board of Directors of the Nashville Psychotherapy Institute, or the Editor of the newsletter. 2022 NPI BOARD OF DIRECTORS Linda Manning, PhD; Chair/Social Justice Tom Neilson, Psy.D; Chair elect John Nichols, MS, LPC/MHSP; Immediate Past Chair Avi Dressler, LMFT; Treasurer Tonya Mills, LPC-MHSP/T; Treasurer-elect D. Kirk Barton, MD Krista Conrick; Student Member Tiffany Davis, LCSW Emily Ector Volman, LPC, NCC; Communications Kristin Finch, LPC-MHSP (temp), NCC Laura Fritsche, LPC MHSP; Membership Chair Valerie Martin, LCSW Doug Taylor, LPC-MHSP; Speaker Research Jay Tift, LPC-MHSP; Hutton Historian Juliana Vokes, MA, LPC (Temp); Social Media Melissa Vickroy, MS; Executive Coordinator JOIN US IN-PERSON or VIRTUALLY Friday, September 9, 2022 “An Exploration of How a Client’s Hispanic Identify Informs Clinical Work,” presentedbyAdrianneMcKeon,PhD.Friday,October14,2022 “Creating Felt Safety - The integration of Sensorimotor Psychotherapy & DBT,” presentedbyEboniWebb,PsyD,HSP Program & Registration Information at www.NashvillePsychotherapyInstitute.org EachpresentationiseligibleforoneCEcredithour
