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Archive for January 27th, 2010

How does psychotherapy actually work?

Good question.  The answer is interesting and has to do with how your brain works.

The basic idea of psychotherapy is that you take emotional content from a primitive part of the brain and bring it to another more sophisticated, thinking part, where it can be examined and understood.

Here’s a quick primer on the design of your brain.

Due to quirks of evolutionary history, the human brain contains three distinct parts, which evolved separately.

In the center, there’s a small, rather rudimentary brain.  It resembles the brain of a lizard.

Wrapped around that, a second brain evolved much later – the paleo-mammalian brain.  It resembles the brain of a dachshund, or any other warm-blooded animal.

Sitting atop these two brains, there is the cortex.  That’s the grey, wrinkly stuff that you probably think of when you think of a brain.  It’s much larger than the other two brains, and is unique to humans, having evolved only very recently.

Like all higher animals, you have five basic emotions:  anger, fear, caring, hurt and happiness.  They exist entirely in the two more primitive parts of your brain – the lizard and dachshund parts.

Your thoughts – and your sense of awareness – exist only in the outer, sophisticated brain – the cortex.

There’s a reason for this.  All animals feel some emotions, but only humans have higher consciousness.  We alone think. (Actually, it could be argued that dolphins and some higher apes do too, but I’ll set that debate aside for now.)

Anger and fear reside in the innermost, lizard brain, because they reflect the primitive fight or flight instinct.  Faced with a ferocious predator, a tiny lizard needed to reflexively know whether to get angry and fight, or get scared and flee for its life.

The other three emotions are located in the paleo-mammalian brain.  That’s because they relate specifically to childcare instincts.

A lizard lays eggs – lots of eggs, and it doesn’t invest much time in caring for its young.  But a mammal bears only a small number of live young, and its off-spring are helpless for a period after birth.  So while a lizard might ignore its own large brood of young (or even dine upon a few of them), a mammal, with its small number of helpless off-spring, developed three important emotions related to childcare:  caring, hurt and happiness.

These emotions, located in the paleo-mammalian brain, lead the parent to care for its young, love them, and find happiness in caring for them, or hurt if they leave before the parental bonds are detached.

That’s your emotions, explained.  Now for psychotherapy.

Speech, and communication in general, including non-verbal communication like art and dance and music, are located in the cortex.  Psychotherapy is talk therapy.  A therapist’s goal is to get you to put your feelings into words.  In neurobiological terms, the idea is to take emotional material from the two inner, primitive parts of the brain – the lizard and dachshund parts – and translate them into speech – forcing them through the neural passageways of the cortex.

In essence, the thinking you is forced to process material from the feeling you.

In Freudian terminology, the two inner brains are the “unconscious” (the superego and the Id) and the outer cortex is the “conscious self” (the ego).  By funneling primitive brain activity into communication, therapy forces the unconscious into consciousness, integrating the self.

It’s a bit like an intellectual holding a conversation with a lizard and a dachshund, which is why the process isn’t always easy, and can take a while.

In any case, it’s better than living unconsciously – walking around thinking you know what’s going on while a lizard and a dachshund are secretly operating the controls.

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We found out last week that Tiger Woods has checked himself into a posh rehab center for sex addicts.

This raises the issue of whether sexual addiction really exists.  I think it is a fair question.

After all, we’re all sex addicts, to some degree – sex is a normal, necessary human drive.

Sex also seems harmless.  It feels good, and if you use a few sensible precautions, no one has to get hurt.  With other addictions, like alcohol or drug abuse, kicking the habit entirely seems like a sensible goal.  But except for a few monks and nuns, no one abstains completely from sex.

So maybe it’s like food – moderation is the goal, controlling your appetite so you don’t get fat.

But that doesn’t seem right either.  No one can say how much sex is enough for another person.  Maybe you like it every night. Maybe you like it every month.  Maybe you like it two or three times a day.  That would appear to be nobody else’s business.

Does sexual addiction exist?

In my experience, it does.  It’s a bit like marijuana addiction.  Plenty of people have sex – or smoke pot – without any detrimental effect.  It isn’t innately addictive.

It only becomes an addiction when you decide there’s a problem.

Usually, the indicators are:

1) you’re no longer enjoying it the way you used to; and

2) you don’t feel in control of your behavior.  In other words, it becomes compulsive – you can’t stop.

I’ve worked with sex addicts who cruised online for hours, exhausted, but unable to leave their computer. Some patients set up endless series of anonymous hook-ups, staying up all night until they were so physically exhausted they lost their jobs.  These patients didn’t look forward to the sex anymore – they felt compelled to repeat the same weary pattern.

Typically, with sexual addiction, it isn’t the sex act itself that you’re craving.  It’s the feeling of being pursued by someone for sex – catching a stranger’s attention, and making him want to have sex with you.

Think about it.  When was the last time you had someone’s positive attention focused entirely, like a laser-beam, on you? Probably back when you were a small child, and then it was a parent’s attention.  It made you feel important, loved, cared for – the center of someone else’s world.

As an adult, you rarely get that sort of focused positive attention – except when someone is pursuing you sexually, trying to get you into bed.  It’s hard to compete with a sexual pursuit.  It brings an affirmation, a high, an ego boost that can feel terrific.  All they want is you, now, right away.  The focus is entirely on you.

Once the sex is over, though,  you crash.  The other person’s interest fades, and you realize you hardly know him.  You might even feel awkward in his presence and just want to be alone. It’s a bit like a hang-over.

A sex addict, like any addict, runs to what once felt really good – especially when he gets angry and feels deprived in other ways. He keeps searching for the easy high of being pursued for sex – trying to escape again into that good feeling.  It becomes like a drug.

After a while, like all drugs, it stops working.  If you do manage to attain the high again, you crash even harder afterwards.

That’s sexual addiction.

The treatment – which Tiger is presumably undergoing right now – is similar to the approach you’d take with any other pattern of addictive behavior.

First, there’s an intervention, in which the people in his life let him know how his addiction has harmed them.  Certainly his wife, and maybe the other women he’s been sleeping with, could confront him with how he’s hurt them by lying and betraying promises.

Then, fellowship is created.  Tiger goes to a place – a rehab center or a 12-step group – where he can meet other people who share his problem, and exchange stories and experiences.  He is educated about his addiction.

Finally, self-awareness.  He is encouraged to be honest with himself, and own up to how he’s been living, and decide for himself whether he wants that pattern to continue.

I haven’t met Tiger Woods, and I cannot say for certain if he is a sex addict.  He might just be a guy who needed to get out of his marriage and do some dating and decide what he wants in a relationship.

Only Tiger can decide if he has this addiction, or whether he’s going to address it.

But that’s the nature of any addiction – no one can make these decisions for you but you.

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