A Post That’s Not About Precognition

…but you knew that already, didn’t you?

There have been a few posts about Daryl Bem recently that I’ve either written or linked to. In short, psychologist seems to believe precognition (aka, ESP) exists, publishes a lot of papers about it, generally upsetting social psychologists.

Actually, I didn’t know the name Bem from this first at all. I knew the Bems (of which there are several! Two of whom used to be married!) from the book An Unconventional Family, written by Daryl Bem’s ex-wife, who’s well known as a psychologist in her own right. From the description:

This engrossing book by the author of The Lenses of Gender is an account of her years as an egalitarian partner in a gender-liberated, anti-homophobic, feminist marriage. Bem reveals how she and her husband, Daryl, became gender pioneers, how they raised their two children, and what their experiences – both positive and negative – have to say about the viability of nontraditional gender arrangements in society today.

I’d agree with this article that ‘gender pioneers’ is putting the Conestoga wagon a little before the horses; what the Bems did was attempt to raise their two children into a gender-neutral house, trying to avoid ascribing gender to clothing and toys and behavior, while also trying to share child-rearing duties.

It’s quite a short book–at just 200 pages–including interviews with the entire family. Mostly, I think it’s an excellent read for thought-experiment reasons. I endorse most of the ideals the Bems held: strictly gendering children is silly! Dolls and trucks being gendered is not worth enforcing! (I loved my tinkertoys, thankyouverymuch) Conversely, I have lots of instinctive dislike of the idea of testing one’s beliefs about how society should be on your children, in ways that can leave them not able to fit in. I have very heavy memories of knowing exactly why I didn’t fit in and knowing I couldn’t fix it, and also feeling awful for wanting to be like Those People because doing something because everyone else was doing it was a Bad Reason. And [Third-Variable]ly, I don’t know how on earth one would predict which would be worse in the long run, or even how far away-from-normal the things you do at ages two and three will leave your children as they grow.

*throws up hands in confusion*

Monday Miscellany: Cutting Boards, Clerics, Campus Sexual Violence Reports

1. This article actually gave me a very different argument against the death penalty: it might be harming medical science in other domains.

Yet even if executions are not medical, they can affect medicine. Supplies of propofol, a widely used anesthetic, came close to being choked off as a result of Missouri’s plan to use the drug for executions. The state corrections department placed an order for propofol from the U.S. distributor of a German drug manufacturer. The distributor sent 20 vials of the drug in violation of its agreement with the manufacturer, a mistake that the distributor quickly caught. As the company tried in vain to get the state to return the drug, the manufacturer suspended new orders. The manufacturer feared that if the drug was used for lethal injection, E.U. regulators would ban all exports of propofol to the U.S. “Please, Please, Please HELP,” wrote a vice president at the distributor to the director of the Missouri corrections department. “This system failure—a mistake—1 carton of 20 vials—is going to affect thousands of Americans.”

2. It’s one thing to have those fancy internet infographics where you can toggle the display. What about IRL versions? I’m so glad you asked. “Stick this page of The Economist to the wall, don a blindfold, and throw a dart in its general direction.”

3. Speaking of neat infographics, who has the largest vocabulary in hiphop? And how does that compare to say, Shakespeare?

4. Geeky cutting boards for reasonable prices.

5. I wrote about Bem, and he’s published another paper. So, should you believe in precognition? No, but you should definitely read that link.

6. Miri reviews the White House Report on Campus Sexual Violence.

7. Someone expanded on the “social justice warriors, what about social justice wizards?!” post that was going around, and it’s even better.

social justice warriors are sometimes the leeroy jenkins, they rush right in usually without buffs, without enough equipment, and probably in misguided and counterproductive ways but their hearts are usually in the right place so everyone who rushes in after them to try and back their asses up usually also gets wiped. refined warriors can usually manage aggro while tailoring their skills to fit the situation, but they gotta be careful.

social justice rangers (sup) occasionally have that One Post that resonated with a lot of people but most of the time they stand back and take potshots at easy targets. rangers are pretty good at getting to the point (if i do say so myself) but prefer to back up the party than to wander into the thick of the mob.

My general goal? Cleric.

Housekeeping Note

I’m trading the freezing hellscape of Chicago for the Bay Area today through Sunday, and likely won’t be minding comments or answering questions at all. Apologies if your thoughtful rebuttal gets caught in moderation.

Monday Miscellany may occur on time, but this depends heavily on how well I adapt to the time changes and such.

Have a vibrating penguin and a lovely weekend!

Aversive and Achievement Goals

[Related to The Cockroach of Motivation. If you’re here and generally consider yourself part of the rationality community, check out the quick note first.]

In psychology, especially the subsector focused on motivation and identity, there’s this idea of future possible selves: the ways you imagine yourself being as you go forward. You can have lots of them at once: being good at math, popular with friends, owning a pet, being responsible, not procrastinating, being known as friendly, avoiding debt, etc. Some of them are considered ‘positive’ and some ‘negative’. This has little to do with the actual goal you want, as how you frame it. Are you aiming to ‘be X’ or ‘not be Y’? The first is positive, the second negative. In other words, one is about achieving something (grades, a relationship, being known as a certain personality trait), the other about being averse to something (procrastinating, failing a class, debt).

In general, people who have more specific and elaborate positive possible/future selves (rather than an equal mix of negative possible selves and positive possible selves, or lots of elaborate future selves they want to avoid) seem to be more motivated and persistent. (here, here, and here)

If you pull this apart, it fits. One of the roles of future selves is something to become more like or less like. If you check in with yourself about whether or not you’re achieving this, you’ll probably get markedly different results from positive future selves and negative future selves. It’s easier to mentally rehearse Doing Something than it is to mentally rehearse Not Doing Something.

And I’ve been using this framework to poke about it my goal setting and motivations. I’ve started tagging things as aversive (negative/go away from/be less like) or achieving (positive/aim for/be more like), and then flipping them around the axis.

Here’s an aversive one, as I decided when to have a stressful phone call:

I don’t want to be the sort of person who avoids things because they’re emotionally weighty.

Okay, I feel fairly good about wanting this. I don’t want to be someone who avoids these interactions! I’m  impressed by people who dive right in to figuring out emotions that make me want to mentally recoil. I find myself frustrated when people aren’t willing to introspect.

But I also flip it around to achievement:

I want to be the sort of person who tackles emotionally weighty conflicts.

Actually, I feel even better about this framing. Not only that, but I’m likely to be able to notice when I get closer to this goal. Hello, availability heuristic, let me use you to my advantage!

Take the aversive framing: when I ping my brain and ask “Have I been the sort of person who avoids things because they’re emotionally weighty?” I’m asking it to come up with times when I’ve avoided things that were emotionally weighty. If the question is Am I This Person, and This Person is defined by “not avoiding”, I’m going to pull up times when I avoided–it’s faster to locate instances of something happening than discrete instances of something not-happening. As Robby put it, it’s easier to remember elephants than not-elephants. So suddenly I’m recalling all the times I screwed up. Wheeee!

But look at what happens with the positive framing: I ask myself Have I been the sort of person who tackles emotionally weighty conflicts? And now the elephant that my beleaguered brain is looking for is instances of dealing with emotionally-heavy conflicts. Suddenly, I have a list of times I did the right thing!

And even if I don’t have a list right now–maybe I still haven’t achieved this future self–I know that I’ll be closer when I have a longer list. Whereas with the aversive framing, it’s probably always going to be possible to come up with an example or two when I avoided a stressful conversation. If I think about the goal like that…well, I’ll likely end up frustrated with myself even when things have improved. “I could do better!” is a useful mindset, but when it plays out into “I suck just slightly less than I used to” repeatedly, it’s hard to motivate myself.

Yeah, but what if you already frame goals in the achievement direction?

I want to prioritize cooking meals for myself. 

Nice and achievement-oriented. So I flipped it around:

I want to not fail to prioritize cooking for myself.

…which, uh, sounded a little bit awkward and ungainly. What the hell did that even mean? How would I know if I was ‘not failing to prioritize’? And this train of thought lead my brain into figuring out exactly what prioritizing meant–if only so I could rescue that sentence from its awkward grammatical puberty. One obvious way was to define my terms in the aversive condition:

I want to avoid eating out more than twice a week.

Evanesco double negatives, Accio simple sentences!

Which also gave me a better achievement orientation:

I want to cook meals all but two times a week.

And beyond rescuing a horrible sentence, I’d now spent more than a few mental cycles on this goal. I’d turned it over in my head, defined the more nebulous bits, and pictured and discarded other versions of the plan.


Hello LW/Rationalists/People Who Were Curious and Clicked the Anchor: make sure to keep an eye to the abstract and methods section within research links. For some reason, the LW colloquial usage of ‘future/possible self’ doesn’t quite jive with how they’re operationalizing it, and this will save you time and confusion. If that doesn’t clear things up, here’s me giving a more informal explanation. [Return to top.]

The Cockroach of Motivation

[Draft-clearing again. Quite old, somewhat updated for clarity.]

Today, as I have several times this year, I told someone that I had gone on a date with that I would prefer not to see them again. Then I gave a presentation I thought could have gone better and proceeded to be horribly unproductive all day.

The first two are things that give me shivery-panic, and that I have to deliberately talk myself into doing, the third will can leave me feeling hopelessly behind (I was) and awful for days. But I mostly muddle along with Pollyanna cheer and Doing The Thing(s). And I do it with cockroaches.

Explanation via Pervocracy:

The Worst Thing In The World is a yawning chasm of failure, constantly open beneath you, and there is no describing the horror at the bottom.  You just go around with the knowledge that if you make a mistake big enough, you can fall in.  If a relationship fails, if you get fired, if you get rejected… you’ll fall into TWTITW, so you put everything you’ve goddamn got into that relationship.  You’ll try anything to keep the relationship. Because it’s literally unthinkable what will happen if it ends.

That unthinkability is how it traps you.  Because it’s like Stephen King says in Danse Macabre–knowing that there’s something horrible behind a door is terrifying.  Once you open the door, it’s ruined.  Even if it’s a really terrible thing behind that door, even if it’s a six-foot cockroach, any horror you feel is going to be mixed with relief.  “Oh, thank God, it’s just a six-foot cockroach. It could’ve been a sixty-foot cockroach.”

It resonated with me, I think because I have spent most of my adult and teenage life knowing like what many of the logical close-to-ends of my fears were, and quietly calming myself with them. Scared of doing that interview? Nah, remember that time you gave your first speech and a whole class and teacher laughed at you to your face? You survived that. Nervous about turning that guy down? Remember the one who followed you around the cafe, calling you ‘bitch’ and ‘cunt’ because you said you couldn’t talk now, you had homework? You were shaky but you walked all the way home and made lunch.

And I think this is perhaps not the story I want. I want to have been strong, to have set boundaries, to have faced down the mundane scary things like bad performance reviews and the-one-who-never-called not because I was certain that worse things have happened to me, but because they were important to do. I am wary of a framing that is only about Things Could Be Worse. I want to delight in things because of how they are–not because they are better than the sixty-foot cockroach.

I am concerned that I might be training myself to spend too much time looking for the worst possible option. Is this it? What would be even worse than this? Is there a six-hundred foot cockroach I’ve forgotten about? How much of my time am I spending looking for awful eventualities?

Not only that, but I want to give myself permission to mope. I am an extraordinarily happy person by nature, but my habit of not reflecting on when things were sad or bad or disappointing means that it can take a series of badbrains days before I realize “OH, there have been a lot of horrible and distressing things in my life, perhaps I should consider those caused this.” Framing everything as “not the worst possible option!” means I don’t leave myself for space for sitting with exactly how bad the option I got was.

Monday Miscellany: Corgwn, Childhood Immunizations, Challenges

1. Drop everything you’re doing and read this Reddit AMA with Lemony Snicket/Daniel Handler. And if you haven’t read A Series of Unfortunate Events, clear a space in the debris from the stuff you just dropped and read a while.

Q: What should I name my new cat?
A: “The Plague.” Has anyone seen The Plague? Is the Plague in your room? It really rolls off the tongue.

Q: Hello Mr. Snicket/Handler! I’m a huge fan. When The Beatrice Letters came out I spent hours dissecting it for clues. Here’s my question: was there any reason you kept the ending of book 13 so ambiguous rather than answering a lot of the questions readers had about the series directly?
A: I think books which ask questions are more interesting than books which answer them. For instance, after reading this comment I had the question, “How can a huge fan manage to use a computer? Isn’t it busy cooling the air someplace?”

2. It took me a very long time to figure out that this (excerpted at pull quote) was the difference between my experience of happy occasions and the experiences of my depressed friends. Miri on the 100 Happy Days challenge:

I can’t be happy for 100 days in a row because my brain doesn’t work that way. The good feelings don’t “stick.” When they happen, they’re genuine and meaningful, but they wash away like words scratched into the sand. I argue against them without meaning to. That essay was shit. He doesn’t give a fuck about you. Everything about you is ugly. Your parents will die and you won’t even have the money to fly to their funerals. Your siblings barely remember what you look like because you’re never home. Your partners will leave you for real girlfriends, as opposed to the sloppy facsimile of one that you are. Everything good is temporary; everything bad is permanent.

3. The failure mode of naked is ‘objectification’.

A few years back, John Scalzi wrote a blog post with a line that has made its way around the internet. “The failure mode of clever is ‘asshole.’”  ‘The effectiveness of clever on other people is highly contingent on outside factors, over which you have no control and of which you may not have any knowledge; i.e., just because you intended to be clever doesn’t mean you will be perceived as clever, for all sorts of reasons.’
[…]
Why do I bring this up nearly four years after Scalzi’s post? Because I’ve been chewing over a different case of failed communication in the last few days, and I realized that it can be generalized to a rule very much like the one Scalzi posited: The failure mode of naked is “objectification”.

4. Hunh. This is an interesting way to look at IQ/personality:

It’s theoretically possible to measure personality traits through ability tests. For instance, agreeableness could be measured through tests of perspective taking, conscientiousness could be measured through tests of self-control, and neuroticism could be measured through measures of emotional self-regulation. Viewing IQ as a personality trait is helpful because it puts IQ in perspective. We can take a birds eye view of all the many fascinating ways we differ from one another in cognitive processing, emotion, and motivation, while seeing where IQ fits into that bigger picture.

5. Gwen Pearson would like you to know that “Jumping spiders are the corgis of the spider world.” Color me….skeptical. (h/t Ed Yong) Also, the lesser-known plural of corgi is corgwn. Welsh is cool.

6. I grumped about the way we talk about childhood immunizations and lo, here’s the American Academy of Arts & Sciences with a monograph on research to increase public trust in vaccines. (Again, h/t Ed)

7. I want your imperfect empathy.

Halloooo!

There’s a new set of readers over here, and I wanted to stick a quick “wave, smile, and offer a nice hot dish” post up.

I’m Kate! I write Gruntled & Hinged. Many? Possibly most? of you seem to have come over from Slate Star Codex, but there was a recent influx of people from Unequally Yoked.

-I’ve been writing more frequently than usual, and expect to keep this up, within some constraints. Every Monday, there’s Monday Miscellany, a collection of links and suchlike. Otherwise, posts appear at around a rate of two per week.

-This blog is loosely themed around psychology, and breaks down into roughly:

  • 39% thinking about how human interaction (including therapy) works, could work better, and fails.
  • 18% Kate grumps about bad data collection/confounds/research/teaching of any of the previous. This is the Someone Wrong on the Internet part.
  • 27% stuff that relates to eating disorders and eating disorder treatment
  • The remainder: “HUNH. Look at THIS. Just look at it! Aren’t brains weeeeird?”

-Other post topics include baking (have some Nutella cookies!) atheism, and studenting.

-I belong peripherally to the rationality community, and participate in the secular-atheist-skeptosphere on a semi-regular basis.

-For five more weeks I’m an undergrad getting two degrees in psychology (applied and research-based) in Chicago. Very shortly thereafter I will be getting a Master’s in Social Work in Boston. I’ve worked previously in schizophrenia research/treatment and adoption services, and have an unfortunate amount of personal experience with eating disorders.

-There is no official comment policy, but the unofficial one is Be Nice And Cite Your Claims, Please. Commenters are on first-time moderation, but I’m quick about approval.

So! Hello! Well met! Who are you?

 

 

Please Stop Talking About All Those Babies Waiting To Be Adopted

Wikimedia, Creative Commons

This post was inspired and cobbled together from an internet comment that accidentally grew into a novel.  I’ve attempted to include citations where possible, but the majority of this information comes from working in adoption services research at the Fabulous Unspecified Internship last year and is not easily accessible for citation. Add salt as necessary. 

That being said, I’m not an adoption counselor (or any kind of counselor, actually). I’m also not a lawyer, a parent, or a zebra. What I have done is work and research in this field. I am slightly more qualified than your average zebra, but this is not medical, familial, psychological, or lion-avoidance advice.

As a second note, it’s worth saying that I like adoption! I am not discouraging it as an institution or way of having children! I am significantly more likely to adopt than have non-adopted children. There’s a reason the Fabulous Unspecified Internship was amazing, and much of it had to do with working in adoption services. What I am opposed to is telling people to adopt with very bad arguments and misinformation. And one I hear slung about is that of All The Babies Waiting To Be Adopted. (It’s lesser cousin, You’ll Have To Wait A Million Years For A Baby To Adopt is rarer*, and worth it’s own post.)

I’ve heard both arguments–there are hundreds of babies out there waiting to be adopted! and you could be waiting years for a child!  The former seems to be the go-to for guilt-tripping people who want to have their own children, the latter for sighing in disapproval at the people who do decide to adopt. And I would like us to stop guilt-tripping people for having their own children.

While less complicated than say, designing a literal Stork Delivery System, adoption is somewhat more complicated than deciding you want a baby and then walking home with a small human. This has something to do with a confusion of language–we call all sorts of ways of getting legal custody over a child that you didn’t contribute genetic material to ‘adoption’.

1. Uncle Joe and Aunt Jane legally adopt Abusive Niece Sally’s son, not wanting him to end up in the foster system? Adoption.

2. Sarah and Jeremy are infertile. They find out about a daughter of a family friend who’s going to have a baby but wants to put it up for adoption and set up a legally binding agreement through a lawyer to adopt that baby. Also adoption.

3. What about Bethany and Emily, who go to an agency, answer lots of questions about their lives, get put on a waiting list, and adopt Baby Andrew a year later? Adoption.

4. Nicole and Noah foster a number of children. They are able to make a ‘forever home’ with one of them–Jason. You guessed it…that’s also adoption.

[What you are experiencing now is semantic satiation.]

When people encourage adoption, or talk about all the babies out there waiting for homes, they seem to be thinking about the experience of #3, with the numbers of #4, and a poor understanding of all. (For the sake of sanity and manageable sentences, we’re going to call #3 ‘adoption’ and #4 ‘foster-adoption’.) They seem to be expecting that there are lots of children who are up for the take-home-forever adoption, in a way that is experientially equivalent to having your own kids: they won’t look like you, but that’s about the only difference, yeah?

Not….really. I’d even venture to say not…at all, and those differences are what make me extraordinarily wary of pressing people who aren’t already eager to adopt to do so.

Foster adoption (#4) is geared towards getting the child back to relatives. That is, the approach is not to locate a new family, but to place the child in a stable situation while their current family stabilizes, or an extended family member can be located. If, and usually only if this doesn’t work out, they’re placed with a new adoptive family.** So, sure, there’s LOTS of kids, and it would be lovely to see them placed in homes that were stable. But you’re effectively telling parents to attach to children they cannot expect to keep, over and over, in the hopes that they someday, will get to keep a child. That’s not a thing many people can or should be expected to cope with. Not to mention, I only want people who can do what it takes to be a good foster parent emotionally doing it.

So what of not-foster adoption?

Well, there just aren’t bunches of babies waiting around to be adopted, as evidence by standard wait times. (In the link, time is measure post-portfolio creation, meaning that you’ve interviewed with the agency, gone to training, gotten references, been approved and processed, and created a portfolio,  all before the clock was started.)

Adopted healthy-at-birth children, just like nonadopted healthy-at-birth children, can go on to develop mental or physical issues not known at birth. However, parents of nonadopted children might know of the issues in advance–inherited conditions and the like, or because Aunt Jane and Cousin Sally didn’t walk until much later, so no worries when Child Sarah’s motor skills lag a little. Whether or not the parents should be concerned, whether or not Cousin Sally’s delay in walking has anything to do with Child Sarah’s delay, there’s a reference point, and probably an expectation that we, Healthy Parents, were fine, so our child will be!

In fact, I’m willing to bet that this mechanism is partially why adopted children are twice as likely to have contact with a mental health professional. Uncertainty and what if we missed something, and what if this is indicative of problems later and a dash of hyperawareness, combined with on-average higher incomes/class status, and you have greater chances that James’s minor issue will merit getting things checked with your local psychiatrist/psychologist/occupational therapist/etc. But also, referring to that same study–plain English writeup here–adopted children are more likely to end up with a set of disorders called ‘externalizing‘ and are extraordinarily overrepresented in psychiatric care. Friends who have worked in the field confirmed that this was common knowledge.

This is something agencies prepare parents for, of course, but saying to parents “you should adopt a child, who’s at higher risk for issues you aren’t prepared for, and haven’t necessarily seen play out in your own family, and you should do this instead of having a child because there are children who can be adopted” seems incredibly dangerous–those children are suddenly at risk of abuse from overwhelmed parents. (Yes, we should definitely better prepare parents and people at large to interact with people with disabilities. I am 100 percent on board with this! However, given the condition of people’s attitudes and behavior towards disabilities as well as a general wariness at using children as pawns and teaching tools, adopt children! seems like a Very Bad Solution to ableism.)

A note on international adoption: Adoption of children from outside the US is really limited, actually. If you want a closely regulated adoption through the Hague (you want this, this means less chance of false/missing information about the child), there are few countries, and they’re generally closed to you if you’re not young, married, straight, and have no health problems.

Advocate for adoptees! Advocate for less ableism! Create better and more effective treatments for infertility! Improve the foster system! But please stop being inaccurate and guilt-tripping parents who prefer to have children the ‘traditional’ way.

 

*It’s likely that it’s just rarer in my social circle. In fact, since I started writing this post, it’s become more common.
**Somewhat oversimplified, because bureaucracy.

Other notes:
(1)As a general reference, studies of children adopted after 1990 are more representative than those of children adopted earlier than 1990. Open adoption became the standard practice unevenly, but so far as I can tell, by 1990, everybody figured out that not keeping big secrets and doing a dramatic reveal that radically changes your child’s sense of belonging is usually a better plan. 

The Therapeutic Alliance and Just….Not ‘Getting It’

No, I didn't spend lots of my afternoon creating a logo for a fictional, crime-fighting Therapeutic Alliance. What makes you ask such a thing?

No, I didn’t spend lots of my afternoon creating a logo for a fictional, crime-fighting Therapeutic Alliance. What makes you ask such a thing?

[Related to Some Musings on Cognitive Behavioral Therapy and Counterintuitive Underreactions and Overreactions]

There’s a lot of talk in my clinical classes about who and what succeeds in therapies. Does it matter if you’re a matched or unmatched gender from your client? (Probably not, except maybe for teens. ) What about matched ethnicity? (Maybe for some ethnicities.) Does it matter what sorts of therapy you’re practicing? (Sort of? Maybe. Okay, we’ll concede that we disagree a lot.)

But there’s this one thing that we do think is important, across all sorts of other variables. The therapeutic alliance. Sadly, not a secret cabal of psychotherapists, fighting crime and kicking ass.

[Psssst, I would TOTALLY JOIN if someone reading this were recruiting for such an alliance. Ahem.]

Therapeutic alliance is the sense of working together as a team, client and therapist. Depending on who you talk to, it involves empathy, reciprocated positive feelings, a sense of collaboration, and the client’s belief that the therapist supports them. More interestingly, it’s a fantastic predictor of both whether or not clients will stay in therapy and whether or not therapy will result in positive outcomes, across the type of therapy.

…Okay, not exactly earth-shattering. If you don’t feel like you and your therapist are on a team, or don’t feel as though you’re supported or understood, you’re not going to want to go back to therapy and spill your heart and guts. You’ll want to find someone else or stop paying for hours of awkward and uncomfortable interaction. If you don’t feel like your therapist understands what’s going on, where are you going to dig up motivation to practice the (hard) skills you’re developing in sessions? If you don’t think your therapist empathizes with you, are you going to tell them when you failed? If you don’t tell them when things fell apart, how are you going to develop coping mechanisms for failure modes? Of course you’ll put in more work with a therapist you want to please, and that will show in better outcomes.

Right okay, so the importance of the therapeutic alliance makes intuitive sense too.

Except, imagine that your professional success hangs very much on being able to make people with a wide variety of backgrounds, cognitive distortions, and expectations for therapy like and trust you within the first few hours you spend together. And your job is to do this over and over and over.

And the advice you get for how to do this involves things that seem to be on the simplistic side. Don’t seem distracted. Don’t watch the clock. Don’t invalidate their emotions. Don’t seem judgemental. Great advice! But not exactly going to turn you into the perfect stranger to share deep and scary secrets with.

In trying to pull this apart, I’ve a theory, which generalizes outside of couch-based relationships. When people say lots of words at you, picking which ideas you respond to is important.

Again, not earth-shattering. Boring and mundane, even. Bear with me.

An example, from the non-therapist version:

Jeremy: Hey, I noticed you’ve seemed a little upset this week. Is anything going on?

Eliza: Yeah, it’s been a rough week. My parents have been fighting constantly–you know, the loud, shouty fights that you can’t not hear. I’m afraid they’re considering splitting up. And I’ve been stuck at home because my car’s in the shop; I have no idea how I’m going to afford the repair I need.

Jeremy: Yeah, I hear you. It’s almost impossible to take a car in and not have to spend a ton of money.

…and at this point, I bet a bunch of you are patting yourselves on the back for spotting what happened. Go you! Jeremy asked after Eliza, who helpfully explained she had BIG STRESS X [parents shouting constantly and unavoidably] and Small Stress Y [cars are expensive to repair]. Given the opportunity to respond to X or Y, Jeremy commiserated about how cars are expensive to maintain.

If Eliza and Jeremy are close, she can agree and then turn the conversation back to shouting parents, or decide that Jeremy’s response doesn’t condemn him as Worst Friend Ever, and find someone else to pour her heart out to later.

And I want to throw some sympathy in Jeremy’s direction! “My parents are shouting and might be splitting up” is not light conversation and I’d bet that his internal monologue sounded like “helphelphelp, what’s the script for this, OH, I know how to talk about repairs being expensive!” or “oh noooo, that sounds really hard, what do I say next? uh oh she stopped talking now I talk aaaaah”

Point is, this might be frustrating for Eliza if it’s the default mode of their friendship, but I expect it’s unlikely she’ll even notice at the conscious level it’s happened this one particular time. Most people simply don’t analyze friendships at the level where they can articulate “I expressed two worries and Jeremy picked the lesser of the two to discuss, when clearly the greater worry was my parents marital status”, nor do they need to.

Let’s go back to therapists and therapeutic alliance. I think that lots of what stymies the therapeutic alliance is a version of this. Except instead of having a background of friendship and understanding, there’s this client, who maybe isn’t even sure therapy can help, and what if this person makes fun of these weird feelings like everyone else did? There’s all these unseen, not-quite-expressed negotiations where the therapist is trying to get information without interrogating and the client is trying to test the waters with progressively more personal information and lead the therapist towards asking the questions that will let them do that.

So, Client Eric says that he’s been worried about school and can’t sleep because he’s had so much homework. And Therapist Evangeline wants to talk about coping techniques for dealing with school–which helps Eric. But Eric, who has only met Therapist Evangeline once before, at intake, was hoping she’d ask after that not-sleeping part, because he’s had insomnia for a few years and everyone else thinks it’s normal college behavior, but a few times he didn’t sleep for days and what if that’s really bad…?

Client Eric might be able to fix this if he points out that he wants to talk about his sleep, and does Therapist Evangeline mind, but that’s hard, especially if Eric’s mindset is that the therapist is the expert who will fix his brain. It’s not that this is a bad mindset, it’s just that Correct the Authority Figure” is a harder game than Correct the Nice Stranger Sitting Across From You.

So after a few sessions where Eric says A and B, and Evangeline focuses on A, when Eric’s worried about B, Eric might feel like he’s not being listened to. He’s not right, exactly–Evangeline is listening. If you press Eric, he might be able to tell you that she just….didn’t get it.

And I think this is basically what makes the therapeutic alliance fail between some clients and some therapists, all other things equal. For some set of clients, a therapist is great at figuring out what part of a given response to hone in on, and for some other set, they miss enough to give the feeling that they’re not paying attention or don’t care or just…don’t ‘get it’

I…don’t actually know how to fix this. Or if it’s fixable. I know that being able to label this difference between a therapist I adored and a therapist that was meh made me feel more in control. I wasn’t unreasonable, it was that I kept wanting to talk about Thing One, and they kept asking after Thing Two, which in my mind was more a detail to round out my story than a Large Problem. Once I was there, I could point out that my concern was Thing One, and did they mind if we explored that? It was tiring, and all things being equal, (they weren’t) I would have found another therapist. But instead of therapy being a nebulous and confusing interaction, I could pinpoint exactly where the exchange was getting unhelpful.

 *For the record, this is probably overly simplistic. If you’re trans*, I’d bet it would make things a lot more relaxed and open if your therapist were too, along with some other permutations that probably haven’t been investigated closely. Further, my guess is that the effect is fragile for most of these differences anyways. 

Some Musings on Cognitive Behavioral Therapy

 Robby Bensinger told me to finish a post on CBT, so hark! A post on CBT. Many, many thanks also to Miri for critiques and help with the composite example in Part Three. 

Recently, I’ve been on this kick where I read books about therapy and self-help not because I think they’re going to be useful to me, but because I want to know if they’re going to be useful to other people. Like, this marriage manual*, for instance. Books that teach you to do Cognitive Behavioral Therapy on yourself have been a particular focus. When I’m asked for resource recs, people often specifically ask for evidence-based therapy or CBT, and I give the classic suggestions. (If you’re coming up with titles here, you’re probably right.)

And I get feedback! ….which is often mixed. The most common thing I hear is that the advice was good, but the narrator was condescending/annoying/patronizing. In fact, this is what I’ve heard almost every single time. Keep in mind that these are people who sought me out for a specific kind of book rec, then bought or rented the book I suggested, expecting that it would help. With that expectation, they read the entire thing, despite hating the writer’s tone.  (And they described it as ‘hate’ too.) That’s not encouraging.

—-

I’ve been thinking lately about what kind of therapist I want to be. I’m approaching termination with my third therapist in three years. Very shortly I’ll be in exactly the same place my previous therapists were: in an internship, practicing microskills and hoping I sound supportive and trying to take notes and watch the clock and never have distancing body language and not sound overly judgmental and to do it all at once.

I’ve watched them work at it and improve and have off days when the prevailing theme of therapy was “You’re watching the clock and I’m watching you watch the clock.”

At the same time, through some combination of blogging, talking openly about my mental health, and social selection, I’ve spent most of the last few years around people who have tried therapy, are seeking therapy, or are in therapy. These too, are usually people who actively sought out therapists who offered CBT or ‘evidence-based therapy’ techniques. Many of them…maybe even most? that have abandoned therapy as a useful solution have done so because they felt their therapists talked down to them.

“They asked stupid questions!”
“Of course I’d considered that!”
“Yes, I know not literally everybody thinks I’m worthless, hasn’t anyone heard of exaggeration? I just said it felt like that sometimes“

—-

So for a very long time I had this model in my head that my friends has just encountered the Bad Therapists, and some rule of conversation meant that people preferred to commiserate over Bad Therapists more than they wanted to tell me about Sparkling and Perfect Therapists. (A version of misery poker or Northwestern’s favorite: homework Olympics.)

And then Part One of this post happened, and I switched from primarily reading instructions for clinicians administering therapy to instructions from clinicians to laypeople.

Sometime later, I noticed how many times my reaction to reading an example was “Wow, this example is painfully heavy-handed, but what’s the principle behind it?” or “I mean, obviously the client in this example didn’t mean that literally, but what’s the skill the therapist is trying to teach?” I was intentionally ignoring all the stuff that might turn clients off therapy entirely, in favor of learning techniques.

An example**

Jason has anxiety, and has been having trouble sleeping because he’s afraid he won’t finish his next project on time. His daughter has been ill, and he’s missed more work than usual, though he has a stellar track record with the company. He might be able to ask his boss for an extension, but every time he considers it, his chest gets tight and he has trouble breathing. He says he fears his boss will fire him for failing to complete a project for the important client.

I, [Therapist X] asked Jason to work through some questions for me.

“Have you ever had a friend who got fired for respectfully asking for an extension?”

“Don’t you think that your boss would rather have your work a little late rather than have to go through the process of hiring someone new to get it done even later?”

Except that if I were Jason, answering No to the first and Yes to the second still leaves me with the crushing fear of “What if I am the exception and I need this job to support my sick daughter, even a five percent chance of firing is still scary.” Working through the questions might give him an idea of what to think about when the fear is crippling, decrease the physiological reaction, or prevent future fears from spiraling out of control, but that hasn’t been made explicit. Jason has to trust Therapist X to have a plan.

And while there’s an argument to be made that books have to construct examples that are larger than life to have clear cut principles, I started noticing it in therapy myself. It was actually, once I was paying attention, very common for me to suspend my annoyance, as it were, in favor of expecting the paradigm of therapy to succeed.

So when my therapist asks “You said you wanted to restrict your calories after eating dinner two days in a row. Does that seem like it’s part of your plan for recovery?” I don’t say “Of course it’s not how I want to do recovery, but I’m struggling with anorexia, dammit!” I trust that she has some goal that involves me learning something new about triggers or a coping mechanism, and that that goal is served by the conversation her question is starting. So I say something like “No, it’s not, but I don’t know how to feel okay with eating so much more than I’m used to” and we go merrily on from there.

The problem is, this only works if I expect that therapy is going to be beneficial to me, trust that I might not be the best judge of what is succeeding, and believe that what sounds like stupid questions or silly roleplaying has an end goal I support.

Guys, I want to be a therapist, and I still have to work on suspending my initial, irritated reaction to CBT techniques.

—

Then how do we prevent the feeling of condescension? The image of the snooty psychotherapist, making judgemental notes and pontificating on childhood repression is still very much part of the public imagination. (Someday, I want a world where “penis envy? *snicker*” is not the rejoinder to my career plans…) “Here’s let’s try some roleplay to practice this social skill!” “Yes, but can you think of another way of looking at that?” …they don’t exactly make people disengage from that mental picture.

What about taking the opposite tack? Closing the distance a lot, laying many more cards on the table.

We say “Look. This is CBT. It’s been shown to help quite a bit for some people, and I think it could help you. Sometimes I’m going to ask you questions that sound condescending or silly or obvious, and I’d like you to step back and just answer them. Play along, as it were. Imagine that you’ve got to choose between sometimes being annoyed with what happens here, and not trying a therapy that’s evidence based. I’m asking you to pick the one that means you’ll sigh in frustration occasionally. And in return, I’ll do my best to frame questions well and make this a good experience of getting better.”

And then we really do see if there’s another way to see that situation.

*It says relationships. It’s 95% about marriages.

**composite, not from any of the books/writing I’m referencing in this post