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There are articles, web sites, and books galore on self esteem and the need to have it.  If you don’t, some of those articles say there are dangers that you will become depressed and anxious and in general lead a miserable life.  But what is self esteem?

The popular definition is something like, “I feel good about myself.”  It is having a confidence and satisfaction with your ability. Too often, though, we focus on the feeling good about one’s self without regard to one’s ability. Samantha Clever in an article called, “Too Much of a Good Thing” says, “In 2004, according to Jean Twenge, author of Generation Me, 70 percent of American college freshmen reported their academic ability as “above average.” But, once ego-inflated students get to college, they’re more likely to drop out, says Twenge, when their skewed sense of self and overconfidence affects their ability to make decisions.” She also cites studies about US students rating their math skills as very high while Korean kids rated their skills much lower. In test scores, the Korean students far outpaced the Americans, though the Americans felt the best about themselves.

I think that self confidence is more important than the concept of self esteem.  You earn self confidence by what you do. What you do also gives you indicators of what you can achieve, and also what you need to do to get better.  Praise for mediocre performance does not improve performance and it does not boost confidence. What it may boost is a sense of entitlement. Praise for nothing is just not believable. Similarly, affirmations do not boost performance or mood if the person does not believe the words are true for them. It may actually make them feel worse. There are brain changes as you learn and get better. You are setting up new neural pathways for the new behavior. The more you practice well and improve (and learn from the inevitable mistakes) the stronger that pathway becomes. Empty praise does not do that. Mistakes are good. They teach you.

If you want to feel better about yourself, work on what you want to get better at. Realistic praise can reinforce the improved behaviors and skills. Work in incremental steps that challenge you but are not impossible. Sometimes a little doubt that gets you motivated is a good thing.  It can even help boost your confidence when you do succeed leaving you feeling good in a realistic way.

See, Perceiving, VisionsI’m about halfway through Phantoms In the Brain, by V. S. Ramachandran, MD, PhD and Sandra Blakeslee. The early parts of the book are about phantom limbs and associated pain and how something as simple as the use of a mirror can trick the brain into turning off the pain, at least while the mirror is there.

I am in the part now about vision. There are over 30 parts of the brain that enable us to see. Alter any part in that system and vision goes awry. An artist has a stroke so slight that he doesn’t know it happened till he gets home and everything, including his paintings, are a stark black and white. Other persons cease to “see” in the left or right visual fields but are still able to perceive. When asked whether an object is horizontal or vertical, they can accurately say even though they cannot see the object and don’t know how they know. Some have their blind spot increased and miss fairly good sized chunks of the visual field. But the brain fills in the blanks. There are perceptual and conceptual parts to vision. One very interesting condition is called Charles Bonnet Syndrome in which persons with visual impairment hallucinate. One woman sees cartoons, another man sees all sorts of things including a monkey sitting on Ramachandran’s lap, but is able to intuit that the monkey is not real. James Thurber, who lost vision in one eye as a child in an accident, eventually lost the vision in his other eye but continued to “see” with the syndrome, and it most likely had an effect on his stories and cartoons. Contrary to seeing it as a handicap, some persons actually enjoy it and see it as a gift.  Most people don’t mention that they have visual hallucinations because as a culture, the west does not see that as a gift, but a problem or an illness that must be medicated.  Parts of the visual system recognize the “what” while others recognize movement as a steady flow (one woman lost that ability and now sees movement as a sort of strobe effect and cannot cross streets because she can’t tell exactly where something is), other parts add color, texture, etc.

What is amazing is the system that integrates all this and does it in real time. It also fills in the blanks. Cartoonists and other graphic artists rely on this. A few lines can enable you to see or visualize an entire picture. You can also see part of the face of a friend looking around a corner and see and recognize the whole friend. What is also amazing is that the actual field of vision that is in focus in about the size of your thumb nail when you hold your hand out from you. When we get anxious, we get tunnel vision even more. It is part of who we are to look for patterns and to fill in blanks with what we think should be there and base it on our mental map of the world and our life experiences. Sometimes that works well and sometimes works very badly. The authors say that it is almost like there are a lot of selves in us, most of whom we are not even aware, that unconsciously put all the pieces together that we act upon. I think that is a basis of Bayesian logic which seems to be at least one of the bases of the flow state. And when you become conscious that you are in a flow state, you lose that state. This seems to me to be in keeping with the Buddhist tradition of there being no self. You gain enlightenment when you realize that and let go and be.

Relativity by M. C. EscherPBS Nova Science recently did a program on how the brain works. Magic and its misdirection depends on us reacting in certain ways that have over the course of evolution, helped us survive.  For instance our eyes follow movement and we construct a reality with what we expect, and the magician depends on that for the trick to work.  The drawings of M. C. Escher similarly play upon how our minds form constructs to view what we think of as reality, but is subjective to perspective and relativity.

There is an old Zen story of a samurai who came to a master and asked the difference between heaven and hell. The master said, “How could someone as ugly as you ever have become a samurai?” The samurai was overcome with anger and was drawing his sword to kill the master when the master said, “That is hell.”  The samurai smiled as he came to realize that the hell was coming from within.  With that, the master said, “That is heaven.”

So often our feelings are determined by the stories we tell ourselves and the constructs we make.  I always think about a woman I met years ago in New York City.  She was Jewish and had escaped from Poland with her father just ahead of the advancing German army.  At the time, the Japanese were assisting with visas for those leaving.  The escape route led them across Siberia to Japan to Canada and eventually to the US.  She told me how things are all relative.  She complained then of New York winters, but in reality they were mild compared to those of Siberia.  She said you tend to forget or ignore those difficult times in the past, and lose perspective on the present.  I thought of that this past weekend as a person was complaining of how it was freezing outside.  It was 68 degrees Fahrenheit.  She was from central health.

When things are looking difficult, remember your strengths. Have you been in similar situations before? Is this really so bad that it is insurmountable?  Can you break down whatever it is into smaller more manageable pieces? Imagine how you would like the situation to be or to resolve in a positive way, and write your story to move in that positive direction. And talk to people you trust to help you with ideas, follow through and support. And they can help you maintain perspective.

I’ve been reading “The Black Hole War: My Battle with Stephen Hawking to Make the World Safe for Quantum Mechanics,” by Leonard Susskind. One particularly intriguing part is that quantum mechanics is not deterministic, which is the notion that the future can be predicted if we know enough about the present. There is a certain comfort in a belief in determinism. We see that desire in psychology; people want to be able to predict what will happen, how people will be. Years ago I read a book called “Travels With Dr. Death.”  Dr. Death was a psychiatrist who made his living as an expert witness in death penalty cases in Texas. He always testified that if the individual was not executed, the prisoner would undoubtedly kill again.  In a quantum view, that confidence in predicting the future would be unfounded.

I think the quantum mechanics model is a good model for psychology. Anyone who says they can absolutely predict behavior is just wrong.  In quantum mechanics, like weather forecasting, you can make educated guesses, but you do not have absolute accuracy. The model works well with Lambert’s four therapeutic factors theory. These factors are qualities that cut across all types of therapy and affect outcomes.  The factors are extratherapeutic, common factors, expectancy, and techniques. He said that about 40% of change in therapy is due to exratherapeutic factors – qualities of the client and of his or her environment.  That includes things that happen unexpectedly or chance life events.

The medical model is deterministic, and for medical issues it is a great fit. Diagnose the disease; give the prescribed treatment for that disease. At some point perhaps all behaviors will be reduced to the neuro-cellular level. At that point there will only be a need for neurologists. And if it ever gets to that level, who controls the ability to determine behavior will be the critical moral issue of the time. But for now the diagnoses in psychology are behavioral, not biological, and are voted upon for inclusion and change with each edition of the Diagnostic and Statistical Manual. Diagnosis is not a result of a lab test or an x-ray, but of a conversation between therapist and client, which in some cases is a very short conversation.  And the diagnosis does not determine the outcome or even necessarily the treatment.  What plays a major role in outcome is the therapeutic alliance, the common factors of Carl Rogers-like mutual respect in counseling.

This desire for forecasting is especially acute after high profile shootings in this country. After the murders at VA Tech a few years ago, the commitment laws in Virginia were changed to make hospitalization easier. (I still remember a psychology “expert” on CNN the day of the shootings before any facts were known saying that it was the result of violent video games.)  But the laws in Arizona are similar to those currently in Virginia, and Gabrielle Giffords was still shot along with others.  In all the discussions after each, one thing I never heard mentioned was the extratherapeutic factor of culture.  Individuals “go mad” in culturally prescribed ways.  In the past couple of years in China, there have been at least two instances of stabbings at schools, very in keeping with the Asian culturally prescribed “running amok.”  There is a tradition of shooting in politics in this country going back at least to the duel between Burr and Hamilton, and the fighting literal and figurative between the Hamiltonian Federalists and the Jeffersonian Democratic Republicans. Later in our history, rather than slave states going to court for nullification and secession, fire eaters forced those issues into civil war. The second amendment guarantees the right to bear arms, but also mentions a well armed militia as a necessity. What has been forgotten is that the aim of the amendment was that we all be citizen soldiers with a responsibility to defend the country, and that there be no standing army. Standing armies were seen as a threat to democracy. Generals who became president from Washington to Eisenhower warned about the role of the military in government.  At the time of the Revolution, the threat was from British regulars and Hessians. Ike warned about the military-industrial complex and allegedly an earlier draft added congress to the mix. In our time, gun play is a frequent metaphor in discourse.  The “surveyor sites” over congressional districts on a web site in question in the Giffords’ case also had a phrase to not retreat but reload. Do surveyors reload?  And it was not the first time violence occurred. The home of the brother of VA 5th district congressman Tom Perriello (who had a site over his district as well) was vandalized earlier, as was Gifford’s office. Our culture and our words set our choices of how we act. But they do not determine it. We do have choices.  Despite the violence of late, times are still less violent than the 1800s (no canings in congress or duels) or even the 1960s with assassinations and riots. The question is, when will we remember the goal of citizenship and cooperation with each other? For contrast, Israel has universal military service and Switzerland has universal military service for males. Citizens are pretty heavily armed, and yet, the homicide rates are much lower than in the United States.  Countries without universal service but with gun control, such as Great Britain and Japan, also have lower homicide rates.  Perhaps the differences are due to cultural norms and expectations.

At this point, it is not possible to absolutely predict behavior. Like on the quantum level, chance events happen and there are just too many factors affecting outcomes for any guarantee.  What is clear is that outcomes for persons diagnosed with a condition such as schizophrenia, the outcome is better in third world countries than in the industrialized West. (See books written about previously such as “Crazy Like Us.”) The difference looks to be that they work together better with each other rather than relying on drugs and other attempts at quick fixes, and stay involved with each other. They realize that they are all in this life together, and work together. When the cultural expectation is that we work together and that people can get better, that expectation has a much better chance of being met.

“We cannot live only for ourselves. A thousand fibers connect us with our fellow men; and among those fibers, as sympathetic threads, our actions run as causes, and they come back to us as effects,” said Herman Melville. But those actions and effects are sometimes unintended and unforeseen. We do the best we can, and we adapt and flow. Having the self confidence, self efficacy and positive adaptability to deal with uncertainty is a major part of coping in this life and in reducing stress, anxiety, and depression.

Yin YangI have come to believe that everything in life is a relationship.  We have relationships with ourselves, with others, and with everything in our environment. Those relationships can be healthy or unhealthy to varying degrees.  They can be intense to casual and that level changes.  Think of the yin and yang symbol.  There is a bit of yin on the yang side and a bit of yang on the yin side. Nothing is constant and absolute.

Those relationships are part of systems.  Our bodies are systems of organs and tissue and even have other organisms like bacteria that we depend on for life and that sometimes cause us illness and worse. We are in systems with family and friends and strangers and our various cultures.  Systems are parts of larger systems.  We depend on our senses to perceive the world and those systems, but our senses are incomplete. We fill in the blanks with a process called “closure.”  Think of the dots that make up pictures in newspapers.  The closer you get and the more you magnify the picture the more it becomes a series of gray scale dots. We do the same with our perceptions in every day life. What we don’t perceive, we fill in based on our experience and expectations.  A theory as to why overheard cell phone conversations are so annoying is that we are hearing only half the conversation, and our brain wants the whole. We choose our truths based on what we perceive, and what we perceive is incomplete.

Change is not only possible, it is inevitable.  The question is, how much you want to control change in your life.  That does not mean you have control over everything that happens. You do not.  Things outside our knowledge that are part of the greater system can have a great impact.  Chaos theory tells of a small event – the wind from the flapping of a butterfly’s wings – affecting the weather in another part of the world as the air molecules begin to bump and flow.  You can think of examples in economics, health, and any area of life. The flow passes through distance and time. Counterfactual history is full of the study of what-might-have-beens and what-ifs based on small choices having major and long term impacts. Where you do have control is in the choices you make. Those choices help you cope and determine how you cope.  Those choices affect your relationships. Those choices impact the systems, and then come back and affect you again.

Some years ago, I read an article about chance life events – those moments that just by chance change the course of a lifetime.  One that really stuck in my memory was that Charles Watson decided to visit some friends in California and the last address he had for them was the Spahn Ranch.  When he got there, his friends had moved on, but “Tex” decided to stay with the current residents – the Manson family – a decision that profoundly affected his life and the lives of others.  I am currently reading a book called “What If” by Robert Cowley – a collection of stories by historians about how history has been changed by chance events. But for small decisions that seemed inconsequential at the time, history would have been vastly different. This type of historical study is called “counterfactual” and often focuses on military campaigns – what if the Harold had won the Battle of Hastings or the Union at First Manassas or Germany had followed its original battle plan and quickly won the Great War.  Each could have easily happened and history would have been vastly different.  The possibilities for counterfactual examination are infinite. The same is true in our own lives.  This past weekend was Homecoming at my alma mater. I got together with the people who have been my closest friends for over 30 years now.  I could just as easily have never met them.  First I had to chose and be admitted to the college.  At the end of my freshman year I didn’t have a room mate or a dorm picked out.  I happened to bump into a friend one afternoon who suggested a specific dorm. I walked over and checked it out. Prior to that I had not ventured there and I’m not sure I even knew the names of the buildings.  So I put on my application for housing I wanted to be there. It was chance that I actually was assigned there and chance that I was put on the hall where I was.  On that hall I met a group of friends that I have kept to this day. I discovered this weekend that the friend who made the suggestion died this past summer without ever knowing what impact that chance conversation that spring afternoon long ago had on my life.

Every moment in our lives impacts what is to come. We can choose how to live those moments, they are all we have.  We can be mindful of the future and remember the past but the evanescent now is all we have.  For living, in the words of Ram Dass, “Be here how!”


The peak age for physical activity – participation in sports, working out, etc. – in America is thirteen years old. After that, people start to slack off.  We run less, we bike less, we swim less, and we play less.  With our lack of motion coupled with our fast food diet, is it any wonder that obesity, diabetes and other diseases are becoming epidemic and that healthcare costs are skyrocketing? When asked, people give a variety of reasons for not working out. “I don’t have time.” “I’m too tired.”  They may already have pain from illness or injury. They may have bad memories of physical education classes in school.  The cost to belong to a gym is too much. They are embarrassed by how they look.  Even if they do get moving, the motivation may not last.  Treadmills become boring.  Muscle soreness sets in.  People start too fast and burn out or get injured. There are as many reasons not to follow through as there are people.

There are many reasons to stay active. On the physical side, there are the benefits of increased endurance, improved sleep, improved blood pressure, improved muscle tone, stronger bones, reduced body fat, improved balance, improved sex, more sociability, reduced risk of disease, etc. There are psychological benefits to being fit as well. When your body is fit, you feel better mentally and emotionally as well.  Self-confidence increases, self-discipline increases, cognitive abilities improve, and your sense of well-being increases.  Other benefits include reduced stress, and exercise has been proven to work as well to lessen depression and anxiety as medication. Physicians in the United Kingdom today write prescriptions for exercise for individuals experiencing mild depression.  Studies from Germany to the United States have found the benefits of exercise for mental health, particularly in dealing with depression.

I think that some of the laws of physics also apply to our behavior. An object at rest tends to remain at rest unless acted upon by some outside force.  It is difficult to get going when you are not feeling well to begin with. These days we all too often seek instant gratification and results. Anything less is abandoned.  If you do get going and then go out and overdo it, you do get a quick result of muscle soreness and even exhaustion. The goal is to pace yourself, be patient, and I think most importantly, do something you love.

The late John Wooden was one of the best coaches of all time. He is a legend for his UCLA teams that kept on winning NCAA basketball titles.  Oddly enough, Wooden did not urge his teams to win. He taught his players to play their best, to care about each other, and to care about the game.  There were times he would be upset after a win and the team did not play its best, and times when he would praise the team after a loss in which they gave their best effort. Olympic distance running coach Joe Vigil also talks about character for athletes at all levels of ability. He defines character as consisting of compassion, courage, challenging yourself, and making the journey of life a good and joyful one.

The first step then is to make a commitment to act.  Sharing this commitment with others is a good idea. We are social beings, and the support we get from others and that we give to others makes all the difference. Find an activity that brings you joy. Again, having a group can help you stick to your goal. Another tool can be social networking online. There are sites where you can set goals, track your progress, and get support and feedback from others.  One goal setting site is  The second K in Stickk is shorthand for contract. Stickk is a contract commitment and has a four step process. First you set your goal. There are ready made goals, such as “exercise regularly” or you can customize your own goal. Second, you set your stakes. Stakes are reputation and financial outcomes of how well you do.  For instance, you can specify an amount of money to go to a charity you like or to a group you really dislike, which Stickk calls “anti-charities.” The web site has a listing of both. Making an anti-charity a stake can increase your motivation.  If you meet your goal, you donate nothing. If you do not, the money you put up goes where you specified.  For example, a Republican could have the Clinton Library as an anti-charity and a Democrat could have the George W. Bush Library as an anti-charity.  Third, you add a referee to track your progress. The fourth step is adding friends for support.  Stickk also has communities of people with similar goals you can whom you can also build a network of friends.  Use of the site itself is free.

Other sites let you track progress in specific activities. and are two examples. In each you map out your routes and record your run or your bike ride.  The sites calculate your calories burned, your pace, and allow you to post to your social networking community. Add a heart rate monitor and GPS and you can get moment to moment feedback on your workout. A similar site for weight loss is Traineo has diet, exercise, and motivation tips and a community of other people trying to lose weight.  Kaiser Permanente Center for Health Research recently studied the use of an Internet based weight loss and maintenance program and found that those who continued to log on and track their progress for the two year follow up were the most successful at maintaining weight loss. The researchers recommended you look for the following in web based programs:

  • Sites that encourage accountability by asking users to consistently record weight, exercise, and calories consumed
  • Sites that include tailored or personalized information
  • Sites with interactive features that allow users to communicate with each other and with nutrition and exercise experts
  • Sites with accurate health information.

Take the first step in feeling better physical, mentally and emotionally. Get moving. As Coach Wooden said, “Failure to act is often the biggest failure of all.”

I’ve read a number of amazingly good books this summer, and somehow despite the different topics, they all have things in common.

The first is called “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America” by Robert Whitaker.  Whitaker looks at historical data and finds that mental illness didn’t always carry the lifelong “you will never get better” prognosis that it has for some time now in the US. Granted there is the current “recovery” movement in the US but as one individual he interviewed said, you are still a patient and you are still expected to do as told.  It wasn’t always so. People actually used to get better and the diagnosis of “bipolar” was almost unheard of. For years, studies have found that people diagnosed with mental illness in the third world have had better outcomes than those in the industrialized West.  Years after first becoming ill they are more likely to be living at home and working and functioning in their communities than those with Western medicine. Whitaker looks at causes and again follows the data. The definition of what constitutes mental illness has steadily expanded over the years. He also looks at the validity and reliability of diagnoses and finds them lacking. This has many ramifications including whether you will later be able to get insurance because somewhere along the way you got a diagnosis that raises red flags with insurance companies. He also looks at medication and finds that it can actually make things worse in the long run.  It is hard to trust the research on medication anyway these days with the ties between cash starved universities and pharmaceutical companies which allegedly ghost write studies in professors’ and physicians’ names and the studies are run by the marketing departments rather than R&D. Whitaker also looks that alliances that perpetuate myths such as “mental illness is an imbalance of brain chemistry” when the studies actually show that this is not the case. He looks at treatment models that work well in places such as Finland, and he also looks at how children at ever younger ages are being diagnosed and put on medications and the outcomes of that.  In short, this is a must read for anyone involved in any way with the mental health system – which with the ever expanding disability rolls based on “mental illness” and the associated variety of costs that means everybody needs to read this book and be well informed.  There are several books which would be good companion reads with this book.  First is “Crazy Like Us: The Globalization of the American Psyche” by  Ethan Watters. Watters looks at several scenarios as to how we are expanding the epidemic in our image on a global scale from anorexia in Hong Kong to our notion of PTSD to how depression was “introduced” into Japan by a drug company looking to expand its market for its anti-depressant. I like the cultural aspects of the book. Watters also looks historically at “diagnosis” in America and how even the “illnesses” themselves have changed over the years. He posits that each culture in its time has a “pool of behaviors” that individuals draw from when they are distressed. That pool of behaviors and how the culture responds to them is our system of “mental illness.”  A couple of older books – “Models of Madness – Psychological, Social, and Biological Approaches to Schizophrenia” edited by John Read, Loren Mosher, and Richard Bentall explore the history of how schizophrenia came to be a diagnosis (as does Whitaker in his book) and the different methods of treatment. Mosher is noted for the Soteria project and the social model. Research in this book also finds that the medicalization of mental health problems has actually increased stigma rather than lessen it. The Whitaker book tells a bit about how the Soteria project and Dr. Mosher were treated by the medical model proponents. Lastly, “Escape From Babel” by Scott Miller, Barry Duncan, and Mark Hubble is an older read but still worthwhile and one that also looks at what works in therapy and proposes a unified way of working in the mental health field – one based on outcomes rather than dogma.

“Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen” by Christopher McDougall started with McDougall trying to find a way to run that didn’t hurt. He found two discoveries. First was that form matters and he learned the Evolution running method. Second he found that modern scientific running shoes cause problems with your form and therefore with your body.  He looks at the history and marketing techniques of Nike. Who knew that the higher priced and more padded the shoe, the more likely one is to be injured.  Apparently the marketing departments of running shoe companies have a similar effect on research and development as on the pharmaceutical companies. Caveat emptor in the free market.  Try to find good evidence (not always easy) and follow it. The support and padding weakens the foot and encourages heel striking which is not in keeping with how your body’s natural shock absorption works according to what McDougall found. Along the way we learn about a tribe in Africa that can still hunt by running and exhausting the prey and anthropologists who theorize that homo sapiens was able to outlast Neanderthals because of our running ability.  We meet an amazing cast of ultra-marathon characters including Scott Jurek and Cabello Blanco, who is an amazing story by himself, and the Tarahumara Indians of the Copper Canyon in Mexico. The race referred to is between the Indians and the American runners and embodies the best of sportsmanship and running out of love for the sport.  What does “Born to Run” have to do with psychology? Whitaker points out in his book that exercise can have the same positive effect on alleviating depression as therapy and/or medication.  Physicians in Germany can write prescriptions for exercise for those who present depressed. (You can find some evidence based practice on foot strike and running barefoot or shod at

“In Pursuit of Silence: Listening for Meaning in a World of Noise” by George Prochnik starts in Brooklyn and takes us all the way to Gallaudet University. We learn about boom cars, noise maps, and soundscaping as well as marketing based on sound.  He looks at the evolution of hearing in humans and how it has helped us survive.  He found a tribe in Africa which has no guns or drums and two individuals standing facing away from each other can carry on a conversation in a normal tone of voice though they are a football field apart. The noise of our industrial culture has taken a toll on our hearing. (I read today about a local group getting money to educate youth on the difference between energy drinks with and without alcohol looking to lessen the use of the alcohol drinks. When youth are taught that playing iPods at high levels with earphone can damage their hearing, they crank up the volume. I expect the same results with this project.) Noise can both cause and lessen pain. Sounds can change our moods.  Sound can damage our physical and emotional health or help with healing. Even those who cannot hear have a sense of sound and a unique culture, especially in terms of the relationship of the conversation. Among the sounds we have the most positive feelings for are the laughter of a baby and water sounds such as rain and streams. Among the most distressing sounds are metal scraping on glass, the scream of a woman, and the crying of a baby.  He visits schools in New York. In the public school with kids from a poorer neighborhood, they did not have a sense of quiet that was positive.  Silence happened when there was loss, sometimes violent in nature. That was quite a contrast to the experience at a Society of Friends school.  He also cites some research that suggests that children raised in a noisy environment are more prone to autism. As they develop, the noise slows down their capacity to process language.  He also tells the story of Julia Marnett Rice, the “Queen of Silence” of New York City who investigated the noise of the tugboats on the Hudson River back over a century ago. She found that even on clear nights the captains blasted their horns a total of over 1,100 times a night. And when asked, most of the time it was just saying hello to other captains or to call in drunken crews from saloons or to “send signals to servant girls cloistered in houses along Riverside Drive.” Not only were people living along the river unable to sleep, the whistles were useless for their intended purpose of signaling and safety. She got changes made. Ultimately, however, the war on noise goes on and on and is doomed, like other wars on behaviors.  What Prochnik concludes is that our efforts would be better spent increasing the number and availability of quiet and peaceful places.

I started the summer with a couple of books that encourage critical thinking. The first is “Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives”, by Michael Specter. Specter examined how people tend to put their beliefs and ideology over the rational pursuit of factual knowledge. “Voodoo Histories: The Role of the Conspiracy Theory in Shaping Modern History” by David Aaronovitch is in a similar though less rigorous vein. The latter does look at how we seem to be driven as a species to tell stories. The facts are often optional and we look for what we want to see. When someone is given absolute evidence that what they believe is false, they typically dig in deeper with the belief.

The last book I want to talk about is one of the most thoughtful and thought provoking books I have read in a long time. It is called “A Tear at the Edge of Creation: A Radical New Vision for Life in an Imperfect Universe” by Marcelo Gleiser. It is part journal of his life journey and part physics theory. The theory is in terms that are easy to understand.  There is a problem in physics in that relativity theory (which covers the “big”) and quantum mechanics (which covers the “small”) are not always compatible. For a long long time scientists have tried to find the grand unifying principle, the “theory of everything.” Gleiser’s vision is that there is no theory of everything, and that imperfection is all right and just the way things are. Life is just as grand and meaningful – maybe even more so because of just how special it is. It is okay not to be perfect.

The common theme is to look for evidence including things that are at odds with what you believe and consider that evidence. And when it comes to change, it works better to work towards positive change rather than control.

Assay and Lambert (1999) listed the factors that account for change in therapy as 15% due to model or technique (techniques such as cognitive behavioral therapy, solution focused therapy, etc.), 15% due to placebo/hope/expectancy, 30% due to the therapeutic relationship, and 40% due to client/extra-therapeutic factors. The last factor is what happens outside therapy, like finding a job you like, making contact with an old friend – any life event outside counseling that has an impact on you.

I think it is very important to take these factors into account when you consider entering therapy.  We don’t have much control over unexpected life events, but we do have control of the other factors. Therapists tend to be believers in specific theories of behavior and how that theory’s techniques elicit change.  This starts, if it hasn’t already for the person, in graduate school where students are urged to learn theories and to have an allegiance with one.  When Virginia had an oral exam as part of the licensing process for counselors, you provided a case study and presented it in terms of your psychological theory and its techniques.  Study after study has shown that various techniques show about the same effect. I have discussed Project Match previously.  In a tightly controlled study, cognitive behavioral therapy, motivational enhancement therapy, and twelve step recovery therapy were compared and were found to be about equal in the changes that participants made.  What matters is the relationship between the client and the therapist. The Session Rating Scale can help track that once therapy has begun, but what about before?

If you are considering therapy, I encourage you to contact several providers and do a brief screening.  Ask what the person’s theory is and how that plays into the relationship with the individuals that he or she sees for counseling. Ask whether the person will be the expert in the session or if you will be. You can also get an idea of your comfort level with the person before you commit.  Does the person provide therapy in a way that you feel comfortable with and that you believe will help you change? Do you feel understood and listened to?

Therapy works.  No therapist is a good fit for every individual, however.  It is similar to coaching styles.  A person may respond really well to one coach, but not so well to a coach with a different style.  That other coach may work very well with someone else who does not respond to the first coach. The same is true with therapists.  Taking control for yourself in selecting a therapist is a good step in taking control of your life.

I have been using the CDOI measures in my practice for several years now and have found them extremely useful to help people meet goals and get better and also to help me get better as a counselor.  The Outcome Rating Scale is a measure of how the person is doing and the Session Rating Scale is a measure of the therapeutic alliance.  It does not matter what therapy model a counselor uses, the measures are a help and an aid to change.  I think it can best be described by Scott Miller and Barry Duncan:

The web site Barry is referring to is the Heart and Soul of Change Project.

If you are a person thinking of getting counseling, you may want to consider seeking out someone who uses these measures. There is a directory at the Heart and Soul of Change website which you can access here.

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