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The Game Of Rescue: BE Careful, You May Become A Victim.

Offering to help someone who is in need of assistance just seems like the right thing to do. We’ve all had the opportunity to lend a helping hand, or go out of our way for a friend, relative or even a total stranger. The scene, more than twenty-five years ago, of that fireman diving into the freezing waters of the Potomac River to save victims of a passenger jet that crashed while taking off from National Airport during an ice storm lingers in my mind. We praise the heroic actions of first responders who risk everything to save total strangers. So, when someone who is familiar to you asks for help would you rush to assist them and do whatever is required? We’ve heard it said: ‘A friend is a friend – no matter what!” What if that “friend” is engaged in a behavior that violates the law or, your moral judgment. What if their behavior is, in some way, pathological? In those cases, helping that individual might wind up jeopardizing you. Your intentions were honorable but you wound up in trouble or having a major problem!

The complexities of our interactions became the focus of a theoretic formulation known as Transactional Analysis. TA is a method of analyzing and understanding communications and interactions ( transactions) between individuals. The goal of TA is to eliminate dysfunctional behaviors and develop effective coping strategies in our relationships. Clients learn to identify disruptive interactions and replace them with direct, Adult – Adult, communications.

Eric Berne developed the concepts of TA after extensive study and training in traditional therapy and the practice of psychiatry and psychology. He suggested that we develop “life scripts” early in our development that influence how each individual chooses to live and behave. The role of therapeutic intervention would be to “re-write” destructive and self-limiting script messages.

As a result of problematic script messages and learned styles of interacting, Berne noted that we develop dysfunctional patterns – called Games – in which we intend to gain positive “strokes” but actually reinforce negative feelings. Further, Games can be a way of interacting while avoiding intimacy (intimacy here defined as revealing the “real self” to others). Take, for example, the game of “Psychiatry.” You meet someone at a party. He is quite engaging and asks many questions about you. He seems interested in you and appears to be a good listener. However, when the conversation ends, you realize that he has revealed nohting of himself – thus avoiding intimacy. A second example is a game called “General Motors.” Same party: a bunch of guys stand around talking about the virtues and limits of Camaros and Corvettes. In the end, after a discussion of camshafts, transmissions and engine displacement, they part knowing nothing about each other. They interacted, but easily and skillfully avoided any personal knowledge of one another.

You may have heard the saying: “No good turn goes unpunished.” If we offer to help someone who has not requested it, we force them into the role of a “Victim.” They can easily turn and become hostile toward us, shifting from “Victim” to “Persecutor.” Claude Steiner points out that we are encouraged to be selfless, generous and cooperative with people, even if they are deceitful, selfish, stingy and uncooperative with us. Engaging in this type of interaction is guaranteed to take us from the position of “Rescuer” to the “Victim” position while the so-called “Victim” becomes the “Persecutor.”

In the game of “Rescue,” the Rescuer (that’s you) views that problematic, needy person as the “Victim” and thinks: I’ll save you!” As the paradigm progresses, the “Rescuer” becomes the “Victim” and the “Victim” becomes the “Persecutor.” Let’s look at a real life example.
rescue triangle

Archie (not his real name), a recovering alcoholic, was planning to go out on New Years’ Eve. He had tickets to a fancy gala and had rented a tuxedo. His date lived some distance away and he had planned to leave his house no later than six o’clock.

Early in the afternoon, he received a call from Edith(not her real name) whom he had met at a meeting of Alcoholics Anonymous. She was “in a jam” and asked if she could borrow his car for a brief errand. Archie quickly agreed (boosting his own ego and self esteem) and told her to return the vehicle by 4 o’clock . “No problem,” she replied, as Archie watched his washed and freshly waxed car roll out of the driveway.

Of course, 4 o’clock came and went with no sign of Edith. By 5 o’clock Archie, agitated and concerned, started calling some of Edith’s favorite haunts (bars). He located her at a neighborhood pub and asked her to bring the car back immediately – she (now drunk) hung up on him. Furious, he called the police and reported the car stolen. He told them where the vehicle could be found and the police went to the bar to confront Edith.

When they arrived, Edith told them that Archie had assaulted her and she had “fled for her life!” She filed assault charges against Archie and the police arrested him! Archie spent the evening at the police station, in his tuxedo. By the time he had arranged bail and was released, it was too late to go out- Happy New Year, Archie! The “Rescuer” had become the “Victim” and the “Victim” had become the “Persecutor.”

There are countless examples of this paradigm: the house guest who never left; the loan that was never repaid. However, the key to avoiding the game of Rescue is to carefully analyze whether the alleged “Victim” is really a victim; or have they created their own problem. After all, we are each responsible for our own behaviors. What is the “payoff” for you as the “Rescuer?” If you can understand your own motivation and can take an objective look at the so-called victim, you may discover your own co-dependency or realize that you are “enabling” the pathology of the other person.

About the author: Charlie

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Dream a Little Dream

It is common practice in psychoanalysis for the patient to report the content of dreams as part of treatment. Sigmund Freud believed that dreams were a window into the unconscious mind. Therefor, by understanding and interpreting the content of dreams the patient would reveal thoughts and images that would possibly clarify current or past experiences, feelings and actions.

Dream analysis, once in vogue for both patients and doctors, has given way to what is termed cognitive-behavioral therapy, or CBT. A CBT approach to treatment might view dream content as random neural activity. However, if one considers the complexity of our dreams and the fact that there are repetitive themes and images,frankly, that hardly seems “random.” CBT examines cognition,our manner of thinking about issues. It also evaluates and treats behavioral concerns, like nail biting, smoking or other compulsive behaviors. Dream analysis is more within the realm of psychotherapeutic approaches that incorporate a deeper analysis of the complex developmental issues, or psychodynamics, which are the causal basis of personality and cognitive concerns.

The dream is divided into two components. The first level of analysis is the manifest content ( which is the actual experience of the dream). “I was driving my car down a mountain road and I had no brakes!” The second level is the latent content of the dream,( what the dream really means). In this case it might be a feeling of loss of control or an inability to control something. We dream in symbols. If we identify certain people in the dream that image could be a “stand-in” for someone else. Dreaming about snow could represent depression or a desire to “cover up” something or jus a pleasant memory of childhood.. So, how do we know the “correct” interpretation? The symbolic items in the dream can be better understood if interpreted within the context of that particular person. Freud suggested that we dream in symbols to “protect” our sleep. If we see through the symbolic process it can cause anxiety and would awaken us, possibly identified as a nightmare.

Dreams can be viewed as the dreamer’s attempt to “work through” or resolve some conflict that they are experiencing in reality. Another aspect of the dream is “wish fulfillment.” Within a dream one can see themselves mastering a task or problem. Apparently, we experience dreaming several times on most nights, even if we do not recall the experience. However, some medications can interfere with neurological function and inhibit dreaming. Interestingly, we seem to have a need to dream.In a classic study people were awakened as they began to dream.It was easy to identify the dream state since dreams are accompanied by rapid eye movements that can be identified and recorded. This procedure occurred for several days. Finally when the subjects were allowed to sleep, their number and frequency of dreams increased. Deprived of dreams, people began to dream more; possibly to make up for the deficit. Dream deprivation increases dreaming when subjects are permitted to have normal sleep.

Finally, dreaming is the only time that we can really “time travel.” One can be a young child in the dream and instantly become a teen or young adult. While the meanings in dreams may be elusive, they can provide meaningful thoughts and ideas that can help the patient to overcome the challenges and the demands of life that have brought them to treatment.

The Columbia Counseling Center offers an eclectic and integrated approach to treatment. The doctors on our staff are trained in the use of multiple techniques and strategies to relieve anxiety, improve mood and effectively modify coping strategies.

You can call 410 992 1949 for the first available appointment.

The Serotonin – Depression Connection

Recent articles( such as this piece from psychcentral.com have posited the notion that serotonin is not a significant component of the depressive process .Further, that drug companies, having developed serotonin enhancing medicines, began an advertising campaign to “convince” the public that serotonin was the “cure” for depression.The idea that drug companies would conspire to mislead the public is quite questionable ( although I do enjoy a good conspiracy theory). One of the problems is that we cannot measure serotonin in the brain directly. Further, if we manipulate serotonin with an SSRI (selective serotonin re-uptake inhibitor), this also disturbs the balance of norepinephrine and dopamine- two of the major neurotransmitters. Now, it is really more complicated than this. There are many sub-types of each of these substances so it is not a simple matter of manipulating one of these chemicals.There are also many sub-types of receptor sites in the brain. The more we learn about the chemistry and structure of the brain, the more complicated it becomes.

The data from numerous studies indicates that psychotropic medications may only work about 50% of the time. In addition, psychiatrists may have to try a number of different medications in order to gain a positive effect. Of course, patient compliance is always a problem. It is not a good idea to wash your Prozac down with scotch whiskey – but I have had a number of patients who have done just that!

Michael Greger points out that diet ( whole food plant based nutrition) and exercise may be just as effective as some anti-depressants. While there is merit to this assertion, trying to get a depressed patient to exercise and eat properly is quite challenging – to say the least! It is my impression that “comfort foods” carbohydrates, potatoes, bread, mac and cheese act as “comfort foods” because they do, in fact, raise serotonin levels along with a number of other “calming” chemicals (such as tryptophan) that do cross the blood-brain barrier. Unfortunately, a bag of potato chips only increases serotonin levels for a couple of hours.

It does appear that cortisol is a precipitating chemical in the depressive process and influences a decrease in certain neurotransmitters. Indeed, being in a stressful situation for two to six weeks can trigger a depressive episode. This is chemistry, not “psychological” weakness. The notion that neurotransmitters are the causal factors in the depressive process is strengthened by the apparent genetic relationships within families. If we examine the family of origin of a depressed patient we will find both genetic and psychogenic factors that contribute to the depressive process. Further, it is interesting to note that if a particular antidepressant medication is effective for a “blood relative” ( biological parent or sibling) there is a high probability that the medicine will be effective for the patient.

The “holy grail” of treatment for depression will not be easily discerned. Light therapy can be effective. Likewise, trans-cranial stimulation shows promise. Various approaches in psychotherapy can be quite effective. However, anti-depressant medicines will continue to be a major component of treatment.Columbia Counseling Center’s integrated treatment protocol carefully evaluates the multiple causal factors in depression and provides both pharmacological and psychotherapeutic approaches for maximum effective treatment of depression.
Call 410 992 9149 for the next available appointment.

The Most Powerful Treatment for Depression

The title of this 2008 study says it all: “Faster remission of chronic depression with combined psychotherapy and medication than with each therapy alone”. The study of over 650 patients with depression compared medication treatment alone to medication treatment plus psychotherapy. The results were clear: patients on medication and therapy recovered from chronic (meaning repeated episodes of) depression faster than patients on either treatment alone.

Many studies over the years have identified both cognitive-behavioral therapy and interpersonal psychotherapy as being just as effective as medication in reducing symptoms of moderate depression. Other studies have shown that the improvements gained in therapy alone can last longer than the improvements gained from medication alone.

In my opinion, it’s the minority of cases that improve on just medication. The job of antidepressant medicine is to reduce the most immediate and troubling symptoms that interfere with your ability to function at home, at work, and socially: low energy, loss of interests, poor concentration, crying spells, hopelessness, and suicidal thoughts. The job of therapy is to identify the life issues that have led to depression and make changes in how you deal with those issues so they stop depressing you.

Therefore, we have two powerful and effective tools to treat depression. Use them together and you are likely to get the fastest and most enduring relief from your symptoms. At Columbia Counseling Center, the psychiatrists and therapists are all under one roof and we work with each other to ensure that your treatment is coordinated and efficient.

Written by: Dennis Glick, M.D. Board Certified Psychiatrist at The Columbia Counseling Center

Generalized Anxiety Disorder (GAD) is a common and recurring condition. Typical symptoms include near-daily worry, anxiety, tension, feeling on edge, irritability, and sleep disturbance. Features of panic attacks and/or social anxiety may also be present. Your primary care doctor may have already ruled out medical causes such as thyroid, electrolyte, cardiac, or nutritional abnormalities.

Cognitive-behavioral therapy (CBT) is a very effective form of treatment, typically requiring 6 to 12 weekly sessions that may include the use of workbooks and homework. The SSRI and SNRI antidepressant medications (Prozac, Paxil, Zoloft, Celexa, Lexapro, Effexor, Cymbalta, and Pristiq) are highly effective and should be continued for a period of 6 to 12 months following symptom reduction. Benzodiazepines such as Xanax, Ativan, and Klonopin are best used on a temporary basis due to the risks of addiction, memory impairment, physical incoordination, and potentially endangering combinations with alcohol and pain killers. Other medicines such as Buspar, Vistaril, Gabapentin, and Seroquel are occasionally used but are not specifically approved for treatment of GAD.

Many patients will benefit from the combination of CBT and medication. The Columbia Counseling Center is uniquely able to provide coordinated treatment as our staff includes both psychiatrists and psychologists specifically trained to diagnose and treat GAD and other anxiety and mood disorders. Your clinicians work together to ensure you are receiving the most effective treatments for your condition.

Conflict Resolution vs Separation

By Dr. Susan Minsky

Couples often believe the easiest solution to frequent arguments that appear unresolvable is to threaten separation and divorce. Divorce is the last choice to resolve what initially may appear as unreconcilable differences. Marriages require the willingness on both parties to rebalance needs, expectations, hopes, on a consistent basis at various stress points and change which occur throughout a long term relationship. Clear, direct communication, hearing each other in an accurate manner is necessary to produce effective changes for both parties. Couples often require refresher courses and new skills to promote a growth oriented exchange during stressful times, in particular.

Come join the Columbia Counseling Center team who provide an integrated approach to promoting and strengthening the bonds between partners in relationships. Individual and couples therapy are offered simultaneously to promote more rapid and productive identification of issues that require resolution to enhance the lost intimacy and positive communication and interaction between partners.

 

 



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