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The ‘Rules’ of Psychotherapy

The ‘Rules’ of Psychotherapy

When Julia first appeared in my office, she was approaching her 35th birthday. She had resolved it would be her last.

A hard-working surgeon at a nearby hospital, Julia endured a monastic, grueling existence even in the best of times. Then a deep depression struck. Soon it had shut out all remnants of pleasure, robbing her nights of sleep and locking her features into a mask of anguish. She began to think about suicide. Finally, a colleague of hers insisted she seek help.

From the start of therapy, and despite her weariness, Julia mustered the determination to protest what she called the “rules of therapy” — especially the notion that I would not disclose personal information about myself during her treatment. She’d manage a faint, defiant smile and rattle off interrogations: “Don’t you get bored listening to us mental patients?” “You’re holding your head in your hand — do you have a headache?” “Do you have children? How many?”


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The Dharma of Insomnia


by Dan Rubin

Good Morning!  In the Shambhala Buddhist tradition, we say “good morning” at any time of day.

“Good morning” expresses the cheerful confidence that wakefulness is always available. It is a reminder that we are basically good, and that it is good that we can wake up, and any time is a good time for spiritual awakeningI didn’t always believe this to be true, because I suffer from insomnia.

For a long time, I felt very strongly that being awake with insomnia at 3:00 a.m. was not a good time for spiritual awaking, or, really, awakening of any kind. It was not a good time for anything at all, except for going back to sleep as quickly as possible.

But something happened late one night that changed my mind, and insomnia has since become a beloved friend and an invaluable reminder of that any time truly is a good time to practice being awake.

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Psychotherapy Works, So Why Not Try It?

By John M. Grohol, Psy.D.

In honor of National Psychotherapy Day, I must beat the drum for one of the best known forms of treatment for virtually any mental illness or mental health concern — psychotherapy.

It’s a drum I’ve happily been beating since I went to grad school in the early 1990s. There I learned about the decades’ worth of research into the effectiveness of psychotherapy for virtually any disorder. Since then, I’ve been telling anyone who will listen — psychotherapy works!

And now with the implementation of the mental health parity act and the Affordable Care Act, psychotherapy will become even more affordable to anyone who wants to give it a try. So why not try it?

Psychotherapy is suffering a decline in usage in the past decade. Yet the research tells us psychotherapy is often more effective than medications in helping patients relieve the symptoms of common mental disorders, like depressionanxiety and bipolar disorder.

As Horvath (2013) wrote earlier this year, there is no question whether psychotherapy is effective or not: “The impact of the first meta-analysis, and those that followed, was multidirectional and far-reaching. To a large extent, the question whether psychotherapy — as such — is effective is no longer debated.” Put simply — it works.

Too often today, people first turn to a medication, and then to psychotherapy. What I argued back in 2008 is still true today — psychotherapy goes along with medication. Always. For virtually every disorder, and every individual, psychotherapy will enhance and speed up the process of recovery and healing from mental illness.

Forgo psychotherapy, and you’re getting half the treatment effectiveness, which will more often than not take twice as long. I’m not just make this up… Glick (2004) cites multiple studies that clearly demonstrate psychotherapy’s value in conjunction with medication: “The Barlow et al. study on panic disorder [for instance] showed that following drug alone, about 85 percent of patients relapsed, but only 15 relapsed when they had psychotherapy plus drug.”

Psychotherapy works as a first-line treatment for many common mental disorders, including most forms of depression. Psychotherapy is effective and time-limited when wielded by an experienced therapist.

But it’s important to find the right therapist — one you can form a good, professional working relationship with. In the field, they call this forming a strong therapeutic alliance. And in such relationships, you’ll find good patient outcomes according to Horvath (2013): “One of the most important research finding is that alliance, measured as early as between the third and fifth session, is a reliable prognosticator of therapy outcome.”

Just like you may not find the right contractor when you go to build a deck on the back of your house, or the right hair stylist when you go to get a haircut, you may not find the right therapist on your first try. It’s important to recognize that the therapist works for you — so it is in your best interests to find one you feel comfortable with and helps you bring about changes in your life and thinking.

In short, psychotherapy works. So why not try it?

This post is written in honor of National Psychotherapy Day, “a day when clinicians, clients, and therapy advocates will unite to promote the profession, fight stigma, educate the public, and draw attention to the needs of community mental health.” I hope you’ll join us!


Horvath, AO. (2013). You can’t step into the same river twice, but you can stub your toes on the same rock: Psychotherapy outcome from a 50-year perspective. Psychotherapy, 50, 25-32.

Glick, ID. (2004). Adding Psychotherapy to Pharmacotherapy: Data, Benefits, and Guidelines for Integration. American Journal of Psychotherapy, 58, 186-208.

The value of your life…

Living in the Grey Space

by Lauren Suval

Living in the Grey SpaceEach time you stay present with fear and uncertainty, you’re letting go of a habitual way of finding security and comfort.
~ Pema Chodron

I can’t exactly pinpoint where this is from, but I do remember recently reading that, sometimes, we have to learn to live in the “grey space.” Those words resonated very deeply and transcended into one of those ‘aha’ moments that crystallized a particular truth.

Life is composed of changes and unknowns through and through; we can’t ever truly predict what will come our way in the years ahead.

And now, zoom in on a transitional period (such as graduating from college, being in between jobs or relationships, or just deciding exactly what it is that you want), and the grey space never appears quite as bold and present. (Trust me; I’ve had my share of moments where stress mode ensued.)

Since this realization can induce fear or acceptance, I choose acceptance. I choose to embrace this anti-black and white area of being, and I’ve found other writers who have taken that road as well.

Erin Smith discusses her experience of being at a crossroads: “I was unhappy with my job, no longer wanted to be living at home, I was tired of being three states away from my boyfriend, and I was sick of feeling unfulfilled,” she said. She felt stuck in a state of limbo, waiting for an alternative path to appear and lead the way — until she realized that she had to be the catalyst for change herself. In one of her college courses, she was taught to see uncertainty via a different lens.

“We often interpret the unknown as bad or scary, but it is all in the viewer’s perception,” Smith said. “Just as you can choose to see the glass half full instead of empty, you can choose to view the future as brimming with possibilities instead of emptiness. I still have frequentpanic attacks in which I fear that I am unemployable and worry that I will not find a job; however, that is when I breathe and remind myself of how much I accomplished already.”

Leigh Fortson, author of Embrace, Release, Heal talked about living with uncertainty in a 2011 Psychology Today post. She talks about how she’s been situated in the ‘house of uncertainty’ time and time again, due to her rollercoaster ride of medical issues, including three cancer diagnoses. “The house of uncertainty is typically dark, imploding and cold,” she writes. “It’s frightening to be there. But when there are no quick and definitive answers, uncertainty is where we often find ourselves.”

For Fortson, being more mindful of beauty and fostering love aids her unsettling emotional tendencies. She deliberately pauses to notice the light on the clouds or the beautiful growth of her children. When she basks in beauty and love, uncertainty isn’t as daunting. It just is; it becomes her home, comfortable and livable.

Living in grey space might promote feelings of restlessness, or even the temptation to go down comparison lane, noting how all your friends or acquaintances ‘have it together.’ But, I’m realizing that it’s okay not to know what’s on the horizon. Thought Catalog blogger Kovie Biakolo said: “When you’re a twenty-something, it’s a period of figuring out everything. But now, more than ever, when our responsibilities and obligations are for many of us, mostly to ourselves, maybe it’s a good time to learn how to just be.”

Oh, let it be. I think The Beatles might know a thing or two about that.


The 5 Stages of Intimacy in a Relationship


The 5 Stages of Intimacy in a RelationshipThis guest article from YourTango was written by Zoe Hicks.

I want to preface this by saying that although there are no typical couples, there do tend to be intimacy stages in a relationship. Within the grief process, according to the Kübler-Ross model, we have denial, anger, bargaining, depression, and acceptance.

These stages do not always happen in this particular order. We may have anger, then denial, then acceptance, then bargaining, and then depression — then circling back around to acceptance. Grief and intimacy seem to be made of the same fabric — the intensity, the dullness, the gains, and the loss all mirror one another.

So without further ado, I bring you my five stages of intimacy in a relationship.


The 5 Stages of Intimacy

1. Infatuation.

“OMG, I just met the love of my life.” “He is perfect. I want to marry him.” “I can’t believe we have so much in common.” “He is great in bed.” “I cannot wait to see him again.” “Oh I should eat something. I am going to vomit.”

Oh, the sweet, syrupy stage of infatuation. It’s so wonderful and so difficult to resist. Hormones and logic rarely coincide, so we find ourselves doing things like checking email 12-24 times an hour, not eating, going to get our nails done at midnight, buying pajamas to match our bedsheets…

Infatuation makes your dopamine levels soar, producing a full-body euphoria that causes humans to seek out sex again and again. To wit, brain scan studies show that the brain duringorgasm is 95 percent the same as the brain on heroin. Your brain cannot, biologically, maintain the high of infatuation: You will fry.

The infatuation will ebb and flow at different points. The sex will not always be that good … it may get better, or it may get worse. But all those lovely feelings of that first initial swim in the cool crisp pond of falling in love: How many movies could we watch about that? Billions. It’s pure poetry. Love magnified; a revisit to the warm womb of security. Then, the negotiation between security and autonomy, that life-long struggle, crawls in and we begin to land.

2. Landing.

The landing from that fantastic flight can be the scariest part. We see things a lot more clearly. There is a great article along the lines of, “The day you wake up and say you have married the wrong person is the day that your marriage truly begins.” Meaning, this is the day where the veil of infatuation has lifted and the 20/20 vision of everyday living comes in. “Wow, she is neurotic.” “OMG, he tells the worst jokes.” “I didn’t think about him at all yesterday. I hope we are okay.”

The landing can be light and sweet, or rocky and discombobulating. But eventually the clock strikes midnight and Cinderella must run home before the stage coach becomes a pumpkin and her dress returns to rags. Landing! Oy, so bittersweet.

3. Burying.

This stage happens when all the to-do lists of life come toppling into the relationship and before you know it, conversations are focused on things like who’s doing the laundry, your boss, or the crazy mother-in-law. During the burying stage, other things — like, oh, life — begin to encroach on your beautiful oasis of a relationship.

Burying is not always bad; it’s a sign that the relationship is real and weaves into your everyday existence. The important thing to remember here is to “unbury” yourselves. Take tango lessons, go relive your first date, go have sex in public, buy some sex toys, tie yourselves up to bedposts, grab the whips … Do something that allows real life to take a break and the gentle, sweet intimacy to resurface, bringing us to the next stage.

4. Resurfacing.

Resurfacing is the stage where you turn to your partner, and say to yourself, “Wow. I forgot how hot he is,” or “She is stunning,” or “I lovehim so much.” Resurfacing is the resolution of a relationship: “She is a mixed bag, but so am I.” “He sits on the toilet for an hour reading comics, but I pluck my chin hairs.” And you start thinking things like: “I can’t wait for our next date.” “I can’t believe I have such a sweet person in my life, who always has my back.”

It can be triggered by a massive problem that you two resolved, a great date, an especially good night of sex, almost losing the other person, or good couples therapy. Anything can jolt us awake; maybe a death in the family or even a birth. And then we hit the last stage.

5. Love.

This is what it’s really all about, right? The part where we look across the dinner table, fight over the remote, or go on a great trip to Chinatown and think … “Oh, I have it really good.” “I am blessed.” “I love him/her more than I could ever imagine.” Here, the sex is (usually) better than it has ever been. True love blossoms around year five. The rest is a rotation — sometimes rapid and sometimes slow — of the other stages.

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