Don E. Gibbons, Ph.D., NJ Licensed Psychologist #03513
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The New Center for Counseling and Psychotherapy, LLC

The New Center for Counseling and Psychotherapy, LLC, is located at 675 Route 72 E Manahawkin, NJ 08050. Telephone us at(609)709-2043 and (609) 709-0009.Take Mill Creek Road South, just off Route 72, on the road to Beach Haven West.After about 400 feet, turn right into the office complex of Greater Coastal Realty. Then turn right and go past the Lyceum Gyn. Continue on to the Prudential Zack Building. We. are the last office at the end. We accept Medicare and most other major insurance.Weekend and evening office hours are avalable.

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Wednesday, October 30, 2013

Humanistic Psychotherapy for Dealing With Life's Absurdities

Several years ago, I initiated the petition to establish the Division of Humanistic Psychology in the American Psychological Association, which became Division 32.

It has long been recognized that a warm and supportive atmosphere and a strong therapeutic alliance is essential in dealing with many of the problems which come before us. In this regard, I often think of the poem by Lewis Carroll, entitled, "The Walrus and the Carpenter," which describes what appears to be a journey between the therapist (whe walrus in the poem), and a carpenter (the client, who is a work in progress), as they outwit and defeat life's problems (the oysters).


The Walrus and the Carpenter - Lewis Carrol

The sun was shining on the sea,
Shining with all his might:
He did his very best to make
The billows smooth and bright--
And this was odd, because it was
The middle of the night.


The moon was shining sulkily,
Because she thought the sun
Had got no business to be there
After the day was done--
"It's very rude of him," she said,
"To come and spoil the fun!"


The sea was wet as wet could be,
The sands were dry as dry.
You could not see a cloud, because
No cloud was in the sky:
No birds were flying overhead--
There were no birds to fly.


The Walrus and the Carpenter
Were walking close at hand;
They wept like anything to see
Such quantities of sand:
"If this were only cleared away,"
They said, "it would be grand!"


"If seven maids with seven mops
Swept it for half a year.
Do you suppose," the Walrus said,
"That they could get it clear?"
"I doubt it," said the Carpenter,
And shed a bitter tear.


"O Oysters, come and walk with us!"
The Walrus did beseech.
"A pleasant walk, a pleasant talk,
Along the briny beach:
We cannot do with more than four,
To give a hand to each."


The eldest Oyster looked at him,
But never a word he said:
The eldest Oyster winked his eye,
And shook his heavy head--
Meaning to say he did not choose
To leave the oyster-bed.


But four young Oysters hurried up,
All eager for the treat:
Their coats were brushed, their faces washed,
Their shoes were clean and neat--
And this was odd, because, you know,
They hadn't any feet.


Four other Oysters followed them,
And yet another four;
And thick and fast they came at last,
And more, and more, and more--
All hopping through the frothy waves,
And scrambling to the shore.


The Walrus and the Carpenter
Walked on a mile or so,
And then they rested on a rock
Conveniently low:
And all the little Oysters stood
And waited in a row.


"The time has come," the Walrus said,
"To talk of many things:
Of shoes--and ships--and sealing-wax--
Of cabbages--and kings--
And why the sea is boiling hot--
And whether pigs have wings."


"But wait a bit," the Oysters cried,
"Before we have our chat;
For some of us are out of breath,
And all of us are fat!"
"No hurry!" said the Carpenter.
They thanked him much for that.


"A loaf of bread," the Walrus said,
"Is what we chiefly need:
Pepper and vinegar besides
Are very good indeed--
Now if you're ready, Oysters dear,
We can begin to feed."


"But not on us!" the Oysters cried,
Turning a little blue.
"After such kindness, that would be
A dismal thing to do!"
"The night is fine," the Walrus said.
"Do you admire the view?


"It was so kind of you to come!
And you are very nice!"
The Carpenter said nothing but
"Cut us another slice:
I wish you were not quite so deaf--
I've had to ask you twice!"


"It seems a shame," the Walrus said,
"To play them such a trick,
After we've brought them out so far,
And made them trot so quick!"
The Carpenter said nothing but
"The butter's spread too thick!"


"I weep for you," the Walrus said:
"I deeply sympathize."
With sobs and tears he sorted out
Those of the largest size,
Holding his pocket-handkerchief
Before his streaming eyes.


"O Oysters," said the Carpenter,
"You've had a pleasant run!
Shall we be trotting home again?'
But answer came there none--
And this was scarcely odd, because
They'd eaten every one.

Friday, October 18, 2013

The Twenty-First Century Revolution in Trauma Treatment

The first stage in psychotherapy with multiples and other trauma survivors is to make the client feel safe, in order to avoid triggering previous traumas. It is necessary when working with DID clients to rely more on providing an environment in which they can feel comfortable, instead of trying to uncover all of their previous traumatic memories, with the goal of providing "insight," which might only serve to re-traumatize them and extend the course of therapy indefinitely. (As one multiple who had previously been in therapy for seventeen years with no improvement exclaimed, "What insight? They were horrible!")  

The following video by Babette Rothschild (herself a victim of childhood trauma) illustrates how to overcome panic attacks by focusing awareness on the perception of here and now rather than on the internalized memories of previous trauma.



After this basic level of security and safety has been attained, client and therapist can then collaborate in the construction of a therapeutic relationship which will increase feelings of confidence and self-esteem, overcome anxiety, depression, and despair, and bring forth an optimistic outlook on life which enables them change the narrative of their life story. (Levine, 1997; Naparstek, 2004; Rothschild, 2000; Scaer, 2007).  These new methods of treatment by the world's leading trauma researchers and clinicians constitute  ". . .a paradigm for understanding trauma's far-reaching psychological and physical consequences, without which, psychotherapeutic interventions remain extremely limited, and at times harmful to our clients." (emphasis mine). 

Procedures such as these are rapidly dealing a death blow to outmoded, Twentieth-Century notions of "healing" based upon regression to cause, which is about as sophisticated and as useful as trying to housebreak a puppy by "rubbing his nose in it." The puppy will usually stop sooner or later, but is that because of our treatment or in spite of it? And if the "training" is vigorously pursued, could the frustration and anxiety thus engendered actually make new learning more difficult? 
The following video from PESI Seminars features some of the world's leading experts discussing how recent breakthroughts in the treatment of trauma, dissociation, and multiple personality are making it possible for clients who have gone years without improvement to finally begin to change.  


References
American Psychiatric Association (2013). Diagnostic and Statistical Manual, DSM-V, 5th ed. Washington, DC: American Psychiatric Association.

Forward, S. (1997). Emotional blackmail: When the people in your life use fear, obligation, and guilt to manipulate you. New York: Harper-Collins.  
Forward, S. & Buck, C. (2002). Toxic parents: Overcoming their hurtful legacy and reclaiming your life. New York: Bantam.
Levine, P.A. (1997). Waking the Tiger: Healing Trauma. Berkeley, CA: North Atlantic Books.
Naparstek, B. (2004). Invisible heroes: Survivors of trauma and how they heal. New York: Bantam.
Rothschild, B. (2000), The body remembers: The psychophysiology of trauma and treatment. New York: Norton.  (Click on the link for a YouTube book review.)
Scaer, R. C. (2007) The body bears the burden: Trauma, dissociation, and disease. New York: Routledge.

Thursday, October 10, 2013

Breakthroughs in Psychotherapy for Trauma, Dissociation, and Multiple Personality

Some people have children just so they can torture them! (Forward & Buck, 2002). Quite understandably, trauma, dissociation, and occasionally dissociative identity disorder (formerly called multiple personality disorder) are often the result. (Forward, 1997; McBride, 2008). Unfortunately, some therapists are inclined to doubt the existence of dissociative identity disorder and would rather act as if it did not exist, in order to discourage people from adopting what they consider to be a delusion. However, the research-driven Diagnostic and Statistical Manual of the American Psychiatric Association (2013) expresses no doubt about whether or not dissociative identity disorder exists. Dissociative identity disorder (DID) is assigned the diagnosis code of 300.14, along with other dissociative disorders in this category which include dissociative amnesia (300.12), dissociative fugue (300.13), and depersonalization disorder (300.6).  

It is occasionally true that people who are not genuine multiples can sometimes be subtly encouraged to adopt the belief that they are. We all tend to be one person in one situation and someone else in another, because of the conflicting demands placed upon us in our daily lives. When this conflict becomes extreme, some people might be inclined to conclude that they do indeed have multiple personalities, in order to lessen their guilt and gain notoriety and attention, particularly if they are encouraged in this belief by an unsophisticated therapist. Genuine multiples, however, may say things like,  "I have to hide it, so that my family won't find out," and express suspicion of people who "flaunt" their diagnosis. 

The DSM states states that many people who do qualify for a diagnosis of DID have an early history of severe physical abuse. In addition to the main personality, which is frequently passive, dependent, guilty, and depressed, there are  two or more distinct identities or personality states, each one  having its own history and identity. One alternate personality may be angry and aggressive, for example, while another one is highly controlling. Over half of all reported cases involve the presence of ten or more experienced personalities. There may be frequent lapses of memory for periods during which another personality is in control. Sometimes one personality may function as an executive, allocating time to the others. Differences between the personalities can include differences in age, gender, vocabulary, general knowledge, or prevailing mood. 

When one of their childlike personalities is present, multiples may take a sudden interest in children's coloring books, and, like very young children, sometimes have difficulty staying within the lines of the pictures they are supposed to color. They may enjoy playing games which are more appropriate to children than to adults. Multiples may also be surprised to find themselves in possession of clothing, cosmetics, or foodstuffs which they have no recollection of purchasing and which their current personality may not even like.  They may hear voices which can be just as clear as spoken speech -- but, unlike many schizophrenics, the voices are experienced as coming from within their head rather than from without. 

People who qualify for a diagnosis of DID may also present with symptoms of substance abuse, borderline personality disorder, mood disorders, sleep disturbances, or other psychiatric diagnoses. They may suffer from various co-existing physical complaints, such as asthma, migraines, sleep disorders, digestive disorders, and irritable bowel syndrome. Their tendency to repeat earlier patterns of abuse renders them especially vulnerable to episodic or ongoing victimization -- by lovers, marriage partners, or even casual online acquaintances. 

One client who is a genuine multiple has shown me printouts from a Web site operated for people diagnosed as having DID. Although there may be only ten to twenty people who actually belonged to this site, the actual number of members was over two hundred, because each personality was given a name and allowed to register and post entries separately, sometimes arguing or disagreeing with the other personalities with whom they shared a common physical body.  She informed me that the site was very secretive, and operated like a cult. Its "members" were generally opposed to psychotherapy, because their separate personalities do not want to be integrated.  Indeed, they were inclined to view any therapist who attempted such integration as a potential executioner! My client reports that she was blocked from membership because, in her efforts to collect information about this site, the administrators began to suspect that she was an "informant." The site was subsequently closed, and many of the former members organized a secret group on Facebook.

Popular literature has emphasized the fact that multiples are usually highly hypnotizable due to their great capacity for dissociation. However, because of their constant vigilance against potential sources of danger, some of their personalities may not be.

Psychotherapy with trauma survivors may proceed unevenly, because statements made by one personality may not be remembered by another one with different opinions concerning the previous trauma. This can sometimes lead to complications, with one personality defending, and another condemning, either the abuser or the therapist. Multiples with co-existing condiions such as borderline personality disorder may carry this idealization and devaluation to extremes, with a perpetual "battle going on inside their head" as to which one to defend or condemn at a given point in time. 

The first stage in psychotherapy with multiples and other abuse survivors is to make the client feel safe, in order to avoid triggering previous traumas. It is necessary when working with DID clients to  rely more on providing an environment in which they can feel comfortable, instead of trying to uncover all of their previous traumatic memories, with the goal of providing "insight," which might only serve to re-traumatize them and extend the course of therapy indefinitely. (As one multiple exclaimed, "What insight? They were horrible!")  

After this basic level of security and safety has been attained, client and therapist can then collaborate in the construction of a therapeutic relationship which will increase feelings of confidence and self-esteem, overcome anxiety, depression, and despair, and bring forth an optimistic outlook on life which enables them change the narrative of their life story. (Levine, 1997; Naparstek, 2004; Rothschild, 2000; Scaer, 2007).  These new methods of treatment by the world's leading trauma researchers and clinicians constitue  ". . .a paradigm for understanding trauma's far-reaching psychological and physical consequences, without which, psychotherapeutic interventions remain extremely limited, and at times harmful to our clients." 

The following video from PESI Seminars features some of the world's leading experts discussing how recent breakthroughts in the treatment of trauma, dissociation, and multiple personality are making it possible for clients who have gone years without improvement to finally begin to change.      






The principle that the most important aspect of trauma treatment is to first construct an atmosphere of warm acceptance, which in itself may be all that is necessary for some clients, may be illustrated poetically by the following verses by Lewis Carrol, in which the therapist (the Walrus) and the client (the Carpenter) discuss the absurdities of life until the problems which have sought to overtake them (the oysters) have all been consumed.


The Walrus and the Carpenter - Lewis Carrol

The sun was shining on the sea,
Shining with all his might:
He did his very best to make
The billows smooth and bright--
And this was odd, because it was
The middle of the night.


The moon was shining sulkily,
Because she thought the sun
Had got no business to be there
After the day was done--
"It's very rude of him," she said,
"To come and spoil the fun!"


The sea was wet as wet could be,
The sands were dry as dry.
You could not see a cloud, because
No cloud was in the sky:
No birds were flying overhead--
There were no birds to fly.


The Walrus and the Carpenter
Were walking close at hand;
They wept like anything to see
Such quantities of sand:
"If this were only cleared away,"
They said, "it would be grand!"


"If seven maids with seven mops
Swept it for half a year.
Do you suppose," the Walrus said,
"That they could get it clear?"
"I doubt it," said the Carpenter,
And shed a bitter tear.


"O Oysters, come and walk with us!"
The Walrus did beseech.
"A pleasant walk, a pleasant talk,
Along the briny beach:
We cannot do with more than four,
To give a hand to each."


The eldest Oyster looked at him,
But never a word he said:
The eldest Oyster winked his eye,
And shook his heavy head--
Meaning to say he did not choose
To leave the oyster-bed.


But four young Oysters hurried up,
All eager for the treat:
Their coats were brushed, their faces washed,
Their shoes were clean and neat--
And this was odd, because, you know,
They hadn't any feet.


Four other Oysters followed them,
And yet another four;
And thick and fast they came at last,
And more, and more, and more--
All hopping through the frothy waves,
And scrambling to the shore.


The Walrus and the Carpenter
Walked on a mile or so,
And then they rested on a rock
Conveniently low:
And all the little Oysters stood
And waited in a row.


"The time has come," the Walrus said,
"To talk of many things:
Of shoes--and ships--and sealing-wax--
Of cabbages--and kings--
And why the sea is boiling hot--
And whether pigs have wings."


"But wait a bit," the Oysters cried,
"Before we have our chat;
For some of us are out of breath,
And all of us are fat!"
"No hurry!" said the Carpenter.
They thanked him much for that.


"A loaf of bread," the Walrus said,
"Is what we chiefly need:
Pepper and vinegar besides
Are very good indeed--
Now if you're ready, Oysters dear,
We can begin to feed."


"But not on us!" the Oysters cried,
Turning a little blue.
"After such kindness, that would be
A dismal thing to do!"
"The night is fine," the Walrus said.
"Do you admire the view?


"It was so kind of you to come!
And you are very nice!"
The Carpenter said nothing but
"Cut us another slice:
I wish you were not quite so deaf--
I've had to ask you twice!"


"It seems a shame," the Walrus said,
"To play them such a trick,
After we've brought them out so far,
And made them trot so quick!"
The Carpenter said nothing but
"The butter's spread too thick!"


"I weep for you," the Walrus said:
"I deeply sympathize."
With sobs and tears he sorted out
Those of the largest size,
Holding his pocket-handkerchief
Before his streaming eyes.


"O Oysters," said the Carpenter,
"You've had a pleasant run!
Shall we be trotting home again?'
But answer came there none--
And this was scarcely odd, because
They'd eaten every one.



References

American Psychiatric Association (2013). Diagnostic and Statistical Manual, DSM-V, 5th ed. Washington, DC: American Psychiatric Association.

Forward, S. (1997). Emotional blackmail: When the people in your life use fear, obligation, and guilt to manipulate you. New York: Harper-Collins.  

Forward, S. & Buck, C. (2002). Toxic parents: Overcoming their hurtful legacy and reclaiming your life. New York: Bantam.

Levine, P.A. (1997). Waking the Tiger: Healing Trauma. Berkeley, CA: North Atlantic Books.

Naparstek, B. (2004). Invisible heroes: Survivors of trauma and how they heal. New York: Bantam.

Rothschild, B. (2000), The body remembers: The psychophysiology of trauma and treatment. New York: Norton.  (Click on the link for a YouTube book review.)

Scaer, R. C. (2007) The body bears the burden: Trauma, dissociation, and disease. New York: Routledge.

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The Blog contains many other examples of experience as an art form, for the enhancement of human potential, the ennoblement of the human spirit, and the fulfillment of human existence.


See also the following print sources:

Gibbons, D. E. (2001). Experience as an art form. .New York, NY: Authors Choice Press.

Gibbons, D. E. (2000). Applied hypnosis and hyperempiria. Lincoln, NE: Authors Choice Press (originally published 1979 by Plenum Press).

Gibbons, D. E., & Cavallaro, L (2013).. Exploring alternate universes: And learning what they can teach us. Amazon Kindle E-Books. (Note: It is not necessary to own a Kindle reader to download this e-book, as the Kindle app may be downloaded free of charge to a standard desktop or laptop computer and to most cell phones.)

Gibbons, D. E., & Lynn, S. J. (2010). Hypnotic inductions: A primer. in S. J. Lynn, J. W. Rhue, & I. Kirsch (Eds.) Handbook of clinical hypnosis, 2nd ed. Washington, DC: American Psychological Association, pp. 267-291.