It’s a new year, and for many of us we are thinking about what we want for ourselves, our family and the world in 2021. Having survived 2020 we probably want something different than what we endured for the past 9 months. Maybe we want health, travel, connection, stability, prosperity, or peace. For many of us it could be all of the above. But how do we go from wishing for these things to actually getting them?
Being a research-based person I turned to science to see what researchers have found on this topic. Fortunately for us, goal-setting and achievement have been studied for many decades. We actually do have a good sense of what steps lead people to achieve their goals versus dream big but stay at home on the couch.
Some of you may have heard about the mythical “Yale study” where graduates of Yale were interviewed years after graduation about their earnings. The typical story is that the researchers asked these Yale graduates (or sometimes it’s Harvard) if they wrote down their financial goals prior to graduation. The alleged study authors “found” that of the 3% of graduates who reported writing down their fiscal goals before graduation they were making more than the other 97% of graduates combined (who did not write down their earning targets). Sounds great, right? Sadly it turns out that study never happened. However, other studies have been conducted, such as this one done by Gardner and Albee in 2015, which showed that following certain steps MORE THAN DOUBLED participants chances of achieving their goals. The bad news is that it wasn’t as easy as just writing them down, sticking them in a drawer, forgetting about them and then years later outperforming 97% of everyone else. It required more effort. However, nothing that the participants did was super-human. One of my favorite parts of the study is that the goal-setters harnessed RELATIONSHIPS to help them achieve more. Since humans are naturally relationally-oriented this makes sense. Since our earliest evolution as pack animals we have been concerned with how others see us and have benefitted from the support of others. So it’s nice to see that this carries over into achieving our goals for a new and better year.
OK, so the nuts and bolts of what this particular study showed is that there are a series of steps that one can take to increase achievement of goals. The more of these steps you take the more likely you will be to achieve them. I’m going to start with Step Two because Step One was just to think about these things without writing them down. I assume we all know how that will go...so let’s move on to Step Two which actually starts the process for real...
Step Two: Write your goal down, rate how difficult it seems, how important it is to you, to what extent you have the skills to accomplish the goal, your level of motivation and commitment to the goal and any prior experiences with working on this particular goal. You can make up your own scale for this, such as a 1-5 scale or 1-10 scale, or use a progressive list of adjectives such as “easy, moderate, difficult, impossible”. So for example if my goal is to get in shape I could say that it seems, on a scale of 1-10, with 10 being the most difficult thing I have ever done, that getting into shape is going to be a “7”. Then for what extent I have the skills I could say, again 1-10 with 10 being “I have all of the skills”, it’s a 9 because I have gotten into shape before so I actually am pretty confident that I know how to do it (what exercises, etc.). My level of motivation, again 1-10 for this example, may be an honest “5” given the year I just had...my commitment may be a “6”.
Step Three: Now write “action commitments” for each goal. These are concrete steps you can take towards a specific goal. For example if my goal is to get in better shape an “action commitment” is to schedule some classes with a personal trainer, or buy a gym membership, or carve out an hour every evening to walk in my neighborhood.
Step Four: Share these goals and action commitments with a friend. In my example this does not need to be someone who is actually going to go to the gym with me but just someone who knows I am trying to get there 5x/week (or whatever my goal is).
Step Five: Update this friend on a weekly basis as to your progress on your goal, using your action commitments as ways to measure your progress.
It’s not lost on me that this process mirrors psychotherapy, be it individual, couples or group. For most therapists goal-setting is an important part of the intake process as well as, over the intervening months, helping clients figure out the steps necessary to take in order to bring these goals into fruition. Then the weekly therapy sessions act as these “touch points” where the client reports to the therapist how they are doing towards their goals. Therapists can offer support, collaborative problem-solving and feedback to help the client move closer to achieving them. Of course this isn’t the only thing going on in therapy but in my experience it is an important part.
OK, so if you are willing to do these 5 steps what can you expect? Based on the aforementioned study, what I will call the “Dreamers” (Step 1, just thinking about your goals) surprisingly got at least 50% of the way there (towards achieving their goals) 43% of the time in the 4-week study period. Of course I’d like to think that they stalled out in weeks 5, 6 or beyond, because in my experience just dreaming about things rarely makes them happen. But another way to look at that is this: if you are too burned out, battle-weary, overwhelmed or depleted thanks to the year we all just had, at least thinking about your goals will, 43% of the time, get you half-way there in a month’s time. So that’s actually good news given how we all probably feel right now.
BUT, if you want to try to channel that Type A, kick-butt, storm-the-hill person you used to be before the pandemic laid us all flat, press on. Because the “Committers with Friends” who actually wrote down their goals, made action commitments and shared it with a friend had achieved at least 50% of their stated goal 62% of the time. That’s a 44% increase in achievement. Not bad for just a brief writing exercise and a one-time chat with a buddy! But of course if you are ready to kick 2020 in the teeth and go for the gusto, keep talking to your new goal-BFF on a weekly basis to update him or her on your progress on those action-statements. That will get you a whopping 76% towards at least 50% goal achievement in a mere month’s time. That’s a hefty 77% improvement over the Dreamers group.
This study was done on folks in their 20’s through 70’s so that’s good news for those of us over 50. You can still teach old dogs to achieve new tricks. It’s also good news for those in a generation that has been plagued by accusations that they can’t achieve doing their own laundry (sorry, Millenials).
The take home point here is that we can ALL get better at making our dreams a reality with a few not-so-time-consuming steps that will increase clarity, committee to, support and accountability. That could go a long way to making 2021 a redemptive year for all of us.
Wishing you health and happiness in the new year, along with better goal achievement!
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VICTIM. RESCUER. PERSECUTOR. That about covers it sometimes, right? Ever feel like you are in some weird play where there are always the same three characters? One person is getting screwed, one person is the hero trying to rescue that person and one person is the villain who is always seen as the bad guy. Which one do you most often get cast as? And how can you get out of that dynamic?
That dynamic is called Karpman's (Drama) Triangle. I would love to say that I invented this dandy little concept. But it's actually been around for a long time. Since 1968 actually. It was invented by Stephen Karpman, a student of transactional analysis, and was called Karpman's Triangle or the "drama triangle". As anyone who has ever been in this dynamic can attest, it is definitely drama-producing! None of the roles are actually healthy and the goal if you find yourself in this situation is to move as much to the middle as possible, not aligning yourself with any of the positions.
Despite what they might say about how they feel in the moment, be aware that the Victim role is not actually a person who is being harmed, it's a person who is emotionally invested in looking like they are being harmed. It is also a person who does not want to have to take responsibility for helping themselves out at all. They want everyone else to come and rescue them. They often complain to others that they are being abused, oppressed or victimized and that they cannot do anything about it. They are likely to block any suggestions that they can change their circumstances by saying things like "that won't work" or "I can't do that because _______". In reality they are invested in not acting as agents of change for themselves. These roles are usually learned in childhood by having them modeled by a parent, so if your mom played the victim role, you may find yourself repeating that pattern. Interestingly people who tend towards the Victim role will seek out Perpetrators if they don't have one in their life currently. Unconsciously they don't feel comfortable not being in that position so they have to create it. Sometimes what is at the bottom of this is a history of having been rewarded for being helpless and small and dependent as a child. This creates a conflict where they feel that in order to get their needs met they cannot actually do things for themselves or "grow up" and act as mature adults. They have to find ways to get a Rescuer to save them from a Perpetrator because they were trained never to "rescue" (or take care of) themselves. Remember that all of this is happening unconsciously so no one is actually "asking" to be victimized while being aware that is what is going on. The Victim thinks that they are just in a bad spot and can't seem to find a way out until they find the magic Rescuer who rushes in to save the day. I am not in any way saying that we cannot be compassionate about someone whose life is not going the way they want it. I am also not saying that whatever is done to someone in the victim role is acceptable. I am not victim-blaming. I am, however, saying that everyone has some power to make some changes in their lives and that victims often have a hard time seeing this.
Rescuers are compulsive helpers. This is the classic Martyr role. Rescuers are so inclined to rescue that if they see a person in need and don't rush to their aid they feel terrible. They feel compelled to help others and don't see that this can deprive the Victim of learning to do for themselves. It also allows the Rescuer to focus on other people, which tends to be much more comfortable for them. They derive a lot of status and satisfaction from taking care of others and they don't have to face any of their own issues. Al-anon was originally developed for Rescuers and one of their mottos is "keep the focus on yourself (not the Victim!)". However just like the Victim, Rescuers are usually totally unaware that their role serves to keep them from dealing with their issues since it is entirely unconscious. They just tend to think of themselves as "good" people in a world where a lot of folks need a lot of help! They were often raised in families with a Victim and they learned early on to care for the Victim, which made them feel better about the situation of the family.
The Persecutor tends to come from families in which one or both parents were bullies. They have seen this behavior modeled and follow along, blaming others, trying to control them, being critical, rigid, angry and often acting (or at least feeling) superior. The Persecutor thinks of themselves as "realistic" and "hard-nosed" but typically not malicious. They feel that the Victim and the Rescuer are naive and don't realize that it's a cold world out there and people are going to take what they can. It's kill or be killed and they plan to be on top. They view Victims as people from whom things can be extracted-- work, love, sex, money, status-- but not in a mutual way that cares for both people. When they have gotten what they need from others they may discard them. This can come in the guise of "realizing it just wasn't working out" because they have detected a "fatal flaw"in the person. As parents they tend to want to "toughen-up" their kids and may make kids feel like no matter what they do it's not good enough. Or they may blow up and rage at the kid(s) and then blame the kid(s) for causing them to get angry. They may have unreasonable rules that must be followed and refuse to allow kids (or partners) to negotiate on their own behalf.
While we often learn one of these roles more deeply than the others in our families of origin we can also switch roles at any given time. A Victim may see an opportunity to retaliate against someone who has been a Perpetrator and take it, often in a passive-aggressive way that is not easy to detect. In this way they temporarily enjoy being a Perpetrator while maintaining the image of the Victim. A Rescuer may get tired of taking care of others and experiment once in a while with throwing up their hands and acting like a Victim. A Perpetrator may find that by occasionally acting like a Victim they can avoid taking responsibility for bullying others. However if we do this "drama triangle" regularly we do tend to gravitate towards one position based on our early experiences.
Again the goal of emotional health is to not enter into any of these roles. Each of us has the capacity to be passive and dependent and wish that some fairy God mother/father would come along and take care of everything for us. And each of us has the fantasy of being the knight in shining armor riding in to save someone. And yes, even if we often don't like to admit it, we can also all be the kill-or-be-killed person who steps on others to get ahead and gets a thrill out of winning, even at any cost.
If you suspect that you came from a dysfunctional family you may want to spend some time honestly asking yourself whether or not your parents show up in this triangle. If they do then you can ask yourself do YOU show up? And where? And what work do you need to do in order to move more to the middle? Victims need to learn to do for themselves and to feel pride and competence by growing up and owning their own power rather than wanting others to fix things. Rescuers need to ask themselves how they are avoiding their own pain, anxiety, sadness, grief, etc. by focusing on others all the time. And Perpetrators need to learn to be vulnerable and realize and express their own desires to be dependent sometimes rather than to only feel safe when they are lording themselves over others.
Therapy can be a great way to learn about the Karpman triangle and other dysfunctional dynamics. It is also one of the best ways to change those dynamics. You don't have to stay stuck in the Drama Triangle forever.
Wishing you health, happiness and balance in all of your roles in life,
A guest blog by Margaret Martin, LCSW
Margaret Martin is a social worker that I have known for nearly a decade. Over that span of time we have shared many clients and I have always found her to be warm, brilliant and highly effective as a therapist. Recently Margaret posted a blog on trauma therapy which is a speciality of hers. I wanted to re-post the blog here so that my readers can learn from her expertise on this very important subject. What follows is her post:
Over the years I’ve found that there are some frequent misconceptions among clients seeking treatment for trauma. Based on outdated ideas of trauma therapy and a misunderstanding of the process, any one of the following beliefs could be enough to keep an individual from seeking treatment for trauma. So I want to challenge them here.
“I have to tell my whole story in order to heal.” Nope, not true. In fact, telling the story, especially all at once or repeatedly, can be re-traumatizing. Some approaches to trauma (most notably Prolonged Exposure Therapy) promote the belief that healing comes from the repeated re-telling of the trauma story. However, many clinicians see exposure therapy as simply creating a state of habituation or desensitization, a kind of “numbness” to the trauma, rather than true recovery or restoration. Desensitization not does not necessarily equal healing. Somatic Experiencing (SE), developed by Peter Levine, PhD, is one approach to trauma treatment that not only does not require the re-telling of the traumatic story but discourages moving in a way that might be re-traumatizing for the client. SE provides a compassionate approach, allowing clients to test the water and dip their toes in and take them out again, rather than diving into the deep end of the trauma pool.
Several years ago I moved away from using Eye Movement Desensitization Reprocessing (EMDR) as my go-to weapon in the fight against PTSD, particularly with clients with complex trauma. Although EMDR is still the best choice for some clients, I now use SE more frequently because I see it as much more gentle on the nervous system, especially for those with few coping skills or who currently function at a very limited capacity. Healing from trauma is hard work, but the process should not leave the client feeling raw, overwhelmed or exhausted. When that happens the process is moving too fast and needs to slow down. This does not mean that healing happens more slowly; it means the process is less painful.
“If I can’t remember what happened, or I’m not sure, I can’t heal.” Many people don’t remember the details of a traumatic event. Sometimes people have symptoms of PTSD and don’t know why. Others have vague, dream-like memories that frighten them, but for which they have no context. If trauma occurred before an individual was able to process the information verbally (any time prior to age 3-5) the memories are “implicit” rather than “explicit,” and typically have no language attached. Memories of early life events may also take on a more mythical form, such as being smothered or attacked by a shadow or monster, or hiding from an unknown danger. All of these are normal responses to trauma. Healing from trauma can happen whether or not the client knows “what really happened.” Many clients doubt their own stories or memories. This too, is normal, especially if the experience has been invalidated by other family members or friends. The reality is that symptoms of PTSD don’t occur without reason. Luckily we don’t have to know or fully understand the reason in order to heal.
“Therapy won’t help or it will get worse before it gets better, and I can’t handle that.” Jumping right in and pulling the scab off the wound can absolutely result in the experience of PTSD getting worse before it gets better. That’s why we don’t do it that way. We go gently, slowly, making sure that before we consider abandoning old coping skills, even those that are unhealthy, we work on healthier coping skills to put in their place. We create a safety net and anticipate what kinds of triggers or experiences might be “too much” or something the client “can’t handle.” Although there are times when even the most careful approach can feel overwhelming, I’ve found that especially with SE that is not often the case.
“I’m going to have to confront the perpetrator (if there is one) in order to heal.” In my experience this is a much less commonly held belief but one that can certainly dissuade someone from seeking treatment if they believe it. It’s also not true. In many situations confronting the perpetrator could be dangerous, either physically or emotionally, or could have other negative consequences. Unless confronting the perpetrator holds a clear benefit or gain, such as protecting others or taking legal action, clinicians specializing in trauma often discourage it. It certainly needs to be postponed until the survivor has explored his or her motivations, expectations, and all possible outcomes. Unless they’ve changed significantly, a perpetrator, and those who support and protect him or her, will continue the denial, rationalization, and thinking errors that allowed him or her to engage in the abuse in the first place. Expecting an apology or compassion is unrealistic and potentially risky.
I hope that if you or someone you love has been avoiding therapy due to fear of the process this perspective will be helpful.
Many thanks to Margaret for her words of wisdom. As always if you have benefitted from this information please click on the "like" button below to like it on Facebook, click on the Twitter button below to tweet it or click on the "Comment" button below to add a comment.
Wishing you health and happiness,
First let me say that this blog topic has been on my "to do" list for months. I keep putting it off, frankly, because it's complicated. Psychotherapy has been around formally for about 200 years. However scientific studies explaining exactly how therapy causes change have only been around for about 50 of those. Studies that are able to look inside the brain and show brain changes associated with psychotherapy have been around even less.
Furthermore there are a lot of really good articles on whether or not therapy works. See for instance Jonathan Shedler's article from the University of Colorado Denver School of Medicine entitled "The Efficacy of Psychodynamic Psychotherapy" published in the American Psychologist (2010, 65(2), 98–109). Schedler makes an impressive case for the fact that psychodynamic psychotherapies are very effective and that their effects persist for years after finishing treatment. However, his article, and many others that I have read do not explain HOW psychotherapy works.
While I am prone to want to explain as much as possible through the physical sciences there are a number of theories that are worth exploring as well. So I will put off the neuroanatomy and biochemistry piece until the end of the blog. We'll get there but let's first look at some of the theories that make a lot of sense even without the functional MRI's to back them up.
If you start with Freud you would find that surprisingly some of his ideas still make sense in terms of how therapy works. Freud believed that we repressed things that were too painful or triggering to manage on a conscious level. These could be aggressive feelings, love feelings, sexual feelings or any manner of things. He felt that urges were going to seek expression one way or another and that it was up to the person to try to find a socially and morally acceptable way to express these baser "drives". So for example a person with a high aggressive drive could become a professional football player (an acceptable "sublimation" of the drive) or could become a thug who goes around beating up people. Some people, for various reasons usually stemming from their early childhood experiences, may have trouble finding acceptable expressions for their not-so-nice drives. Those people might, in Freud's opinion, develop symptoms like panic attacks, bouts of depression, or even more bizarre neurological problems like sudden blindness. He felt that by helping the patient to reconnect to those baser drives and accept their existence, and then find a more appropriate form of expression, patients could be freed from their neurotic suffering. While a lot of what Freud believed now feels outdated and archaic, I agree with his central idea that when we cannot accept parts of ourselves and instead shove those into the unconscious realm we may develop painful symptoms that then lead us to therapy. Many of the different styles of therapy that came after Freud actually took pieces of his theory and modified them, indicating that at least some of what he postulated continues to be useful.
One group of clinicians that I think do a good job of explaining how therapy works is the "(intensive) short-term dynamic psychotherapy" group, also called STDP or ISTDP. Authors in this area include Habib Davenloo (it's originator), David Malan, Robert Neborsky and Marian Solomon. This camp of therapists believe that therapy works in a very predictable (and thankfully replicable) way. First, they conceptualize emotional problems as stemming from fear of experiencing certain painful emotions. These tend to be anxiety, shame, guilt, pain, contempt and disgust. Due to our inability to tolerate these intensely negative feelings we respond in maladaptive ways. For example due to intense shame a person may hide aspects of themselves which leads to feelings of loneliness, disconnection and an intensifying of the shame. From the ISTDP perspective therapy works by helping the client to 1) recognize that they have defensive habits (such as attacking the self), 2) be motivated to change this defensive habit, 3) identify the feelings that are being avoided, 4) allow themselves to experience the avoided feelings within the therapy session (where it can be supported), 5) learn to express those feelings in more adaptive ways outside of the therapy sessions and 6) recognizing that by acting differently with others you have created a new identify for yourself that has replaced the defensive pattern with a more adaptive one. According to research in the Harvard Review of Psychiatry in 2012, is a highly effective type of therapy. For those of us who use psychodynamic theory in our practices ISTDP has many elements that are common to psychodynamic therapy in general. Indeed other studies have shown that psychodynamic psychotherapy is also a very effective form of treatment.
Another theory about how psychotherapy works was highlighted in an article on time.com recently. The article discussed the idea of "narrative". Each of us has a story that we tell ourselves (and others) about our lives. When this story is incomplete or flawed in major ways it can interfere with our happiness. For example if our "narrative" is that we were lazy and never tried hard and that's why we quit college and have never achieved much that story could easily lead us to feel depressed and self-loathing. What if the real narrative was more like we had an undiagnosed learning disability, making it hard for us to learn in a traditional environment, causing us to fall behind due to lack of educational success? That narrative leaves much more room for healthy self-esteem and hope for the future. Some therapists believe that helping patients "rewrite" their narrative or life story in a way that is more balanced can lead to letting go of old pains, shame, guilt and negativity. I do think that this is often a component of successful psychotherapy and have seen this alone change people's lives in dramatic ways.
OK now that we have considered some theories and research on technique we can move on to my beloved psychoneurobiology explanation. In an article published in 2011 in Psychiatric Times numerous brain changes were identified as related to psychotherapy. Some of those were similar to the effects of antidepressants but some were distinctly different. Some of the effects reported included changes in activity/metabolism in various areas of the brain (such as the medial frontal cortex or the hippocampus) while others showed changes in the chemical serotonin and it's transport within the brain. Finally more recent studies have looked at structural changes in individual neurons that are thought to be produced by learning. So while the results of various studies differ in terms of how or where the brain changes are taking place, the overall conclusion is that psychotherapy DOES change the brain chemically and anatomically, and that those changes are related to a reduction of symptoms in the therapy graduates.
While there are other explanations of how therapy works I hope that these at least give you an overview of some of the more well-researched ones. As new research emerges I am sure I will be making updates to this particular blog for those of you who are interested in the underlying curative factors of this strange and powerful endeavor we call psychotherapy.
We've all heard that its hard to teach an old dog new tricks. But what about humans? How easy is it to change a person? We've all tried to make changes to ourselves, whether it's losing weight or stoping smoking...and sometimes we can do it and sometimes we fail. So clearly people can change, but clearly it's not an entirely easy process!
Psychotherapy is, at it's core, designed to change people. We do this through helping people have new experiences that are more in line with their goals of who they want to be and how they want to operate in the world. Our brain is shaped largely by experience. If you have the experience of practicing piano every day then the pathways of neurons (brain cells) that are used to play piano get stronger. Think of neurons like muscles-- the more you work them out, the stronger they get. So if you work out the same "set" of neurons (a "neural pathway") every day, say by practicing piano, then those get stronger and stronger and easier to activate. This is how we build proficiency in things, like playing baseball or practicing piano, or even being good at making small talk.
Some people grow up in families where they don't have certain experiences like being able to talk about their feelings, or being able to ask for what they need from others. When those experiences are missing in childhood those neurons that are associated with that behavior are weak and hard to activate. Psychotherapy aims to provide experiences that were missing in childhood (or adulthood) that are needed to build adaptive behaviors that help us lead happy and fulfilling lives. So for example a person who grew up in a house where it was not OK to talk about one's feelings gets to talk openly about how they feel in therapy. That in turn exercises those neurons and strengthens that neural pathway so that talking about one's feelings becomes easier and easier.
In a very real sense psychotherapy is like hiring a personal trainer at your gym-- a person who can learn about how you would like to be (versus where you are now), set up an "exercise routine" to work out those muscles (neurons) and take you through those steps so that you can develop the muscles (skills) that you want. If we were to take a "before" and "after" picture of your brain we could actually see those neuronal changes that are a result of psychotherapy. As a matter of fact, studies have shown that one impact of psychotherapy is that the connections between the frontal lobe (which involves planning, organizing, regulating emotions, understanding consequences, controlling impulses and lots of other things we associate with being mature and healthy) and the limbic system (which is associated with raw emotions that can be overwhelming and "messy" if not regulated) are strengthened. So in a very real way psychotherapy helps your brain use the "smart part" (frontal lobe) to regulate your more primitive emotional center. This give you more control over intense emotions that otherwise may derail you from staying balanced.
The bottom line here is that our brains do change. Even in adulthood. This is good news for those of us who would qualify as "old dogs"! So if there are things about yourself that you wish were different I would encourage you to consider psychotherapy. As one person put it, "it's never too late to have a happy life".
Krista Jordan, Ph.D.
Dr. Jordan has been in private practice for 20 years in Texas. She is passionate about helping people to overcome hurts and obstacles from their past to find more happiness and health in their current lives.