If I get through all this tonight, I will go eat dinner and watch some Flashpoint. Really dense material below - but interesting.


- PTSD is largely a matter of conditioned physiological changes, which are very hard to change via insight and introspection alone.

- Many people face trauma, but not all develop PTSD. People are wired to respond to fear with action (fight/flight.) If they are immobilized and helpless, literally or metaphorically, during a trauma, they are likely to develop PTSD. This may have a biological basis. If they could take action - complete the fight/flight response - they may be able to decondition some of their PTSD reflexes.

- Traumatized people often freak out when meditating due to its internal focus's tendency to send them straight into traumatic memories. But meditation or mindfulness would probably be helpful if they could manage it. Wonder if movement-based meditative practices are less likely to cause freak-outs? If so, that would explain why so many survivors find movement practices helpful. Maybe the movement provides a balance between interior feelings (scary/bad) and external focus (move left arm to block), thus decreasing interior focus and making it more tolerable.

If the trauma is partly caused by the interruption of the fight/flight response and people being forced, physically or by circumstance, into helplessness or inaction, then maybe movement lets them work through the fight/flight (action) response they needed, thus rewiring conditioned responses.

Lots of detail below cut.

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A practical, easy-reading guide to some common issues and obstacles faced by a beginning therapist. This makes a good companion to Yalom’s The Gift of Therapy, which could be described the same way but which has little overlap in content.

What I liked best about Cozolino’s book is his emphasis on the idea that no one is perfect when they start out, everyone feels like an imposter, and that mistakes are inevitable but not the end of the world. While Yalom discusses his own mistakes, they tend not to be embarrassing or stupid ones. Cozolino, to my relief, recounts some truly ridiculous errors of his own. My favorite was how when he was just beginning private practice, an earthquake hit in the middle of a session. Cozolino was so locked into his role as the “unflappable analyst” that he didn’t react at all.

Finally, his client said, “Um… Isn’t that an earthquake?”

Cozolino replied, “How does that make you feel?”

In retrospect, of course, he realized that he had acted like a robot, and also that he might have made his client feel that his own completely normal reaction was wrong.

The book has a nice balance between emphasizing being yourself and not getting so anxious that you become a robot, and pointing out ways to avoid making common errors. A few suggestions:

- Keep what you say as concise as possible. Clients tune out long monologues. Try to get to the heart of what you’re trying to say.

- Put emergency numbers on speed dial. Schedule any potentially dangerous (to self or others) clients for when your supervisor or other backup is present. Discuss emergency procedures with your supervisors before there’s an emergency.

- Stay calm. You don’t have to feel your client’s emotions. Provide hope, and provide structure. It can be helpful to boil down multiple problems into some central core issue, to make them feel less overwhelming and hopeless.

- Don’t try to reason people out of delusions. Cozolino has a great story here in which he tries to prove to a psychotic client that she is not pregnant with a kitten. When he attempts to enlist the other members of her group in this effort, he instead inspires her to persuade them of the truth of her delusion. They end up planning a kitten shower, to which Cozolino is browbeaten into contributing a litter box.

- Always get specifics, especially in the areas of child discipline, sexual behavior, alcohol and drug use, past diagnoses, and cultural and religious beliefs. “One drink” may mean “one glass of wine.” It may also mean “one liter of vodka.” “Spanking” may mean one swat across the butt. It may also mean “a blow to the head with a piece of wood.”

- If something tragic or traumatic happens to you, it’s better to cancel than to come in distracted and upset.

- Don’t voice an interpretation the first time it occurs to you. Sit with it and see if more supporting evidence turns up. Also, don’t get too attached to interpretations. It’s OK if clients reject them.

- Be aware that much of your fees in private practice will be eaten by office rent.

Incidentally, there’s a meme going around: “Pick up the nearest book to you. Turn to page 45. The first sentence describes your sex life in 2012.”

Using this book, I got: "In addition to a growing sense of confidence, it also helps to have crisis-situation action plans prepared in advance." Actually, this describes my sex life to date.

The Making of a Therapist: A Practical Guide for the Inner Journey
Another school book, this one for Personality 1.

A manual for accessing one’s unconscious via dreams and “active imagination.” Johnson is a Jungian and discusses archetypes, but emphasizes that most dream symbolism is highly personal. Whether one believes that dreams are literal messages from the unconscious, or that one’s interpretation of the largely random matter of dreams is a method for accessing unexplored areas of the psyche, if one has any interest in exploring dreams and the unconscious, Johnson’s methods seem likely to be helpful.

He outlines detailed steps for dream interpretation, as follows:

Associations: Write down all the associations for each element of the dream, one at a time, not censoring oneself. That is, if the dream involves a blue car, all the associations for “blue.” Then all the associations for “car.” Etc.

Dynamics: Connect the images and associations with one’s inner life. Which associations seem intuitively valid? What in one’s inner life might relate to them? He suggests that real people in dreams typically don’t represent the actual people, but characteristics one associates with them.

Interpretations: Search for the central message that seems to be communicated.

Rituals: Do a small but concrete ritual action to cement the meaning of the dream and its message.

He also explains and gives steps for “active imagination.” Basically, this is doing somewhat directed daydreaming while writing down the daydream as it occurs. This sounds potentially interesting, and I will try it. (There’s way too much involved to try to summarize it here, but the book is easily available in the US, if you’re curious.)

Caveat: some mild gender stereotyping, and romanticizing of the past and non-western cultures.

Last night I dreamed that Anthony Bourdain and I were strolling around an indoor-outdoor food court somewhere in Asia, sampling and discussing all the food. We each tried a lamb skewer with different seasonings, his tandoori, mine spice-rubbed, then took a bite of the one we didn't get. He deemed mine "tough but good." I also recall ramen, donburi, and some very fancy wagashi.

Inner Work: Using Dreams and Active Imagination for Personal Growth
Attempting to get a jump on and also organize my required reading. Long.

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