The concepts of neediness and emotional dependency have negative connotations in our culture; when it comes to psychotherapy, many people (especially those who've never had any kind of treatment) take a very dim view of clients who come to depend "too much" upon their therapist. You may hear the very cynical opinion expressed that psychotherapists deliberately instill a kind of emotional dependency in their clients in order to exploit them. It seems that a great many people think that emotional dependency in psychotherapy is bad.

In truth, for psychotherapy to be effective, a degree of emotional dependency is inevitable. Clients with extreme amounts of pain and confusion, who have a history of unstable or chaotic relationships, may become highly dependent for long periods of time. If your life isn't working, if you come from a deeply troubled background and never developed the kind of emotional capacity and self-awareness you need to get through life, you have to turn to and depend upon someone else to help you develop it. Effective work can't happen and you can't get what you need if you don't.

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Autism Symptoms Get a Second Look

Joseph Burgoin

Defense Mechanisms

The Medicalization of Mental Health

Unbearable Emotion

January 25, 2012

According to a recent article in the New York Times, the revision to the APA's Diagnostic and Statistical Manual currently underway will reconsider not only the personality disorders (rumor has it that Narcissistic Personality Disorder may be eliminated) but also the autistic disorders. In particular, it looks as if Asperger's Syndrome will be eliminated as a separate diagnosis and subsumed within the more tightly focused Autism Spectrum Disorder. Read the entire article for an understanding of how the skyrocketing medical and social costs of treating autistic disorders are driving this revision, at least in part.

This change once again throws into question the validity of psychological diagnosis as a scientifically precise methodology. If Asperger's Syndrome can be written out of the DSM by committee, one has to wonder if it was ever as distinct a disorder as many people have wanted to believe. Even though I object to the very idea of a diagnosis manual akin to the ICD-10, I'm moderately hopeful that the current revision to the DSM is a step in the right direction: the new name, at least, seems to acknowledge that there's an entire spectrum of autistic disorders. Still, with its focus on symptoms and behaviors (rather than psychodynamic process), this new Autism Spectrum Disorder continues to reflect the kind of pseudo-scientific precision that characterizes the APA and all its efforts.

In working on my book about defense mechanisms, it has become increasingly clear to me that the problem with modern psychiatry is its renunciation of its psychodynamic roots. Whereas psychoanalytic thinking once dominated the American Psychiatric Association of 50 years ago, the continuing revision to the DSM that began in the 1970s has "re-medicalized" psychiatry -- that is, made it more scientific, with identifiable diseases leading to sanctioned cures. Psychodynamic thinking has been written out of the clinical picture so that today, we talk about bipolar disorder, borderline personality disorder and post-traumatic stress disorder as if each was as consistent and identifiable a medical syndrome as diabetes, but with no understanding of their underlying psychic processes. (For more on the medicalization of psychiatry, see Robert Whitaker's excellent book, The Anatomy of an Epidemic, which I reviewed in a series of three articles, beginning with one on the chemical imbalance theory of depression.)

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Anxiety Symptoms, Mindfulness and the Enlargement of the Self

In an early post about anxiety symptoms, I discussed my personal experience with a panic attack several years ago. In particular, I talked about the fear of falling to pieces, a kind of disintegration anxiety; it involved the feeling of a threat to my self in the most physical sense, to my bodily integrity, and the terror that I wouldn't hold together. Anyone who has gone through anxiety attacks or has any kind of anxiety disorder will likely understand what I mean.

Although I've since learned how better to manage my anxiety, and have never experienced another panic attack, this period of intensified stress only recently came to a complete close. Now that I'm on the other side, I've begun to realize the toll it took on me, and the ways that my anxiety symptoms affected me in an ongoing way, much more than I realized at the time. I'd like to talk about the experience, my sense of self and how mindfulness meditation techniques have proven useful to me.

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anxiety symptoms defense mechanisms mindfulness panic attacks

Depression Symptoms and the Role of Rage

Joseph Burgoin

Defense Mechanisms

Depression and Bipolar Disorder

The Psychotherapy Relationship

Unbearable Emotion

January 1, 2012

Before I began taking on new clients for online counseling in November, it had been quite a while since I'd started therapy with someone new; for the most part, my practice had involved ongoing work with long-term clients who were no longer struggling with depression. A number of people have recently come to me with depression symptoms and I've been struck once again by how important it is to understand the role that anger and rage play in so many depressive conditions.

In an earlier post about different types of depression, I discussed severe cases that result from intensely destructive but unconscious rage; I believe unconscious anger plays a major role in less severe conditions, as well. You've probably heard depression described as "aggression turned inward"; accordingly to this view, depression symptoms are the result of unresolved and unexpressed anger that is turned inward upon the self instead of being directed outside, at other people. This might account for the apparently unjustified feelings of guilt that often accompany depression symptoms: while the depressed person has no real reason to feel guilty -- that is, they haven't actually done anything in the external world about which they might legitimately feel guilty -- their (unconscious) enraged fantasies of wanting to hurt people around them nonetheless inspire feelings of guilt. As therapists, instead of treating the feelings of guilt as irrational and unjustified, we might instead wonder what the person has done (in unconscious fantasy) to justify those feelings.

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