Harvey A. Hyman LPCC License #11679

FINDING YOUR AUTHENTIC VOICE IN A RELATIONSHIP
A substantial number of my clients find partners who take command and use their power in the relationship to make my clients feel small by ordering them around, criticizing them, belittling them, and acting as mind readers by saying things like “you needn’t speak because I know exactly what you’re going to say.” Living with a top-dog partner like this makes my clients feel unfree and deprived of the safe space they need to explore their thoughts and feelings, change, grow, and evolve as persons.
My questions for each of these clients is “why do you stay in the relationship?” or “what holds you back from finding a partner who will support your growth and development?” It’s hard to imagine that any rational person would consciously, deliberately choose to be bullied and oppressed. Even Marine bootcamp has a pay off in the sense that the Marines will pay for your education later on.
More often than not the clients who enter and remain in this kind of relationship grew up in a home where one parent openly bullied and oppressed the other or where at least one parent, regardless of gender, acted this way to the client as a child. I have heard many stories from clients about one parent harshly criticize them, call them ugly names or slap them across the face, while the other parent passively condoned it by looking away or conveniently leaving the room.
Being treated like creates a lifelong sense of familiarity with it. It represents the known, whereas kindness, compassion, encouragement, and support feel alien and frightening. Being treated like this can even create the distorted belief that “I don’t deserve to be treated well.
There are many different ways to approach a client this in hopes of waking them up and liberating them. I have developed a simple exercise to increase self-awareness. It involves asking the client to make a list of his core values, core needs in a relationship, and the boundary lines he does not his partner to cross. Taking answers from many clients and turning them into a composite answer would produce something like this.
“I want to be loved, respected, and openly appreciated in an equal partnership where each member seeks the well-being and growth of the other. I want my partner to allow me to speak and express myself without rushing to shut me down and tell me I’m stupid or wrong. I want a partner who is fun-loving and likes to laugh. I don’t want a partner is angry, controlling, and frequently critical of me.”
These are very simple, understandable, and reasonable terms for a relationship. If every client of mine had such a relationship I wouldn’t have any clients and would have to find a new line of work.
Increasing your client’s awareness of the ways in which and the extent to which his values, needs, and boundaries are being ignored or violated is part of the treatment. Using psychoeducation, CBT, and trauma therapy to help him feel that he deserves better and is entitled to better is equally important. The client then has the opportunity to assert his authentic voice in the relationship and try to change it or leave the relationship to find a healthier, happier one.

HOW THE SELF-IMAGE WAS FORMED AND CAN BE CHANGED IN THERAPY
During development in infancy, toddlerhood, and childhood, our brains are highly plastic, which means they are extremely responsive to experiences in how they wire up and how they construct our identity. In a child, the self does not emerge through a conscious process of choice (this is who I will be) or abstract reflection (this is who I am based on how well or poorly I perform at different tasks). Since the developing child does not have adult cognitive capacities the self emerges as a feeling of who I am in response to a pattern of largely positive or negative emotional experiences. All emotional experiences have a valence, which means they are skewed to positive (pleasurable and rewarding) or negative (painful and punitive).
The biggest environmental determinant in how we feel about ourselves is how our parents treat us and respond to us. This, more than anything else, teaches us whether we are extraordinary, adequate or inadequate; whether we are valuable, worthy, and lovable or the converse; and whether it’s better to be bold and take risks or better to be fearful, cautious, and risk averse. All of these puzzle pieces of our identity come from memory and learning that are tied to positive and negative experiences. As children grow, they develop a reference library of emotional experiences in their subconscious mind that filters how they feel about themselves. My self-construct is much more likely to be positive if my parents provided me with attention, nurture, love, care, emotional validation, encouragement, and praise. My self-construct is much more likely to be negative if my parents bullied, teased, mocked, scapegoated, invalidated, ignored or coddled and over-protected me. To avoid pain, I may dissociate from or repress these memories and so have little understanding of why I turned out as I did.
The place that stores and segregates memories of positive and negative emotional experiences (those that make us feel good or bad about self) is the basolateral region of the amygdala. The amygdala is a small almond-shaped cluster of specialized cells in the inner temporal lobe. The thalamus is the brain’s relay station for sensory and emotional information. A part of the thalamus called the paraventricular nucleus utilizes a neuropeptide called neurotensin to route positive and negative emotional experiences to different cell populations in the amygdala. The scientist who first uncovered and understood this mechanism is Dr. Kay Tye.
When I do psychotherapy with a depressed adult and there is good reason to believe my client suffered forms of abuse and/or neglect in childhood, I often use an approach called Internal Family Systems (IFS). IFS helps clients to locate, connect with, converse with, and understand parts of themselves that are influencing or even controlling their behavior through the subconscious mind. These parts, to my observation, are condensed versions of old, highly emotional experiences associated with specific memories and learnings about who we were. Although we may not be able to access these memories in a very clear, well-defined way, we can access memory themes or get the gist of the memories.
In IFS I work with parts that to this day experience tremendous, raw emotional pain first incurred when the client was as young or younger than 3-4 years of age. I also work with parts that play the role of protectors, trying their best to steer the client away from pain, failure, shame or humiliation. Often the cause of depression in adults comes not directly from the traumatic events of childhood but indirectly from a highly negative self-image that formed from those events or from maladaptive coping mechanisms like substance addictions, behavioral addictions, self-harm or relentless self-criticism.
Neuroscience information about how the self-image forms is incredibly important because a major part of healing from childhood trauma is to change the self-image to make it more realistic and more positive. This can be done in a variety of way but all of them depend on brain neuroplasticity. Processing in therapy that weakens the old, learned association between self-image and being bad, stupid, inadequate or unlovable helps. So does the ability of the brain to form new images of self as the client opens herself to new pleasurable and rewarding experiences in her work, social, recreational, and leisure activities.

HOW TO OVERCOME DEPRESSION IN OLDER AGE
As a therapist I have observed how distorted self-concepts that people of older age swallow whole without critical evaluation act as a major cause of discouragement and depression. Here are just some of the inaccurate beliefs that older adults (those aged 60-80) with depression hold.
If I haven’t discovered my purpose or passion by now it’s too late.
The fact that I am weaker, slower, and less energetic than I was in middle age is a sign of irreversible decline and decrepitude. My gray hair reveals that my youth and vitality are gone for good.
The fact that I can’t recall information about people, places, and events as quickly as I used to and can’t recall some of that information at all is a sign of significant cognitive decline and possibly the beginning of Alzheimer’s disease.
As an older person who is not wealthy or possessed of impressive skills I can pass along, I am useless and have nothing of value to contribute to others.
If I have not made enough money in my life to retire to a life of leisure, then I am a failure.
Having lost hair, teeth, height, and muscle mass, and having visible wrinkles in my skin, I am unattractive and ugly.
Nobody needs me around anymore. They just tolerate me so as not to hurt my feelings.
These inaccurate beliefs filter down to us through culture, advertising, social media, movies, and TV. If an older person believes even one of these self-limiting falsehoods it’s easy to see how she would become depressed. Let’s find counterevidence to debunk each myth of aging.
As for passion and purpose belonging exclusively to the young, how about Grandma Moses, Mother Teresa, artist Mary Delaney, actress Judi Dench, businessman Colonel Harland Sanders, and authors Miguel de Cervantes, Daniel Defoe, Laura Ingalls Wild, and Frank McCourt.
Human memory across the lifespan is a process of growth and loss. Although people of older age can experience slow, progressive memory loss (as opposed the sudden, rapid loss seen in Alzheimer’s) memory loss is often due to controllable, reversible factors such as over-consumption of dehydrating substances like alcohol and caffeine, not drinking enough water, not exercising to stimulate blood flow, obesity, diabetes, and the use of prescription and non-prescription drugs. And, even if some loss of memory capacity is inevitable in older age, guess what? You can look things up on Google or Wikipedia, you can ask someone or make the decision that what you forgot isn’t worth remembering.
Neither wealth nor impressive skills are required to be useful. Older people are possessed of long life, lots of experience, and wisdom honed from successes and failures. They can serve as mentors, advisors, and encouragers of younger people. While writing this article I happened to chat with very cheerful older man who turned out to be a 90. When I asked him how he remained so cheerful he said, “let go of your grudges and regrets, just let them go. I walk my dog every day. I also have pleasures to enjoy. I have one beer and a bowl of ice cream every day.”
Making enough money to retire completely to a life of leisure lies outside the grasp of most people in the intensely capitalistic, inequitable economy of America where a handful of wealthy people fully understand exert great influence on the markets and regulations that affect real property acquisition, stocks, inheritance laws, taxes, tax shelters, etc. How much does a person really need to be happy? A plethora of studies show that it’s not that much, and that attitude along with being part of a loving family or close-knit community counts much more than money when it comes to happiness.
The effects of age on human appearance can be fought with cosmetics, cosmetic surgery, crazy amounts of physical training, special diets, supplements, etc., but time always wins. If your motivation to fight changes in appearance due to ageing is the belief only a beautiful, youngish appearance makes you special, then I feel sorry for you. People with plain faces covered in wrinkles can bring empathy, compassion, and kindness to the lives of others and bring warmth to a world threatened with creeping darkness. Be a friend rather than fret over wrinkles.
Lastly, the idea that older people are unwanted, don’t belong, and are lucky if they are tolerated is the biggest myth of all. The most important and valuable person in my life was my grandma who lived until age 99 and a half. She was 67 when I was born and she provided me with unconditional love as I moved through my infancy, childhood, and adolescence. I have always remembered, with the greatest fondness, Grandma’s smiling face, her voice, her unique expressions and gestures, her lung-crushing hugs, her vegetable garden, her straw hat, and her apple pies and jam cookies When these images pop into my head I experience a sensation of melting warmth and the feeling that the world is good.

HOW ANGRY FATHERS PRODUCE SOCIALLY SUBMISSIVE MEN
Right now, a significant number of my clients are adult males who grew up with a volatile, unpredictable, and angry father who was, at the very least, verbally and emotionally abusive, and in some cases physically abusive. Each of these clients survived by freezing, dissociating, trying to hide in plain sight, and shutting down his emotions. None of this is surprising. A small child is no match for a grown man filled with rage and capable of many forms of violence, even lethal violence. Such a sight is as terrifying for a small boy as a T-Rex must have been to prey animals back in the Cretaceous period.
These survivors of fathers who did not control their anger share certain characteristics. They marry or partner up with women who control them; who tell them what they must and must not do to be accepted or at least tolerated; and they criticize my clients frequently for perceived flaws or mistakes. These women, from my clients’ perspective, only focus on how they fail to meet expectations rather than the good my clients bring to the relationship. My clients suffer deeply from being with these women because they do not feel cared about, loved or appreciated. They walk on eggshells waiting for the next stinging criticism.
To gain greater acceptance, and perhaps some crumbs of love or gratitude, they contribute to the household and its finances in every way they can. And yet nothing they do works, so they harbor a sense that their wife or partner is being unfair and unjust. Despite that perspective they dare not stand up for themselves. Partly that’s because they fear triggering more criticism or sharper criticism. Partly it’s because of inner polarization. Although a part of these clients believes they are being treated unfairly, another part squarely blames them for how they get treated by their wives or partners. The self-critical part irrationally believes “it’s all my fault. I’m not worthy of her. She’s right to degrade me verbally.”
When I work with this group of clients, I am filled with the sense that I’m dealing with an avoidable tragedy caused by needless intergenerational trauma. I am also filled with compassion. Sometimes when these men tear up I do too. The good news is that none of these men is an empty shell that cannot be healed. The very fact that they are in pain and do cry brings me hope. I can work with and help men who hurt but I can do nothing for men who are emotionally dead. A crucial part of the healing is to help these clients understand that in choosing the women they do and submitting to them, they are repeating and reliving the pattern of submission they adopted to survive their angry fathers.
As boys these clients needed but did not get nurture, love or affection from their fathers. Just as importantly their fathers did not grant them a safe space to express and develop their authentic selves. Any act of self-expression triggered anger in their fathers so the safest place to be was locked inside an emotional prison, a supremely quiet place where time passed without movement, growth or development. To heal the injured boys in these men requires teaching the clients self-compassion, nourishing them with therapeutic empathy, and encouraging them to take one baby step after another out of their self-created prison and into the light of day where they can express themselves and enjoy the wonders of the world, from the beauty of nature to the joy of friendship.

THE MASCULINITY TRAP
Cultures across the globe define masculinity in their own ways with criteria for who is and isn’t manly. The emotional message to men is that they must measure up to those particular criteria or feel ashamed and less than. The physical criteria include height, weight, shape, appearance, facial hair, physique, and physical strength. The character criteria include being independent, tough, resilient, not backing down, not being overtly emotional and especially not crying, being in control, having opinions on everything, being a leader not a follower, etc. In America masculinity often dovetails with being perfect, i.e., never failing or making mistakes and never being uncertain, confused, anxious or, God forbid, afraid.
As a therapist I have quite a few male clients who suffer shame and anguish because they have fallen into the masculinity trap. The trap exists when a father has indoctrinated them into believing that these inhuman and unreachable standards are not only true but taking them as absolutes. These clients may attack themselves harshly over extended periods of time and fall into depression for a single episode of erectile dysfunction, for being fired or laid off from a job, for earning less than their wives or for not standing up to a bully boss even when they are dependent on the job to support their families. Men stuck in the masculinity trap suffer from not having their own permission to feel, to express emotion, to cry, to grieve or ask for help. They may also make their partners and children suffer by feeling compelled to dominate them by laying down inflexible rules of behavior, demanding absolute respect, not tolerating any “back talk,” and persisting in obviously poor decisions to save face.
When faced with a male client stuck in the masculinity trap it is helpful to use Socratic dialogue to prompt the client to discover for himself that the criteria for masculinity are in some ways tied to conditions of living that no longer exist because the physical and social world have changed significantly since they were invented. It can be helpful to get the client to see how his father and grandfather were so burdened and distressed by these unrealistic standards to as to suffer problems with anger, depression, and/or substance addiction.
Most important of all is psychoeducation regarding self-compassion. Boys that grew up with hyper-masculine fathers tend to see themselves as highly imperfect and inadequate. They focus their attention on where they fall short of the masculine ideal rather than on the ways in which they are good, capable, helpful or kind. For them being a good listener or a good friend pales in comparison with sucking at sports, being short or being afraid of bullies.
Kristen Neff has a wonderful website and book on self-compassion that I believe every therapist should read and introduce to clients lacking in self-compassion. When a male in the masculinity trap learns about and practices self-compassion, he is able to forgive him for not being perfect, accept himself as he is, and begin valuing his positive attributes which may well include sensitivity and empathy for others. Self-compassion is the key to the prison door of the masculinity trap.

STOP BOXING YOURSELF IN
The human mind has evolved to organize information into categories and to label the categories as a fast way to access them. We build knowledge of the external world through perception and analysis of objects and their properties. Unfortunately, we build understanding of ourselves in the same way as objects not subjects, and in this way we give up our power to define ourselves compassionately, fairly, and realistically.
Our self-image forms through the eyes of others – through their observations, impressions, evaluations, assessments, opinions, and judgments of who we are and how we are. It is an inescapable fact that other people take our measure in a myriad of ways, and that these measures may be subjective or objective, accurate or inaccurate, and on a spectrum from the relatively neutral to the extremely biased and stereotyped. Based on how others take our measure they will predict our futures – such as the likelihood that we will succeed or fail in various jobs, careers, and endeavors and the likelihood that we will succeed or fail in forming and sustaining positive, healthy relationships.
As a therapist I have observed the huge influence of mirroring, the process by which parents reflect back to their developing children the feelings, beliefs, and opinions they have of their children’s qualities. Mirroring involves everything from whether or not their child is worthy; capable; lovable; deserving of attention, respect, kindness, compassion, and inclusion; all the way to the most extreme judgment of all – whether their child is a gift to celebrate, a mistake or a curse upon the family. Parental mirroring during child development has by far the most profound, lasting, and impactful consequences on a child’s self-concept and self-esteem. However, mirroring continues throughout the lifespan and how others mirror us as elementary, middle school, high school, and college students, as young adults, middle-aged adults, and elders also affects us greatly. Teasing and bullying in school for any reason (be it size, appearance, disability or other) can severely tarnish our self-image. Being rejected by the college of your choice, fired from a job, or divorced by your spouse can hurt to the core. Being diagnosed at any age with a mental illness can carry stigma that we internalize for life. All too often we automatically interpret how others treat us as an accurate reflection of our worth. Mirroring puts us in a box.
I have learned as a therapist that we can reject and step out of the boxes that our parents, teachers, coaches, and bosses have put us in, and redefine ourselves. The power to see ourselves through our own compassionate and forgiving eyes is one of the greatest powers human beings have. Your life can change instantly and for the better when you stop boxing yourself in based on the opinions and judgments of others.
One way to stop doing this is to notice how, in the past, you have selectively edited evidence about your worth to seriously question and even dismiss evidence that you a good, worthy, useful, and valuable person, while confirming a low opinion of yourself by exaggerating the gravity of any mistakes or failures on your part. Another way to stop doing this is to recognize that mirroring is no better than its source. Thus, a rejecting, verbally degrading father who is an angry drunk unable to keep a job or even keep himself clean is not exactly a great source, nor is a deeply depressed mother who slept all day and did not provide nurture, love or affection. A third way is to ask people who genuinely love or care about you to share what they see as the good in you and share why they love or care about you. A fourth way is to risk trying activities that others opined you had no talent for. Maybe you aren’t Picasso but you might be able to make some nice drawings, paintings or decorated ceramics that you enjoy. A fifth way is positive visualization, a simple technique in which you imagine yourself as the person you’ve always wanted to be. To make this far more potent start acting as if you are the person you’ve always wanted to be. Once you see how easy it is to be that person you need no convincing that you were always far better than the poor prisoner of the box you used to inhabit.

WHEN TRAGEDY BREEDS RESILIENCY
Loss is rightly considered the primary cause of situational depression, the kind of depression that arises in response to one or more specific life events, in contrast to biological depression from one’s genetic inheritance. A loss of someone or something that has great personal importance (a love relationship, a home, a business, a purpose in life or a physical or mental capacity) often sets off a psychological collapse marked by profound despair. And yet, sometimes, what can be viewed objectively as a significant loss likely to trigger a deep and long-lasting depression, works in the opposite direction. Sometimes the person visited by loss refuses to take on the victim role and not only survives but thrives. This ability to bounce back from significant adversity is known these days by the term resiliency. Therapists often use the term resiliency to promote their books, webinars, podcasts, and continuing education courses. I’ve read a lot about resilience but I don’t think I ever saw it in action and really understood it until my family and I visited a farm in Vermont last week.
The owner/operator of the farm was a middle-aged woman named Lisa. She told us that some ten years before our visit her husband died and shortly after that she lost one of her lungs to cancer. Lisa told us she realized after these losses that she could lay down and die emotionally or live out her bucket list. “The one thing I always wanted to do was work on a farm with animals,” she said. So, Lisa found a very low paying job caring for animals on an old, severely dilapidated farm on its last legs. She fell in love with the animals immediately and asked the farmer if he could hold off on selling his herd of cows and let her care for them. The farm agreed on the condition she could find a way to pay for the cows. Lisa managed to pay for them by selling raw milk and inviting families onto the farm for $10 per person to learn about the cows, hang out with them, and pet them. It worked. The farmer let Lisa keep the cows. Lisa went on to invest her life savings to repair the damaged buildings and animal pens and develop a state-of-the-art dairy and cheese making business complete with a cave for cheese aging.
When we visited last week, the farm looked like a cross between Noah’s Ark and a Dr. Doolittle movie. There were chickens, ducks, turkeys, rabbits, cows, sheep, goats, gigantic pigs, and an alpaca. Lisa turned out to be so good with animals that she became a magnet for neglected creatures. Many of the animals had been dumped in the night in sickly condition by people who couldn’t or wouldn’t take care of them. At her own expense and with great effort, love, and compassion, Lisa and her crew nursed these animals back to physical health. Some of them became able to trust human beings again, enough for children and their parents to hold them or pet them. One example is the cow who kept licking my hand and arm. Some were too abused to regain trust and they were kept in a special pen where they befriended each other. I was deeply touched by this particular micro community, which reminded me of the Island of Misfit Toys in Rudolf the Red nosed Reindeer.
As we walked around meeting and petting one animal after another Lisa’s intense devotion to her grand purpose of rescuing abused and neglected animals, restoring them to health, and giving them a safe, loving lifetime home became clearer and more palpable with each passing minute. I had finally found a living, breathing example of someone coming back from tragedy and rising resiliently to a life filled with purpose and joy, a life not lived for self-gratification but for sharing with and benefitting others. Resilience remains merely a concept or a goal (as in “I want to be more resilient”) until it is actually lived out in the world. I’m not sure that we, as therapists, can teach resilience, but we can share stories, like the story of Lisa, to inspire our clients to live again and create meaning after a tragic loss.

NEVER UNDERESTIMATE THE POWER OF WORDS TO HURT OR HEAL
Words are like knives. They can be used for positive purposes the way a sculptor uses them to create beautiful forms from wood or stone or the way the surgeon uses them to remove a cyst or tumor. They can also be used negatively by parents with intent to wound the spirit of their child. I work every day with adults who were wounded by the words of one or both parents and who never recovered.
Why on earth would a parent deliberately use cruel words to cut the fabric of his child’s spirit? Some parents have a preconceived and strongly held idea of who their child should be, how she should look, and how she should behave. If the child departs from their standard, they feel disappointment, frustration, and irritation. They blame and punish the child to vent their anger and let her know she has failed them. If these parents were physically abused by their own parents they will punch, slap, s***k or use the belt. If they were verbally degraded by their parents they will use words instead, words that cut more deeply than blows. Parents who lose themselves in anger and inflict verbal violence tend to be impulsive, disinhibited, and poor at self-regulation. They lack empathy for their child and have no sense of the harm they are inflicting.
Complex PTSD refers to recurrent micro-traumas that combine to saddle a child with lifelong symptoms of depression and anxiety and often with comorbid symptoms such as panic, phobias, OCD, perfectionism, insomnia, fatigue, dissociation, depersonalization or derealization. What verbal micro-traumas cause CPTSD? How about, “you’re a ____________ (disgrace, embarrassment or mistake)” “you will never amount to anything,” “you’re not my __________ (son or daughter),” or “why can’t you be more like your (brother or sister)?” I have heard all of these and more from my clients.
The child assaulted by these degrading words gets the message that she is defective, unworthy, unlovable, and nothing more than an annoying, useless burden to her poor parents. This message is not just imprinted metaphorically; it is literally wired into the child’s brain in the places where the self-image schema and the fight-flight-freeze-fawn responses are held. The child becomes a woman or man with a history of life-long verbal self-attacks, shame, social avoidance, lack of intimacy, and the use of maladaptive coping mechanisms that often include alcoholic drinking.
The flip side of the power of words to hurt is the power of words to heal. As a therapist who has worked with hundreds of adult survivors of this kind of childhood trauma, I have seen and felt the power of positive words which act as a healing balm to old wounds. When I use words of acceptance, validation, encouragement, praise, and hope with my clients, I see and feel them experience relief like desert plants soaking up rain after months of heat and drought. Although positive words cannot by themselves cure years of childhood wounding from hateful verbal aggression by ignorant parents, they definitely help the process along. During therapy the client internalizes the therapist’s positive words when they are spoken with complete sincerity and backed up by evidence. It is a form of relearning that can help reshape the client’s self image schema.
The power of words to hurt or heal is exemplified in no less than the life of Sigmund Freud, the founder of psychotherapy. From many books on Freud, including autobiographical material, it is well known that he had a strict, harsh father (Jakob) and an adoring mother (Amalia) who doted on him and predicted great things for him. In the book Primitive Bodily Communications in Psychotherapy edited by Raffaella Hilty, there is a remarkable vignette about the young Sigmund. Around age 7-8 he peed in his father’s presence in his parents’ bedroom triggering the father to condemn him with the words, “you will amount to nothing.” Think about how Freud’s personal history and the history of the world would have changed if Freud’s mother was not there to counteract these verbal attacks and empower Freud with loving words of praise.