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PsychNotes September 2014
by Monica A. Frank, Ph.D.
Clinical and Sport Psychologist

Index        Previous        Next
September 28, 2014

New Article: Does Cognitive-Behavioral Therapy Lack Compassion? It Depends Upon the Therapist

A complaint often heard about cognitive-behavioral therapy (CBT) is that clients may experience it as harsh and demanding. People turn to therapy for a sympathetic ear, reassurance, and help with addressing an overwhelming problem. Unfortunately, many people report that their experience with CBT and its focus on changing irrational thinking and maladaptive behavior is offensive, belittling, and impersonal (patient forums on the internet).

Why Has CBT Lacked Compassion?

1) The therapist's approach. In my opinion, as a CBT therapist, the problem is not CBT itself but how it is presented by the therapist. Although CBT has been consistently shown in laboratory experiments to be an effective, if not superior, treatment for depression and anxiety, the story is more murky when examining real-world psychotherapy outcomes (Beutler et al., 2012; Nathan et al., 2000). In particular, laboratory studies involve very specific protocols for treatment whereas real-world studies are dependent upon the decisions of the individual therapist. As a result, real-world treatment depends more upon the qualities of the therapist such as warmth and empathy and how the therapist presents the treatment.

2) Demands by healthcare companies. A complicating factor has been that CBT is often considered a treatment of choice by managed care insurance companies because it can be conducted from a manual, and thus, is considered simpler to provide. Such a feature has been attractive to these companies because their provider panels tend to use less experienced and less educated mental health professionals which keeps their costs down (Seligman and Levant, 1998). However, research consistently shows that the experience of the therapist is related to the effectiveness of the treatment even more so than the type of therapy (Hubbert, et al., 2001).

As a result of the manualized approach encouraged by the insurance companies and implemented by less experienced therapists, many clients are on the receiving end of a step-by-step procedural CBT that is lacking. CBT is anything but simple when implemented correctly!


September 21, 2014

PsychNote: Value Your Partner to Reduce Feelings of Rejection During Disagreements

The desire to marry often involves a yearning to be fully accepted and valued by another person. Loving someone signifies a willingness to give oneself completely to the other person trusting that this person will provide an embrace of acceptance. Yet, this very act creates vulnerability and opens the possibility for deep hurt for some people.

Feeling valued in the relationship critically impacts how someone handles everyday disagreements. Those who do not feel valued may feel rejected when their spouse disagrees or criticizes. As a result, they are more likely to engage in self-protective behaviors including anger, resentment, withdrawal and attempts to hurt the other. While those who feel valued by their partner are more likely to draw closer to the partner after a disagreement to show regard and affection in spite of the disagreement (Murray, et al., 2003).

The unfortunate consequence of this dynamic is that those who do not feel valued will often create an environment that fosters rejection by engaging in the self-protective behaviors. For instance, when a disagreement occurs they say something hurtful to their partner which is likely to produce a similar response in return. Or, when they feel rejected, they withdraw which causes the partner to feel hurt and rejected. Thus, this behavior becomes a vicious cycle creating more of the same.

How can this cycle be changed?

Many times when people want to change this dynamic, they think “We need to stop arguing.” However, not only is this easier said than done, it is not necessary. It is often easier to increase positive interactions than to control negative interactions. Changing the focus of the relationship from “How do I protect myself from hurt?” to “How do I show my loved one I value him/her even when I disagree?” can be done in a number of ways:

1) Thank your partner. Frequently, as often as you can, look for the good things your partner does and comment on them. Often, it is too easy to dismiss what they do with the idea “he/she SHOULD do that.” However, think about it, if a stranger fixed your car or prepared dinner, would you thank that person? If so, treat your spouse as well as you would a stranger.

2) Praise your partner. When you first met your spouse, both of you were most likely complimenting one another frequently. Continue to do that! Sometimes people say their spouse doesn't do anything to compliment. However, that is unlikely. This is the person you chose to spend your life with and if you choose to focus on the positives you could find them.

3) Touch your partner. Simple, non-sexual, touch conveys affection and regard whether it is a hug, holding hands, sitting next to one another, or gently touching the cheek. Such touch needs to be frequent, many times a day, although it does not need to be lengthy.

4) Do something for your partner. Instead of feeling bothered or annoyed by a request, see it as an opportunity to value your partner. Try to do something that is meaningful for your partner, not necessarily what you want your partner to do for you.

5) Listen to your partner. Again, how often do people give their full attention to a stranger or acquaintance but tend to ignore or half-attend to their partner? When a person is listened to they sense high regard from the other person. They feel valued. It doesn't matter if you've heard their story already. Show interest in what your partner has to say.

These are all simple behaviors that can be done many times a day to show a partner that he or she is valued. When a person feels valued generally, they are less likely to feel rejected when a disagreement occurs which can help change the negative cycle described above into a positive one of closeness and acceptance.

One final caveat: Don't take this article, shove it in your partner's face, and say: "See? This is what you should be doing!" That sort of defeats the message. Interestingly, when one person makes an effort to change these behaviors, the other partner will often respond in kind. In other words, be a model for the behavior you desire.

Murray, S.L., Bellavia, G.M., Rose, P. and Griffin, D.W. (2003). Once Hurt, Twice Hurtful: How Perceived Regard Regulates Daily Marital Interactions. Journal of Personality and Social Psychology, 84,126–147. DOI: 10.1037/0022-3514.84.1.126

September 19, 2014

New article: When Needs Come Into Conflict

Recently, a website reader submitted a passive-aggressive example to Excel At Life for suggestions. However, this example appears to be a case of when needs come in conflict rather than passive-aggressive behavior (although there is certainly passive-aggressive behavior present):

“My husband and I had a new house built. Our first home was agreed upon to become a rental property. The rental property, we agreed, would pay for our daughter's college education. One week before moving into our new home, my husband canceled the lease that I obtained through a realtor and informed me that his cousin was moving in. You guessed it: the rent was always late and my husband started picking the rent up piecemeal. Didn't work out. Cousin eventually moved out and we had to pay for a moving van! This scenario played out twice more, costing us tens of thousands of dollars. I'm crying all the time, my hair fell out and my daughter's college tuition is still unpaid. Today, my husband claims that he does not understand! When approaching my husband concerning the rental property, I said, “Honey, talk to me, please explain what is happening, we agreed what was the purpose.” Further, I stated to my husband that he went behind my back and offered my sister a lease although my sister came to me and I told her that I needed to speak with my husband. I asked my husband again, what is going on and explained to him that family, friends and business should never mix. Meanwhile, I'm still waiting for an explanation, he moved his nephew's family in without consulting me as if we had never talked at all. All of this took place between 2000 thru 2008 and my husband will not talk at all when this subject is brought up. We went to counseling over this issue in 2004 and after one session, he said to the counselor, 'my wife is grieving her mother and we will not need any other help.' By the way, my mother passed away in 2009!”

This example illustrates the problem of when couples are faced with important needs that are in direct conflict with one another. In other words, meeting one person's need means not meeting the other person's need.


September 16, 2014

PsychNote: How Much Should You Practice Mindfulness?

While mindfulness practice has been shown to reduce psychological distress, improve attention, and even reduce physical illness, researchers recently found that the amount of mindfulness practice is not as important as the quality of practice (Del Re, et al., 2013). In other words, the length and frequency of practice does not improve overall health as much as how mindfulness is practiced.

What are some ways to know you are engaging in quality practice of mindfulness?

1) Mindfulness is not about “zoning out” or falling asleep. Mindfulness is being aware.

2) Mindfulness does not avoid certain thoughts, emotions, or sensations.

3) Mindfulness isn't an attempt to feel only pleasant emotions or experiences but to be fully open to all experiences.

4) Mindfulness is returning focus to the present-moment experience, whatever it may be, pleasant, unpleasant, or neutral.

5) Mindfulness is allowing yourself to return your attention to difficult experiences with a sense that it is “okay” to experience the emotion or sensation.

6) Mindfulness is a focus on the pure experience of the present moment without distracting thoughts.

7) Mindfulness does not try to push away thoughts or feelings but allows them to “be” while gently refocusing back to the present moment.

The practice of mindfulness is simply taking a moment here and there throughout your day and experiencing that moment fully for what it is without judgment, evaluation, or demands.

Del Re, A.C., Flückiger, C., Goldberg, S.B and Hoyt, W.T. (2013) Monitoring mindfulness practice quality: An important consideration in mindfulness practice. Psychotherapy Research, 23, 54-66, DOI:10.1080/10503307.2012.729275.

September 11, 2014

Cognitive Diary Training Example: Responsible for Others' Feelings

EVENT: Upset with a friend

EMOTIONS: irritation, trepidation, hurt

DISTRESS RATING: 7--Feeling distressed, less in control

THOUGHTS: “My friend didn't ask me to join her when she went out with other friends. I feel hurt. I probably couldn't have gone anyway because I'm busy with the kids, but it would have been nice to be asked. Maybe she doesn't like me as much. I'm probably not very much fun. But I can't tell her what I feel because I don't want to hurt her feelings.”

CAN YOU IDENTIFY THE IRRATIONAL THINKING IN THIS EXAMPLE? There are at least 3 irrational beliefs.

HOW CAN YOU CHANGE THE THINKING? What is another way of thinking about the situation that won't cause the feelings of irritation, trepidation, and hurt?


September 4, 2014

Passive-Aggressive Example: Living with Blaming and Guilting Mother (Part 4)

Question: My partner's mum is staying with us and she's quite PA and I'd love to know better ways of dealing with some of what she does...

She has a lot of esteem wrapped up in having been an amazing mother and homemaker. If I choose to do a home-based task differently from how she would have, she will nitpick and point out the many flaws with doing it that way. She'll also say I did it that way because I "don't really CARE" and "that's a lazy way" to do that. Anything that's done her way is just "the way it SHOULD be done" and "why would anyone NOT do it that way!" Despite this she claims she doesn't get ANYTHING done her way although every room in the house is layed out how she wanted and most home things are done her way. When she returns from holidays she spends the next week pointing out things I've missed or supposedly done wrong: "I see it was too hot to mow the lawn!" (I'd mowed three days earlier). "I see no one could be BOTHERED to buy a new salt shaker! You guys!" Shakes her head. Salt shaker is still 3/4's full.


September 3, 2014

Passive-Aggressive Example: Living with Blaming and Guilting Mother (Part 3)

I will examine and discuss the previous question in parts.

Question: My partner's mum is staying with us and she's quite PA and I'd love to know better ways of dealing with some of what she does...

Partner's mum recites lists of what she does for us to her other children. She makes it sound as if we want her running after us and she's totally put upon. We'd rather tidy after ourselves but can't stop her doing this stuff:
Partner (working from home in personal office): "I don't like you coming in here every hour or so to see if I've got any cups. I'll take this cup once I've finished what I'm working on."
Mum: "I'll just take it."
Partner: "I don't want you to. It's distracting and I feel bad like you're slaving after me."
Mum: "I suppose you WANT the house to turn into a sty. You don't mind the house being DISGUSTING."


September 1, 2014

Passive-Aggressive Example: Living with Blaming and Guilting Mother (Part 2)

Question: My partner's mum is staying with us and she's quite PA and I'd love to know better ways of dealing with some of what she does...

Partner's mum is upset dishwasher wasn't run overnight. She complains to my partner loudly enough that I can hear: "I know she doesn't CARE about keeping the house tidy but how could anyone NOT run the dishwasher? Why on earth WOULDN'T you?"
Partner: "That's a little unfair when you make these general statements. I know she cares and she must have had a reason."
Mum: "Why on earth wouldn't you! It's just common sense!"
(In fact I hadn't run it because she'd often complained about running it when it wasn't totally full and had even unpacked the top row to demonstrate that you could jam one more glass inside. This time the dishwasher had five or six spaces.)
Partner: "I would like you to think about maybe not making general statements. It upsets people."
Mum: "I'm not allowed to think anything! I've just got to shut up and keep my thoughts to myself. You want me gone. You make it totally clear you HATE having me here!"
Partner: "We like you here. I just want you to know people feel hurt if..."
Mum: "I'm not ALLOWED to say anything!!" Slams door, sulks in room. We leave her to it. Returns two hours later to scream at partner that he's a hateful (expletive)! Slams sitting room door. More sulking.


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Dr. Monica Frank

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