Month: May 2021

If you can quit biting your nails

EllisLeave a comment

If you can quit biting your nails, you can do anything…

How does someone go about quitting a nail-biting habit? Admittedly, some people seem to just miraculously stop, some people never really got started, some people need a Habit Reversal Training procedure. But nail-biting is still an accessible idea to most people and it’s a common enough and acceptable enough habit that it makes it comfortable to talk about in session. 

Here’s how people think you’re supposed to stop biting your nails. 

(1) You decide you’d like to stop biting your nails. 

(2) You exercise your willpower and stop biting your nails. 

(3) The end. 

And that’s definitely NOT how it goes. 

So, what are the real steps? Something like this…

(1) You decide you’d like to stop biting your nails.

(2) You bite your nails.

(3) You notice after the fact that you bit your nails, and feel a little irritated with yourself. Your therapist explains habit formation (normalizing and depathologizing) and helps you to develop self-compassion. 

(4) You begin to notice you are biting your nails while you are biting your nails. 

(5) You make an attempt to stop, but they’re a little jagged now so you go ahead and finish biting them. 

(6) You begin to notice you are biting your nails when you start to bite your nails. You wish you had a nail file right near you. But you don’t. 

(6a) You repeat step 5. Your therapist repeats step 3. 

(6b) You get up and get a nail file. 

(7) You begin to notice that you are about to bite your nails. You wish you had a nail file right near you. But you still don’t. 

(7a) You repeat step 5. Your therapist repeats step 3. 

(7b) You get up and get a nail file.

(8) You get annoyed with always having to get up to get a nail file. 

(9) You accept that jagged nails are both bothersome and inevitable and now always carry a nail file or clippers in your purse/desk/car/etc.  

(10) You rarely bite your nails because those tools are accessible and you are aware of the need to fix nails early. You occasionally still bite your nails, and you react with self-compassion and simply manage the situation. 

 

Of course, this isn’t the only way change happens!

But this is one great way to talk about it because it emphasizes the importance of awareness, reduces emphasis on willpower (which is almost useless for meaningful, long term change), and makes central the importance of an incompatible behavior and addressing the reinforcer, which is really the foundation of change. It also addresses the impact of meta-emotion regarding the change process (e.g., how self anger, shame, etc. get in the way).

One of my favorite things about this model for explaining change is that when clients “fail” on their first homework attempt (or even later ones), I can tell them honestly that they’re making great progress. And they learn that it’s a process. 

 

Comment below: How do you talk about the change process with clients? 

 

 

 

 

 

Telephone = Telehealth

Ellis1 Comment

Telephone = Telehealth 

You might remember my rant about telehealth, fondly or irritably, but here is a little follow-up. One of my suggestions to clients when they begin telehealth is to mention any tech issues (e.g., lag) immediately, rather than waiting and tolerating that relational discomfort. I am willing to spend up to five minutes (but no longer!) working on a tech issue for telehealth. (Consider that, at some point, they’re paying us for IT work, which is definitely outside our boundaries of competence! Haha!) After then 5 minute mark, or after exhausting the typical fixes, I do something wild… I just call them on the phone.

Besides a large body of data indicating the usefulness of telephone consultation, and the history of telephone as the primary form of telehealth work, I came across a delightfully interesting study, with this main finding: 

Voice-only communication elicits higher rates of empathic accuracy relative to vision-only and multisense [voice and picture] communication both while engaging in interactions and perceiving emotions in recorded interactions of strangers. … Voice-only communication is particularly likely to enhance empathic accuracy through increasing focused attention on the linguistic and paralinguistic vocal cues that accompany speech. (Kraus, 2017)

That’s cool, huh?! Addresses one of the (apparently imagined!) 

Note that this research did not address the difference between voice only and face-to-face communication, which still has a lot of benefits over not being present, including client mimicry (e.g., Salazer-Kampf et al., 2020), interpersonal synchrony (e.g., Rennung & Goritz, 2016), neuroception of safety and social engagement cues (e.g., Porges, 2004), etc. So, I’m not suggesting that telephone is better than being in person together. Just that, if telehealth is necessary, phone might be an acceptable, or more than acceptable, choice!  

Comment below: Have you had great/not-so-great telephone sessions? What helped you have a good experience? 

 

 

 

 

References

Kraus, M. W. (2017). Voice-only communication enhances empathic accuracy. American Psychologist, 72(7), 644-654. doi: 10.1037/amp0000147

Porges, S. (2004). Neuroception: A subconscious system for detecting threats and safety. Zero to Three, 24(5), 19-24.

Rennung, M., & Göritz, A. S. (2016). Prosocial consequences of interpersonal synchrony: A meta-analysis. Zeitschrift für Psychologie, 224(3), 168-189. doi: 10.1027/2151-2604/a000252

Salazar Kämpf, M., Nestler, S., Hansmeier, J., Glombiewski, J., & Exner, C. (2020). Mimicry in psychotherapy – an actor partner model of therapists’ and patients’ non-verbal behavior and its effects on the working alliance. Psychotherapy Research. Advance online publication. https://doi.org/10.1080/10503307.2020.1849849

Why do we yell? (Just a theory!)

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Why do we yell? (Just a theory!) 

Specifically, this idea came to me during some couples’ work. Why do people yell at each other (and this probably goes for parents/kids, too…) 

Here’s a theory I have. 

Animals vocalize in lots of ways. But when do they “raise their voices”? What does the animal research say about this? (e.g., Seyfarth & Cheney, 2003) First, there are two issues here with my reading of the literature – one is that I’m not super familiar with the comparative (i.e., animal) psyc research and the other is that animal research is always observational and about making inferences – can’t ask them any questions! Just bear that in mind. But from what I can glean, animals probably get loud in three circumstances/for three reasons:

 

  • To demonstrate aggression, especially when they feel underpowered (i.e., actual predators who are about to eat prey are sneaky and quiet, but an animal that is afraid it’s about to get killed or eaten may get loud to try to discourage a predator)
  • To sound an alarm, either to warn others of their kind that there is a danger approaching or to call for assistance
  • As part of display meant to push another animal of its kind down the social hierarchy, in a competitive way 

So, whether or not this is precisely accurate, it has been an interesting topic of conversation with my couples. I explain this idea and then make it a little human…

“Is it possible that when people raise their voices, it’s because they’re feeling underpowered and they need a show a vocal strength because their argument isn’t strong enough on it’s merit? Might they get loud because they feel like they’re in danger and actually crying for help from their partners? Or sometimes maybe they just want to diminish their partner – try to shut them down by proving they’re more important, stronger, or otherwise farther up in the hierarchy?”

Then, after there is some buy-in, I bring it to the personal/situational level: “So when you raised your voice just now (or last night, etc.), which of those reasons resonates most with your experience?”

  • Sometimes they reluctantly identify that they lost their cool because they could tell they were losing the argument. That can open the door for looking at the merits of both positions in the less-intense therapy environment. 
  • Sometimes they reluctantly identify it as feeling in danger and crying for help, and that opens a door for softer emotions from them and softer responses from their partners. 
  • Sometimes they reluctantly admit that they wanted to push their partners down, they just wanted to win. And sometimes they try to wiggle out of that by saying “I raised my voice because they just weren’t listening to me!” (Which is a sneaky way of saying the same thing… I deserved to be heard more than they deserved to be heard.) 

Yeah, no one seems to really jump enthusiastically into any of those explanations. But they give clients food for thought, sometimes they come around later or bring it up in a later session. At the very least, it prompts a discussion about the process of the conflicts, and that’s usually a therapy win! 

 

Comment below: Do you happen to know more stuff about animals (esp mammals) vocalizing loudly? I’d love to hear it! (Not including the monkeys that scream for sex – haha!) Or, how do you help couples begin to address the process rather than just the content of their conflicts? 

 

Seyfarth, R. M., & Cheney, D. L. (2003) Meaning and emotion in animal vocalizations. Ann N Y Acad Sci., 1000, 32-55. doi: 10.1196/annals.1280.004. PMID: 14766619.

Photo credit – Joshua Cotten