When I first picked up Dr. John Sarno's book Healing Back Pain, I thought that there was a chance that I would learn something that would help me feel better, but I never imagined that it would offer me a newer and deeper way to look at certain types of chronic pain. 

Dr. Sarno's theory posits that certain types of chronic back, neck and limb pain, as well as some gastrointestinal issues, which are not relieved by standard medical treatments are largely psychosomatic in nature. Dr. Sarno's belief is that while the pain is certainly felt in the body and physical examination will confirm corresponding areas of tightness, the root cause of the perseverance of the pain stems from one's psychological and/or emotional functioning. The reason for the pain, according to Dr. Sarno, is that this physical pain acts as a type of distraction from the more systemic and less easily identifiable repressed psychological, emotional and oftentimes unconscious issues. 

The treatment for this type of pain (Tension Myositis Syndrome) involves verifying the TMS diagnosis (thus ruling out any abnormal structural causes for the pain), thorough patient education about the way that TMS works, and perhaps most importantly, getting in touch with whatever conscious and unconscious emotional material may be causing discomfort and distress. Many TMS sufferers will attest that once their distressing repressed issues have been adequately addressed, the physical pain no longer has the purpose to distract from the underlying emotional pain and begins to subside. 

To put it another way, with psychogenic pain it is not necessarily one's body that is hurt, although that is certainly where the pain is felt, but rather one's emotional and psychological state has been in some way troubled, hurt or disregarded. Unfortunately most people can go a long time repressing their hurt feelings, often not wanting to or not being able to identify the true source of the pain.  However, trying to identify and treat physical pain, particularly in our highly medicalized society, is less stigmatizing, more widely accepted, and appears, at least on the surface, easier to achieve. It is not surprising then that some of us tend to experience our internal distress in a physical form!

While this type of chronic pain is likely not uncommon, before assuming that one is suffering from such psychogenic pain, it is important to first rule out any structural physical causes of the pain by a qualified medical professional. Here is a list of physicians and therapists who often work with TMS and other mind-body disorders who can help in establishing a diagnosis. Additionally, this TMS forum is a wonderful online community established specifically to support and educate those who may be suffering from TMS. 

After having recently listened to this Invisibilia Podcast titled Entanglement, I thought it would be a good idea to share my thoughts on where the major schools of thought on psychotherapy have been and perhaps where the field may be headed...

A portion of this Podcast neatly outlines the three major schools of thought on thinking and feeling, the first being Freud's theory of the unconscious. In part, this theory posits that most, if not all, of our thoughts and feelings in life stem from our childhood experiences. The predominant change occurs when we can get in touch with the origin of these thoughts and feelings and begin to understand that the circumstances that may have governed their formation way back when, may no longer apply to our daily lives.

The second major school of thought on therapeutic change is Albert Beck's theory of Cognitive Behavioral Therapy, which states that our behaviors and emotions are very much connected to our thoughts. The theory posits that if we are able to notice, change and/or retrain our thinking patterns, our feelings and actions will follow suit. 

The third major school of thought on therapeutic change is generally referred to as Mindfulness Based Approaches, and is currently receiving a lot of attention and research. Such practices focus on teaching individuals to become aware of all thoughts and feelings that may come up and help us learn to accepting them without judgment, hence letting go of ensuing reactions and assumptions.

All three schools of thought mentioned above are widely viewed as helping bring about therapeutic change in different ways. The first school of thought focuses on understanding where the uncomfortable thoughts and feelings come from, in hopes that this insight will update the unconscious thoughts and feelings and make them conscious, thus making them amenable to change. The second and third schools of thought on therapeutic change focus instead on deauthorizing the power of thoughts. Namely that by actively changing thinking patterns, or by accepting our thoughts and suspending judgment, our cognitions will have less power to affect our feelings and behaviors.  

In my experience, there is no one correct way to enact therapeutic change, but instead there is a combination of techniques and methods that can be used in order to help each individual achieve long-lasting change. This I believe, is largely based on where (with thoughts, behaviors, acceptance practices or feelings) the individual feels more comfortable starting their therapy. I do, however, feel strongly that feelings are more basic than thoughts (feelings are preverbal, thoughts are contingent on language), and hence when thoroughly understood and updated, can lead more directly to a more holistic and sustainable change. However, meditation and mindfulness practices as well as retraining one's thoughts and behaviors are wonderful ways to appease certain symptoms and contribute to greater comfort in achieving the insight and understanding that will lead to a come comprehensive paradigm shift. 

If you would like to learn more about modern psychotherapy concepts please visit this blog of my dear friend and colleague, Dr. Richard Kestenbaum. 

This recent NYtimes article describes a number of interesting studies that suggest that the act of writing about oneself and one's experiences may change not only the way that people feel about the events that they portray, but may also alter the way that they feel about themselves. This concept is based on the idea that each one of us has a unique, personal narrative that shapes the way that we see ourselves, others and the world around us.

This personal narrative however, is typically quite static in nature. Unfortunately, once most of us have an idea of who we are, what we are good at, as well as what we expect from the world, we rarely seek out opportunities to alter these assumptions, even when our assumptions are not doing us any favors. Because a lot of our opinions about ourselves and our world are based on very early, sometimes forgotten experiences, we may feel that these ideas have always defined us, and hence we allow them to continue to do so! 

But what if we begin to question the origin of our self concept, thereby challenging our assumptions of what is possible for us? Do we not then give ourselves the chance to redefine who we are, what we are capable of and what we expect from the world at large, by simply being willing to rewrite (or retell) our own personal narrative?

After having recently listented to a RadioLab Podcast entitled "Invisibilia", I was struck by the important role that classifications play in our lives. This episodes follows a genderfluid individual who randomly vacillates between feeling psychologically male and female. While these unpredictable psychological shifts are undeniably stressful, the protagonist of this podcast asserts that the most difficult aspect of this condition is having no clear classification, precedent or diagnosis by which to measure this experience. 

It is not surprising that as social creatures, human beings have an intrinsic need to fit in and belong. However, most people would be surprised to realize just how often they rely on various internalized role-models, whether professional, racial, gender, ethnic, or other, to steer and anchor the various experiences of their lives. In fact, some would argue that this social comparison is, in part, what gives life context, if not meaning. 

But what if there was no prototype, no role-model and no guidelines to help guide one's experiences? While some may feel that this type of uncharted existence allows for a more natural, unanchored experience of life that is free from expectations, few would disagree that having a set of guidelines makes the inherent uncertainty of life much more manageable.

Over the last decade, postpartum depression has received a lot of attention in the media, making women fear that this form of depression is something that naturally happens to many women after they deliver their children. In this recent NYTimes article, David Bornstein dispels some of the myths surrounding postpartum depression, and underlines the importance of treating the symptoms of depression during, and preferably even before pregnancy. 

One of the most important points that Bornstein makes in this article is that only a small percentage of postpartum depressions have something to do with "natural" hormonal changes. In fact, this article states that most postpartum depressions are not isolated forms of depression, and at least some of the symptoms may be present during the life span years before and/or after pregnancy, indicating that delivering a baby may not be the underlying cause of the depression. Furthermore, the risk factors for postpartum depression are the very same as for any type of depression, namely a history of depressive episodes, past and current life stresses, a history of trauma and abuse, interpersonal conflict with primary support group, lack of social support and poverty.

Because only a small number of women get treatment for their depressive symptoms before their baby is born, even when the symptoms are present during the pregnancy, it is important for people to understand that treating depressive symptoms early can mitigate, and hopefully prevent subsequent suffering. The good news is that there are a number of ways to treat the various symptoms of depression during and before pregnancy, and not all of them mean having to take a pill. Studies show that non-pharmacological treatments such as exercise, mindfulness practices, increasing one's support network, and psychotherapy can all decrease depressive symptoms. It is also important to keep in mind that if one's depressive symptoms are such that pharmacological interventions are indicated, there are currently a number of medications that have been approved for use in pregnancy.

Currently offering relationship-based social skills psychotherapy groups for TEENS and YOUNG ADULTS with Asperger's Syndrome and High Functioning Autism and Social Anxiety! 

*         Learn, Practice and Implement Valuable Social Skills.

*         Form Enjoyable Lasting Relationships with Your Peers.

*         Get Professional and Peer Support with Organizational/Practical Life Skills.

*         Talk About Your Particular Experiences and Interests with Peers.

Members:                 Teens and Young adults with ASD's and Social Anxiety

Fee:                            $85.00 per one hour groups session 
                                   * (services may be reimbursable by your insurance)

Where:                      1150 Yale St, Suite 2, Santa Monica, CA 90403

If interested in joining or learning more about this group, please contact Dr. Inessa Manevich at 310.804.6339 or at [email protected] to set up an initial assessment 

The recent news that Facebook had conducted a psychological experiment on unsuspecting users in order to see if it was possible to alter the emotional reactions of users by manipulating content, has undoubtedly sparked people to think about what role, if any, social media plays on people's emotions. Yet perhaps it is the very hope that social media might influence one's emotional state, and perhaps even one's sense of self, that drives so many people to be so invested in it's use, and others, to opt-out.

If one is to assume that friendships are, at least in part, utilitarian in nature, and that each party gets what they need or want from the other, it makes sense to assume that one's on-line connections are also serving some sort of inter-psychic need. While most people certainly use social media in order to get information, stay in touch with friends and for professional networking, it seems to reason that we are also using our on-line selves in order to attain peer validation, support, as well as project the exact version of ourselves that we want to be at the moment.

Take the profile picture for example--is it not exactly the visual that we would like for others to associate with the idea of who we are? Is it not a highly-produced version of our idealized selves, or at the very least, some version of the person that we would like to be? And as we continually update our profile pictures and updates, are we not asking our network whether or not they "like" us, thereby seeking the approval from those who typically have limited real-time knowledge of our "real" lives, and are not necessarily in the best position to provide that validation? It certainly appears that by happily sharing our lives on-line we are also choosing to put some version of ourselves in front of a large number of people who we may or may not really know, in order to see whether or not they like us. Or, more accurately, if they like who we are trying to be. 

Perhaps not wanting to put oneself in the position of being judged by others has something to do with why some folks are so staunchly opposed to social networking. Or it may have something to do with simply wanting to avoid the myriad of feelings, ranging from joy and sympathy to jealously, competition, and even contempt that being privy to the accomplishments and failures of the "produced" lives of one's friends and acquaintances may engender.

It is important for mental health professional treating diverse populations to understand that open self-disclosure in psychotherapy is very much dependent on one's culture. For example, when working with Russian immigrants, the clinician may find some initial distrust and reluctance to "open-up" and to "trust" the psychotherapy process. Instead of acknowledging their psychological stressors and subsequent problems and disorders, research and practice show that both Russians and Russian immigrants are more likely to express their psychological distress in somatic concerns (Brod & Heurtin-Roberts, 1992; Kohn, Flaherty, & Levav, 1989).

Newhouse (2005) explained that “historically, the traumas that befell Russians and Russian Jews were so overwhelming, and strictures on personal expression so unrelenting, that people kept their emotional and psychological pain to themselves and presented a stoic front” (p. 705). He goes on to explain that disclosing personal pain and family problems was often seen as a betrayal to the family system, even if the disclosure is made to a mental health professional. Additionally, although emotional pain and difficulties in adjusting to life in the Former Soviet Union were so prevalent among its citizens (Smith, 1990), talking about this pain was regarded as a sign of weakness, as well as a dangerous statement against the political system. Clearly then, the Former Soviet Union was not a place where psychotherapy was often utilized and valued (Leipzig, 2006), a belief system that may be difficult to disown even after immigration.

Yet studies indicate that immigration, particularly from a totalitarian, repressive society such as the Former Soviet Union, can be a traumatic process, frequently leading to family dissolution, problems with separation and individuation, and mental illness of various kinds (Beckerman & Corbett, 2008; Hsu, Davies & Hansen, 2004; Markowitz, 2003). Likewise, epidemiological studies have documented relatively high levels of depression in different primary care settings in this immigrant group, as compared to the community samples (Hoeper et al., 1979; Katon, 1987). Yet when these immigrants do find themselves in a crisis, usually having to do with a family member’s illness or a child’s problems or a somatic manifestation of their psychiatric distress, they will, though reluctantly, seek the help of a therapist (Newhouse, 2005). It may be crucial then for mental health professional treating this population to understand their historical reluctance to disclose personal information, and be able to provide the patient with “a combination of solid credentials, personal warmth, and a proactive approach” (Newhouse, p. 701). 

*A portion of this blog post was taken from Manevich, I. (2010). The Changing Patterns of Self-Disclosure in Soviet Immigrants.