post-case 11 (pure-o response prevention → lesswrong & shedler)
lead vs silver bullets: fixed-point (flawed useful models in model space)
1/19/24
I told myself I would give myself time to write if I finished a school assignment. I am afraid to put a cap on this, even though I am also afraid it could extend to 3 or 4 hours of ruminating and rambling.
I am starting at 7:42 AM and wil try not to go past 8:42 AM. Just as I trusted myself to reward myself with writing, I trust myself not to over-indulge in the reward, perhaps. I stopped at 8:54 AM, good enough.
One way I mitigated the damage yesterday was with bullet points. Maybe this is more in line with Visa’s advice of taking copious notes for disordered attention.
I do not want to stop school, but I kind of want to change my major (part of me believes this will relieve my worry and lack-of-desire, even though I have done it several times; I have never been humanities major—or as is my most buried desire a (fully online) humanities major)
If I do not want to stop school I have to straddle psychoanalysis and ERP to perform “therapy” myself.
But I need to stop building “clusters in model space” to try finding an “optimal model”
This feels bad, wastes my time, & is a maladaptive safety behavior that needs “response prevention—full stop.
I created a fixed point: self-referential break down.
What cluster of models does the cluster-of-models model belong to?
Is the cluster-of-models model optimal?
Anna would talk about the proletarian borderline personality (whom Lacan or Freud or someone excluded from the hysteric, obsession and neurotitic, psychotic distinctions)
As Anna seemed to put it, a “bordie prole” would be someone like a hair stylist who can tell you at least as much using astrology as Psy.D. could tell you using therapy or counseling, or as much as a CEO founder could tell you with life coaching, business leadership, and so on.
Lately, I feel this “bordie prole” as an “astrologer hairstylist” character playing out in my imagination.
I need to remind myself that I do not benefit from the various permutations of Lacan’s 4 discourses with their 16 fantasies
(even if the discourse of the analyst or Kristeva’s text-practice is a risk of the fantasy of perversion, which analysts work through overcoming via the psychoanalytic training procedures).
There are at least two semi-distinct connections or reasons for this: (1) LessWrong and (2) ERP for pure-O OCD
(1) Yesterday, I perused LessWrong for the first time, only having seen two articles before: (a) the joke article calling continental philosophy an attempt at doing undergraduate math without using any mathematical information or jargon (here), and (b) Anna Salamon’s article “Humans are not automatically strategic”.
I guess this is a lie, I looked at my search history (which clears every 3 months), and there are LessWrong articles dating back to October.
Perusing yesterday, I will exclude posts that did not “spark something in me” (so to speak)
Some articles were more interesting than others, especially (a) “unofficial canon”, (b) “IFS”, and (c) “coercion”
If I were to just think of these in the astrologer hairstylist sense:
(a) CFAR has spoken against an unofficial canon for a number of reasons: success relies on group setting, only partial information, not intended to stand alone, not part of the bootcamp time timeframe obligation, individual biases to fill gaps, and so on.
For me, they say you should put a “taboo” on words you repeatedly use, but this is a compulsion behavior that ERP for pure-O OCD works against.
Also, what I’ve called “gaslighting” as a form of “coercion” is what the unofficial canon calls “urge propagation" (called "double crux" as recently as 2022) (the article admits this one is out of date)
(I think I am conflating here, it is not really coercion in the sense of bullying so much as in the sense of getting yourself to do something that your system 1 does not want and your system 2 has lost sight of—so to speak)
(b) this IFS is basically Visa’s model of an internal leader who should not coerce the internal term, else he will lose their trust, but instead the leader must identify what he wants through internal dialogue, then use MVP (“minimal viable product”) to motivate this.
(c) this point dovetails with the other two, “urge propagation" (again, called "double crux" as recently as 2022) from the “unofficial cannon” and Visa’s quasi-IFS linking to his MVP all relate to coercion
“It is currently in flux and has no formal research backing, but it follows logically from a handful of other threads about which CFAR is relatively confident (such as microhedonics, hyperbolic discounting, cognitive behavioral therapy, and useful-even-if-wrong theories like internal family systems or society of mind).”
I’m outsourcing this to an LLM summary. See the notes below.
I have less than 15 minutes left in this hour, and I need to touch on the instrumental limits of ERP for pure-O OCD
See LLM prompted summary of “Exposure and Response Prevention (ERP): How to Motivate Myself to Get Started” in notes below. Shameful sludge
Tl;dr I’ve had a hard time with the symptoms, and the treatment (while heavily flawed) worked for me (to the extent it could) in the past
See LLM prompted summary of “Pure-O OCD: How Can ERP be Effective if I Don't Have Any Compulsions?” in notes below. Shameful sludge
Intentionally think triggering thoughts without distraction. Assume feared thoughts are true; avoid seeking reassurance. Expose yourself to triggering thoughts through voice recordings or imaginal exposure stories. Gradually confront avoided people, places, or objects. Approach feared thoughts without seeking relief. Allow discomfort to rise without attempting to control it. Recognize that any effort to control is a compulsion maintaining OCD symptoms. Be vigilant for subtle rituals, especially mental compulsions.
What if the response preventions become safety behaviors?
E.g., cannot counter bad thought with good thought, so accept bad thought—what if accepting bad thought becomes a form of countering a thought?
How’s this relate to vitalism & post-Nietzschean affirmation?
How can I work in clinical psycho analytic methods?
Fill in for short-sights of self-help, business leadership, LW, ERP?
Recognizing defense mechanisms, etc
That Was Then, This is Now: Psychoanalytic Psychotherapy for the Rest of Us (2006)
See notes for LLM summary
1/18/24
Ex nihilo
I am tired of tallying my personal history.
I am tired of lining up everything in tables.
“My question”: Sawyer Effect & Singer.
“My fall”. JB Peterson: Naive stoicism & Jung.
Img: Bartholomew flayed
Maslow and Frankl.
Naive Freud, Nietzsche, Kierkegaard.
Natalie Wynn: Dennet’s chmess, the west & PMNM
Img: Caged bird
Living on skid row
Studying English
“My humble worker” (get what you need, give what you’re given)
Psychotic Freud, Nietzsche, Kierkegaard.
ERP
Dr. Essig: “My humble worker II”
Rick Roderick: Self under siege
Paul Ricouer Masters of Suspicion
Slavoj Zizek: Lacan and Hegel
Yung Lean: cloud rap, all confessions are meaningful
Gilles Deleuze: Difference and Repetition
& Felix Guatarri: Anti-Oedipus, A Thousand Plateaus
Becoming imperceptible, lines of flight
Julia Kristeva: Revolution in Poetic Language, Powers of Horror, The Black Sun
text-practice (!), abjection
Narcissistic melancholic lacks the drive for symbolic engagement, making their grief incommunicable
Losing Anna: Buddhism, Écriture féminine, Karatani
WHat’s next?:
Visa’s MVP (minimal viable product), IFS (internal family systems)
Regression to MBTI, Jung: INXJ, Ni
Not Andre Green.
Maybe Winnicott, Hillman, Stengers
Identifying “fungus” as above
Recursion, duality, quadrats, hierarchy, transcendence “around mountain”, taxonomy, permuting, genus-species
Fungus creates ruts. Recent ruts:
Mad genius mathematicians. Nash, Gödel, Grothendieck, Newton, Boltzmann, etc.,
Math-is-math. Erdos, Terrence Tao, Jay Cummings
Math is poetry
Literature, philosophy, math fanboy and hater
Hippy librarian blogger
Clusters in “mental industry” space
I have a hard time enjoying my work
How much longer faking until I make it?
—hard time valuing my work
I can justify it, empathize with it.
I feel like I need to coerce myself to do my work.
Is minimizing coercion worth it?
How does coercion effect self-trust?
How does coercion effect desire for long-term goals?
Is there a non-coercive part of myself with the same long term goals?
Can I use LessWrong rationalist methods to motive long term goals without self-coercion?
Urge propagation
Stop over-rationalizing, over-intellectualizing
Is all self-coercion bullying?
I am looking for a silver bullet. The lead bullets are (1) out-patient care or (2) “white knuckling”— or (3) some secret third method (a disguised silver bullet) for wanting more and caring less.
I exclude the fantasies (humble worker, LPMFH, & hippy librarian blogger)
Is part-time hours a placebo? Is it psychosomatic?
What can a “blogger” learn from Proust, Virginia Woolf, James Joyce?
I think I have hit bedrock. Can I perform inception on myself now?
Does Mode of Exchange D require Maslow’s transcendence as text-practice?
ERP posits that: you are caught up in your actions
To change your actions, you must (in a very specific, clincial way) act differently
Thoughts and feelings are only feedback used to calibrate exposure scenarios and response prevention techniques
Even on LessWrong, they distinguish between epistemic and instrumental rationalities, like physics and engineering
Even the best engineers do not need to get into the weeds of physics\
I do not want to get into stereotypes
But I saw myself as a theorist, as someone who contributes theory
I think I am more “emotional” (prefering empathy to strategy)
Notes
Pros-cons self-coercion
This is an LLM assisted summary of this (https://www.lesswrong.com/posts/HDHqvf9vMqSXEBCLh/would-most-people-benefit-from-being-less-coercive-to).
Matt Goldenberg advocates for a motivational system known as non-coercive motivation, which eliminates reliance on force, pressure, shame, or guilt. The benefits of being less coercive hinge on individual goals and circumstances. In situations with slack, those inclined towards an enlightenment orientation may find value in focusing on non-coercion. However, individuals with a heaven orientation (aiming for achievement/saving the world) should consider their current productivity levels. The relevance of non-coercive motivation in self-actualization depends on one's vision of the ideal self. Hypothetically, removing coercion effortlessly may not be universally beneficial, as non-coercive motivation entails replacing coercive structures with positive ones. Matt Goldenberg addresses common objections, including concerns about productivity, messiness, and challenge, underscoring the nuanced nature of non-coercive motivation. The moral dimension is explored, proposing that a non-coercive environment could mitigate trauma and foster happiness, potentially outweighing negative effects on morality. Ultimately, the concept of true non-coercion is depicted as free from resistance or internal conflict.
Urge propagation
Urge propagation is a motivational technique designed to bridge the gap between long-term goals and immediate actions. It involves understanding what your conscious mind (System two) wants and aligning it with your automatic responses (System one) through methods like operant conditioning. The challenge in pursuing goals, such as losing weight or learning an instrument, lies in conflicts with immediate urges driven by System one. These conflicts often lead to a loss of motivation during the pursuit of unpleasant intermediate steps. Urge propagation aims to make long-term goals feel like short-term urges by rewiring the brain to associate actions with specific rewards. The process includes identifying situations where rewards are distant from actions, associating activities with strong feelings of reward, and creating vivid mental images linked to those rewards. This technique can be applied to discourage bad habits by introducing delays between actions and rewards. The realization that small aversive moments significantly impact choices and motivations is a key insight of urge propagation. In summary, the process involves finding reward-action gaps, associating activities with powerful rewards, and creating compelling mental images to enhance motivation.(source)
Center For Advancing Rationality vs LessWrong
LLM assisted summary of (source)
1. Epistemic versus Instrumental Rationality:
- Distinction between normative epistemic and instrumental rationality methods (Bayesian inference and expected utility maximization).
- High-level rationality concepts like "use Bayes' Theorem" can be too abstract for practical application.
- Analogy: Epistemic rationality is like physics (figuring out what's true), and instrumental rationality is like engineering (accomplishing goals efficiently).
- Essential building blocks of rationality (e.g., emotional awareness, thought experiments) are crucial for both epistemic and instrumental goals.
2. Modular Mind:
- The human mind consists of multiple processes that often operate independently.
- Coordinating between implicit-reasoning System 1 and explicit-reasoning System 2 is essential.
- Techniques focus on achieving coherence between different cognitive systems.
- Metaphor of anthropomorphized systems aids in understanding and addressing cognitive conflicts.
3. Focus on Emotions:
- Emotions play a central role in CFAR's curriculum.
- Putting oneself into specific emotional states facilitates various aspects of rationality.
- Emotional awareness aids in overcoming inertia, exploring diverse actions, and conquering motivated cognition.
- Emotions serve as valuable data sources for understanding implicit expectations and checking System 2's conclusions.
- CFAR emphasizes the importance of noticing and understanding emotional states for effective decision-making.
Conclusion:
- Both CFAR and Less Wrong diverge from traditional rationality by focusing on methods that systematically perform well.
- CFAR's perspective on rationality is expected to evolve as more insights are gained from rationality training efforts.
Internal Double Crux
LLM assisted summary of Internal Double Crux
- Title: LW CFAR Handbook Internal Double Crux by CFAR!Duncan
- Date: 21st Jul 2022
- Read Time: 15 min
- Comments: 15
- Technique: Internal Double Crux
- Purpose: Find motivation through truth-seeking instead of coercion or self-deception.
- Order of Teaching: Advocates teaching internal double crux before external double crux for better results.
- Epistemic Status: Preliminary/tentative
- Description: Technique-in-progress related to microhedonics, hyperbolic discounting, cognitive behavioral therapy, and other theories.
- Principle: If two people with the same information make different predictions, at least one is incorrect. Applies to individuals with contradictory beliefs or desires.
- Outcome: Chance to update beliefs toward the truth.
- Conflict Example: Wanting to get good at running but not wanting to put on running shoes and get off the couch.
- Internal Double Crux Goal: Resolve conflicting beliefs by incorporating information from both perspectives.
- Sub-Agents Concept: View oneself as composed of sub-agents with different goal subsets and perspectives.
- Objective: Facilitate a productive double crux conversation among sub-agents to correct tunnel vision.
- Desired Outcome: Both sides of internal disagreement update toward truth, leading to intrinsic motivation and internal harmony.
- Result of Process: Reduced need for duty or force-of-will, aligning urges with actual goals.
- Technique Purpose: Early version for turning wanting to want into straightforward wanting.
- Understanding "Shoulds": Addresses the tendency to arbitrarily support some sub-agents while suppressing others.
- Challenge: People may label motivated aspects positively and lazy aspects negatively, creating internal conflict.
- Shortcut Effectiveness: Ignoring conflicting urges is a shortcut but has a cost.
- Costs Involved: Ignores signals from part of belief set, expends energy on internal conflict, and executive overrides.
- IDC Approach: Encourages updating and integrating conflicting urges instead of suppressing them.
- Goal: Give conflicting urges an impartial hearing before deeming them inappropriate.
- Example - Running Beliefs: Belief in the goodness of exercise and running as the best way to exercise.
- Challenge in Practice: Ruins enjoyment when watching Netflix, leading to internal conflict.
- Productive Reframe: Instead of labeling as "lazy" or "struggling to stay motivated," acknowledge conflicting beliefs.
- Understanding the Situation: Recognize the belief that watching Netflix is also considered a good activity.
- Causal Reasoning: Beliefs are responses to past experiences; the pressure-toward-Netflix stems from a belief in its value.
- Not Lazy, but Tunnel Visioned: The part pushing for Netflix fails to consider long-term health or commitment follow-through.
- Tunnel Vision Acknowledgment: The urge to get off the couch or stay on it reflects tunnel vision, discounting the value of relaxation or hedonism.
- Internal Disagreements Characterization: Describes internal conflicts as "shoulds."
- Definition of "Should": In the context of any default action, a "should" is an urge or pressure to do something else.
- Examples of "Should" Scenarios:
- Struggling with criticism approach despite deciding to be more gentle.
- Feeling resistance to writing the seventh chapter of a book despite its importance.
- Procrastinating on learning something despite the desire and available opportunities.
- Potential Regrets in Different Scenarios: Each action may lead to a sense of should-have-done-something-else.
- Common Default Approaches: People often default to defending inner emotional selves, conforming to social expectations, sticking to the plan, or being flexible and changing the plan.
- Problem with One-Size-Fits-All Solutions: Such solutions miss a large percentage of the time, and deciding without considering arguments leads to inaccurate beliefs.
- Nature of "Shoulds": Shoulds are considered data, and aspiring rationalists seek more data.
- Comparison to Regular Double Crux: Similar to regular double crux, internal double crux encourages openness to all aspects of motivational structure.
- Psychic Components: Different parts of the psyche excel at paying attention to various evidence aspects.
- Complexity Acknowledgment: Given the world's complexity, synthesizing conclusions from different aspects is assumed to be more accurate.
- Analogy - Maze Agents: Agents at the top and right, representing different urges, have unique perspectives in a maze analogy.
- Running Urge's Strengths: Focus on long-term goals, social standing, health, and self-perception as a strong and capable person.
- Netflix Urge's Strengths: Attention to short-term urges, energy levels, comfort, and the potential enjoyment of a new episode.
- Consequence of Ignoring Sides: Ignoring either side leads to feeling torn, halfhearted, decision struggles, willpower drain, suffering from decisions, and internal conflict.
- Strategy for Understanding the World: To build a detailed understanding and strategize effectively, all models—implicit, explicit, S1, S2, endorsed, embarrassing, vague, and exact—must be considered.
- Effective IDC Learning: Participants benefit from following a specific format for initial attempts.
- Importance of Trying as-Written: Recommended to try IDC as-written initially, as there's some experience-dependent magic.
- Example Steps for IDC:
- Step 0: Identify an internal disagreement, a "should" counter to the default action.
- Step 1: Take a piece of paper, draw two dots at the top representing two perspectives/sub-agents, and name them.
- Step 1(b): Check names for resonance and fairness, as you're moderating a debate between different perspectives.
- Visualization Approach: Imagine the perspectives as distressed, angry kindergarteners, each focused on its priorities.
- Moderator Role: Act as the moderator, ensuring impartiality and not taking sides in the disagreement.
- Objective: Convince both sides to bring their perspectives to the table, incorporating all information into a larger world model.
- Caution: Avoid secretly aligning with one side and helping it overpower the other; maintain openness to both perspectives.
- Sympathy Allowance: It's acceptable to have more sympathy for one side but remain impartial in the process.
- Awareness of Default Sympathy: Acknowledge any default sympathy toward one perspective but correct for it in the internal double crux game.
- Compensatory Support: Provide additional support to the less-favored perspective, offering balanced consideration.
- Moderator's Bias Example: Moderator is on "Team Go Running," evident from the choice of words like "laze around" for the alternative.
- Step 2: Decide Who Speaks First:
- Identify urgency or louder clamoring from either side.
- If unclear, flip a coin to decide.
- Step 2(b): Embody the Perspective:
- Step into the mindset of one side and say one thing.
- Moderate the flood of words into something productive and comprehensible.
- Connect with what it's like to hold that value and speak from that viewpoint.
- Usual Prompt: Identify one important thing the other side doesn't understand, a crucial missing piece from their model of the world.
- Embodying Viewpoint: Actively connect with the perspective, avoid a detached performance, and produce authentic sentences.
- Previous Section's Skills: Skills from the Focusing section are useful for ensuring resonance with the perspective.
- Step 3: Get the Other Side to Acknowledge Truth: Encourage the other side to acknowledge the truth presented by the first perspective.
- Exercise Aim: Cause each perspective to absorb the truth/experience of the other.
- Moderator's Role: Encourage each side to start its turn by finding some grain of truth in the other side's point.
- Encouraged Acknowledgment: Doesn't have to be complete; can be a logical consequence or underlying assumption.
- Step 4: Side Adds Its "One Thing":
- Acknowledging the other side's point, the side presents its objection.
- Expression doesn't have to be full, coherent sentences; can be visual, scribbles, or simple words.
- Moderator nudges the conversation back on track but allows flexibility without imposing strict restrictions.
- Step 5: Repeat:
- Back and forth between sides.
- Each side acknowledges truth in the previous entry and adds a new perspective.
- Flexibility Note: Sometimes discussions may deviate from the plan, such as quick pacing or inadequate acknowledgments.
- Moderator's Response to Issues:
- Pause and examine the previous statement to guide the conversation.
- Correct off-script or against-the-rules occurrences, bringing the discussion back to productivity.
- Flexibility Principle: Allow deviations, but steer back toward productive discourse.
- Handling Blue Side's Minor Meltdown:
- Let the meltdown occur without pre-censoring.
- Give the blue side a chance to express disagreement before requiring an acknowledgment of the other side's point.
- Rule-Breaking Example: Orange broke rules by skipping to objection and providing multiple points.
- Benefit of Writing Moderator Interjections: Some participants find it helpful to write moderator interjections, clarifying rules during the process.
- Problem Unveiling: Over the back-and-forth, deeper and more interesting problems often reveal themselves.
- Underlying Disagreement: The initial question of "should I go running or keep watching Netflix?" represents a deeper and more complicated dynamic.
- New Sheet of Paper Technique: Recognizing the underlying disagreement often leads to drawing new dots with new names on a new sheet of paper, providing tremendous value.
- Understanding Deeper Generators: Gaining insight into deeper sources of dissatisfactions and internal conflict improves the chances of effective solutions.
- Purpose of Many Rules: Rules exist to address the root of the problem in resolving internal disagreement.
- Metaphor of Kindergarteners: Like forcing two kindergarteners to stop fighting, traditional methods may cease-fire but lack a genuine resolution.
- Cease-Fire Dependence on Authority: Cease-fires relying on external enforcement are fragile and dependent on continued authority presence.
- Value System Brute-Force Approach: Repeatedly overpowering one part of the value system with another leads to patchy cease-fires and energy/willpower drain.
- Process Outcome: A process that makes inner models understand each other leads to less conflict, imbuing wisdom and virtue into each part.
- Advantage of Rules-Based Approach: Surprisingly useful for a large fraction of participants, reducing conflict and better supporting higher strategic goals.
- Encouragement to Tinker: Participants are encouraged to tinker with or iterate on the technique, or try other methods before personalizing IDC'.
- IDC Algorithm - Step 0: Find an internal disagreement.
IDC Process:
1. Identify a "should" counter to your default action or a belief you secretly hold.
2. Find a charitable handle for each perspective.
3. Embody one perspective and write down one thing the other perspective fails to consider.
4. Embody the other perspective, acknowledge one grain of truth in the previous side's point.
5. Still embodying the second perspective, offer one counterpoint for the first side to consider.
6. Repeat steps 3 and 4 until the disagreement dissolves or transforms. If useful, start over with step 1 with new names.
IDC - Further Resources:
- Psychological Model: Carver and Scheier (2002) use the control systems theory to model goal pursuit and its connection to feelings that motivate behavior.
- Reference: Carver, C. S., & Scheier, M. F. (2002). Control processes and self-organization as complementary principles underlying behavior. Personality and Social Psychology Review, 6, 304-315. [Link](http://goo.gl/U5WJY)
- Openness to Information: People are more receptive to information inconsistent with their beliefs when in a mindset valuing objective thinking and evidence updating.
- Reference: Cohen, G.L., Sherman, D.K., Bastardi, A., McGoey, M., Hsu, A., & Ross, L. (2007). Bridging the partisan divide: Self-affirmation reduces ideological closed-mindedness and inflexibility in negotiation.
- Focusing Practice:
- Source: Journal of Personality and Social Psychology, 93, 415-430. [Link](http://goo.gl/ibpGf)
- Description: Introspective practice systematized by psychotherapist Eugene Gendlin.
- Objective: Build communication and feedback between a person's "felt sense" and verbal explanations.
- Method: Query inner simulator and related parts of System 1.
- Resource: Gendlin, E. (1982). Focusing. Second edition, Bantam Books. [Wikipedia](http://en.wikipedia.org/wiki/Focusing)
- Internal Family Systems (IFS):
- Description: Psychotherapy by Richard C. Schwartz, conceptualizing the mind as a set of parts or subpersonalities.
- Characteristics: Each part has its perspectives, interests, memories, and positive intent for the overall person.
- Approach: Utilizes family systems theory metaphorically to understand subpersonalities' organization and interaction.
- Resource: Schwartz, R. (1997). Internal Family Systems Therapy. Guilford Publications. [Wikipedia](https://en.wikipedia.org/wiki/Internal_Family_Systems_Model)
Starting ERP for OCD
See LLM assisted summary of “Exposure and Response Prevention (ERP): How to Motivate Myself to Get Started”
1. Generate a List of Motivators for ERP:
- Identify reasons for starting Exposure and Response Prevention (ERP) treatment.
- Ensure these reasons outweigh reasons against engaging in ERP.
- Reflect on questions like why you sought OCD treatment, the impact of OCD on your life, and what you might miss out on.
2. Read Success Stories:
- Find inspiration and hope from success stories of individuals who overcame fears and doubts about ERP.
- Understand that the goal of ERP is not enjoyment but hard work leading to long-term joy and accomplishment.
- Acknowledge that ERP involves short-term discomfort for long-term benefits.
3. Reflect on Past Challenges:
- Recall past challenges that initially seemed overwhelming or insurmountable.
- Use past experiences as evidence that thinking about overcoming a challenge does not necessarily align with the ability to overcome it.
- Recognize that anxiety/discomfort in ERP is not dangerous but merely annoying, challenging OCD's lie about intolerance to discomfort.
4. Take the First Step:
- Acknowledge that getting started is often the hardest part.
- Recognize ERP as challenging but not insurmountable.
- Start with a low-level exposure exercise to understand your tolerance for discomfort and gradually progress.
Additional Considerations:
- If hesitant, evaluate if the timing is right and if emotional investment is possible.
- Revisit and recommit to ERP when the timing is suitable.
- Acknowledge that situations, commitment levels, and symptoms change over time. ERP will be available when the timing is right.
ERP for Pure-O OCD
- Understanding Pure-O in OCD:
- Pure-O describes OCD without overt, ritualistic behaviors, focusing solely on obsessions.
- The term is a misnomer as it overlooks mental and subtle physical compulsions often unnoticed.
- Compulsions are acts relieving discomfort from intrusive thoughts, images, or feelings.
- Less-Obvious Compulsions:
- Mentally replaying events, neutralizing bad thoughts with good ones, self-reassurance, seeking reassurance.
- Silent prayer, counting, avoidance (physical or mental), and other subtle rituals.
- Applying ERP to Pure-O:
- Exposure and Response Prevention (ERP) is effective for Pure-O cases.
- Compulsions fuel OCD, and ERP focuses on reducing or eliminating them.
- Specific ERP exercises are tailored to individual thoughts and behaviors.
- Examples of ERP Exercises for Pure-O:
- Intentionally thinking triggering thoughts without distraction.
- Assuming feared thoughts are true, avoiding reassurance seeking.
- Exposure to triggering thoughts through voice recordings or imaginal exposure stories.
- Gradual confrontation of avoided people, places, or objects.
- Key Principles of ERP:
- Approach feared thoughts without seeking relief.
- Allow discomfort to rise without controlling it.
- Recognize that any attempt to control is a compulsion maintaining OCD symptoms.
- Summary:
- ERP is effective for Pure-O cases.
- Be vigilant for subtle rituals, especially mental compulsions.
- Regardless of OCD thoughts or compulsions, ERP offers relief with proper guidance and effort.
Shedler “That was Then…”
Self-canibalized from: post-case 1 (Spinoza vs Winnicott)
This summary was assisted via LLM prompting.
Much of our mental processes occur unconsciously, beyond our awareness. Cognitive science has shown that memory, perception, judgment, emotions, and motivations often operate implicitly. While cognitive scientists use terms like "implicit" and "procedural" memory, psychoanalytic discussions emphasize that there are things we may not want to know about ourselves, especially if they are threatening or dissonant. The author shares an example of an interview with someone, "Jill," who seemed unaware of the deeper implications of her sister's behavior and her father's actions during childhood. The emphasis is on the notion that individuals may selectively avoid acknowledging certain aspects of their experiences, possibly as a coping mechanism to maintain a sense of safety and security. This is distinct from the concept of "repressed memories," which has been misunderstood and misattributed to psychoanalytic therapy. The goal of psychoanalytic treatment, as described, is to promote mindfulness in the present rather than uncovering repressed memories.
In psychoanalytic psychotherapy, it's suggested that many psychological difficulties were once adaptive solutions to life challenges, even if they were costly. Problems arise when these old solutions become ineffective or self-defeating due to changing circumstances. Another key concept is the idea that individuals can have conflicting feelings and desires about the same things. Psychoanalysis provides a vocabulary to discuss inner contradictions and techniques to alleviate suffering by addressing these conflicts. Conflict, in this context, refers to inner contradiction rather than opposition between people. People often try to resolve these conflicts by suppressing certain feelings, but these suppressed feelings may still impact behavior. Conflicts around intimacy and anger illustrate how individuals may struggle with contradictory desires and emotions. Psychoanalytic psychotherapy aims to cultivate wisdom by helping individuals hold contradictory ideas in mind and function effectively despite inner conflicts.
Shedler discusses a patient whose parents were Holocaust survivors and had sacrificed a lot for his success. The patient struggled with expressing anger toward his parents and instead treated others poorly. Through therapy, he learned to acknowledge his anger while still feeling love and gratitude. Shedler also mentions passive-aggressive behavior as a way to express disavowed anger. Examples include burning dinner or being consistently late. Shedler describes ambivalence and inner conflict, using examples like a toddler's charming yet contradictory behavior and patients with bulimia expressing conflicting desires through bingeing and purging. The concept of inner conflict is acknowledged in various therapy traditions, including cognitive therapy and humanistic therapy. Cognitive science research, particularly by Daniel Kahneman, supports the idea of competing cognitive processes, aligning with Freud's descriptions of conscious and unconscious mental processes in psychoanalysis.
Shedler explains how early experiences shape templates or scripts about the world, influencing expectations and behaviors in relationships. People often apply these scripts to new situations, repeating aspects of the past. Examples include a person drawn to emotionally distant partners due to a distant father or someone creating physical symptoms to seek attention. Shedler describes a pattern of recreating past roles, like victims, abusers, and rescuers, in adult life. The impact of past experiences on present perceptions and reactions is discussed, emphasizing that individuals interpret events through the lens of their past. Different therapy traditions, such as cognitive therapy, systems-oriented therapy, and behaviorism, all recognize the influence of the past on present experiences.
The main goal of psychoanalytic psychotherapy is to free individuals from the influence of past experiences, allowing for new life possibilities. The concept of transference is discussed, where patients apply their preexisting expectations and experiences to the therapist. Patients often perceive the therapist in various ways, influenced by past relationships. Transference is seen as crucial in therapy, as it allows patients to examine, understand, and rework old patterns and expectations. Shedler gives an example of a patient whose abusive father shaped his distrustful and defensive attitudes, which were automatically transferred to the therapist. The therapist views transference as central to the patient's recovery, helping them recognize and address ingrained relationship patterns.
In psychoanalytic therapy, the patient's transference, or the application of past expectations to the therapist, is deliberately emphasized for therapeutic purposes. The therapist helps the patient recognize and understand these patterns, using them as a means for change. Shedler considers how therapy elicits strong transference reactions, as it is not just another relationship but stirs up powerful emotions, longings, and dependencies. The therapist becomes a focal point for unresolved feelings toward early caregivers. Empirical research supports the effectiveness of therapists who recognize and use transference, even in therapies that do not officially acknowledge it. The therapy situation, with its ongoing and intense nature, psychologically recapitulates early caregiver relationships, making therapy a potent arena for addressing unresolved emotions. Shedler explains factors such as the frequency of meetings and the one-sided communication in therapy that intensify transference feelings and contribute to its therapeutic potential. Many therapy approaches now acknowledge the importance of addressing and utilizing problematic relationship patterns in the therapeutic relationship.
Therapists from different schools, including cognitive therapists and radical behaviorists, are increasingly recognizing the importance of patients' emotional reactions to the therapist, akin to the concept of transference in psychoanalysis. While convergence among therapy approaches is expected, there's concern when terms like Clinically Relevant Behavior (CRB) are introduced for phenomena well-established in psychoanalysis. Shedler also acknowledges postmodern perspectives in psychoanalysis that emphasize the reciprocal influence between patient and therapist, cautioning against dogmatic interpretations of transference. It underlines the undeniable impact of personal histories on therapeutic interactions and emphasizes that both patients and therapists bring their past experiences into the therapy room. The concept of defense is introduced, explaining how individuals avoid unsettling thoughts or dissonance through various mechanisms, and the term "disavow" is suggested as a more helpful alternative to "repress" in describing this process.
Jill, previously discussed in the context of unconscious mental life, disavowed her father's abuse by keeping thoughts about her family vague. This defensive strategy, habitual and reflexive, helped maintain psychological equilibrium. Another example involved a patient avoiding recognition of his desire for nurturing by choosing cold partners, serving a defensive function to avoid confronting tender feelings. Shedler illustrates how various emotions and thoughts can act as defenses against others, such as anger defending against abandonment or depression as a defense against anger. Defense mechanisms, like projection, reaction formation, denial, intellectualization, counterphobic behavior, displacement, and others, serve to avoid distressing realities. Shedler describes external reinforcement for certain defenses, exemplified by patients attributing their struggles to a "chemical imbalance" to avoid self-examination. This defense is perpetuated by pharmaceutical marketing and trusted medical sources, hindering potential therapeutic exploration of psychological factors underlying their suffering.
Psychoanalytic psychotherapy explores defense mechanisms, which are ways individuals unconsciously protect themselves from unsettling thoughts. Challenging patients' convictions directly isn't recommended; instead, encouraging curiosity and self-reflection proves more effective. The term "defense mechanism" may sound mechanistic, but it's better understood as actions people take to defend themselves. These defensive styles become woven into personality, influencing thinking, feeling, and relating. Psychoanalytic therapy aims to recognize and address these defenses, expanding freedom and choice by reclaiming aspects of experience. However, the desire to deny responsibility can hinder change. Therapy involves navigating patients' ambivalence toward change, as individuals often oscillate between the desire for change and the desire to preserve the status quo. The ongoing tug-of-war in psychotherapy reflects this paradox, with therapists aligning with forces seeking growth despite the resistance inherent in the therapeutic process.
Resistance and defense mechanisms play a crucial role in psychoanalytic therapy, representing the internal conflict within the patient. Resistance occurs when defensive processes hinder the shared exploration in therapy. It's essential to view resistance non-judgmentally and ally with the patient's growth-seeking aspects. Defense, conflict, and unconscious mental life are intertwined, with the dynamic unconscious actively seeking expression. Symptoms that may appear random or senseless often hold psychological meaning and serve a purpose. Psychoanalytic therapy helps individuals recognize connections between thoughts, feelings, actions, and events, leading to a better understanding of their experiences and the potential resolution of symptoms.
Patients' seemingly senseless or random behaviors often have underlying psychological meanings and associations. Psychoanalytic therapy involves exploring these associations to understand the deeper layers of the individual's experiences. For example, one patient's resistance to taking medication revealed a fear of being weak, linked to childhood associations with a sickly younger brother. Another patient's eating binges were connected to complex emotions, such as anger toward her controlling husband, emotional deprivation, and self-punishment. Psychoanalytic therapy recognizes the multifaceted nature of mental life, rejecting one-size-fits-all approaches and relying on empathic inquiry into the intricacies of each individual's inner experience. The therapeutic process involves unraveling the complex web of meanings attached to behaviors, leading to increased self-awareness and improved psychological well-being over time.
Psychological symptoms and mental events are intricately connected within organized networks of thoughts, feelings, and memories. Psychoanalysis assumes that nothing in the mind is random, operating under the premise that the mind is an elaborate associative network. This network, similar to the internet, is emotionally charged, with associations leading to what is troubling or problematic. In therapy, the technique of free association encourages patients to express thoughts without editing or censoring, allowing implicit associative linkages to become explicit. Freud, a pioneer in tracing associative links, demonstrated the value of unraveling psychological meanings through associative connections. While free association may lead to unexpected places, it serves the purpose of making hidden associations visible and aiding the therapeutic process.
Free association, a key technique in psychoanalytic therapy, is challenging for those who seek composure and control. Descriptions of therapy as mere "venting" or akin to casual conversation are seen as devaluing the profound and non-ordinary nature of psychoanalytic therapy. A case example illustrates the power of free association when a patient's slip of the tongue led to uncovering repressed thoughts about the therapist's potential homosexuality. The non-randomness of mental processes is termed psychic determinism or psychic continuity, emphasizing the meaningful associative sequences of thoughts and feelings. Contrary to misconceptions, psychoanalytic therapists believe in human capacity for growth, change, and increased freedom. The chapter's use of the first-person plural "we" considers shared experiences in the therapeutic process.
Psychoanalytic therapy emphasizes the shared humanity of both therapist and patient, rejecting hierarchical dynamics. Therapists view their role as a collaborative effort, recognizing the power imbalance inherent in the relationship. Psychoanalysts approach their work with deep humility, acknowledging the limitations of understanding and the shared struggles of humanity. The therapist's qualities include intelligence, professional knowledge, empathy, and a willingness to introspect. The importance of therapists undergoing meaningful psychotherapy themselves is emphasized, fostering empathy, understanding transference and resistance, and preventing the reenactment of personal pathology with patients.
Therapists who struggle with unresolved personal issues may inadvertently influence their therapeutic approach. For instance, those with problems related to gender may join patients in criticizing the opposite sex instead of fostering self-understanding. Therapists dealing with self-esteem issues might subtly demean patients or offer superficial affirmations. Such conflicts can manifest subtly in therapeutic relationships. Engaging in meaningful personal therapy is essential for therapists, fostering faith in the therapeutic process and conveying hope to clients, a crucial element in their recovery from emotional suffering.
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