I am not worthy of love.  I am not capable of getting the love I need without being angry and clingy.  Others are capabale of loving me but might not do so because of my flaws.  They might abandon me.  I am poor at getting the love I need and I must please my loved ones or I will be worthless and unlovable. 

The ambivalent attachment style often leads to unhealthy dependent relationships on others.  The framework of thinking that leads to dependency goes something like this;

I am incompetent. I struggle to handle things on my own.  I need strong protection.  The world is cold and dangerous.  I am flawed and on one could like me.   Every failure verifies I am flawed.  When someone rejects me, it proves I am flawed. 

Know someone like this?  It’s important to re-frame our thinking and realize that we are competent and we everyone has flaws.  Failures do not confirm a flaw.  It simply means that we have to try again.  It also means that this is not something inherently wrong with us but rather signals that we may have had one or more parents that were inconsistent in “being there” when we cried out for a safe harbor.  That’s not your fault.  It was something you needed as a child and didn’t receive.

In the avoidant style of relating, the child learns that he can’t depend on parents for a safe harbor. The child then develops a “survival” style of relating and develops self-talk that goes something like this:

I am capable of love, but others are not able to love me.  I am worthy based only on my accomplishments.  I depend on my own self and abilities in order to succeed.  Others are unwilling or unable to love me.  I must rely on self.  Others are not trustworthy, others are unreliable.

You can easily see that if one develops this framework of thinking, it will be devastating to relationships.  How can I relate to people when I have a deep mistrust of everyone?

If you recognize these traits and style of relating in your own life, you can re-frame to tell yourself the truth.  The truth is that “I couldn’t rely on my parents at times however, I can trust some people.  Everyone is not like my parents.  I am worthy in God’s eyes regardless of my accomplishments.  I will depend on God to provide direction and assistance.  I can trust God.  I may not have been able to trust or rely on my parent(s) but I can rely on God.

Often this framework of thinking has been in place for a number of years.  Reframing may be difficult and require intense practice, but the truth is….you can do it.

“the infant and young child should experience a warm, intimate, and continuous relationship with his mother (or permanent mother substitute) in which both find satisfaction and enjoyment”

This formed the basis of his attachment theory.  The theory basically says that children develop a framework of thinking about their self worth, about others, about their trust in others, and trust in themselves as a result of the child’s ability to have basic needs met by the parents (and mother in particular).

There are four basic attachment styles or ways in which we enter relationships.  The secure, the avoidant, the ambivalent, and the disorganized.

I’ll address one of these today and others to follow.

The secure attachment style says “I am worthy of love, I am capable of love, and others are willing and able to love me.”  The truth is, regardless of how well your needs were met as a child, you are still are worthy of God’s love, you are capable of love, and others can love you.

People that struggle in relationships probably are acting out the other styles of relationship, ie. the avoidant, ambivalent or the disorganized.    More tomorrow.

Many people who have developed a framework of thinking since early childhood hold onto beliefs,  feelings, and ways of thinking regardless of the evidence to the contrary.  This faulty framework of thinking is also reinforced at times when events and appearances (standing on the shore and looking out at the horizon) seem to validate our “self-talk.”  I recently talked with a client who had been physically abused by his father beginning at around age 3.  It’s a long familiar story, and  you’ve probably heard it all before.  Years of abuse, neglect, and rejection led him to develop a survival personality marked by emotional distance, addictions, mistrust and suspicion of  ALL people.  No one should be trusted, everyone is out to get me,  I’m a loser, I’m stupid, I’m a failure and I’m never going to accomplish anything.  The paradox is, even in light of his extreme negative self talk, this client has a masters degree and has several attributes and gifts to be proud of.  Yes he is clinically depressed, displays some paranoia,and  has trouble establishing emotional intimacy and relationships.  If he can practice telling himself  “the earth is round” even though all of his life he’s been taught and believed “the earth is flat”  he’s going to experience emotional and spiritiual healing.  His own personal history provides  evidence that says he can establish intimacy, he can set a goal and reach it, he’s not stupid but actually has a very high IQ.  I’m currently working with him to re-frame his thinking and tell himself the truth.  The truth is, it feels like the earth is flat sometimes, but the fact is, its round.

Yoruba Proverb

Human beings are creatures of habit.  We do what we know, what is comfortable and what we ‘think” will work.  There are, however, those occasions when “our” way is not “the” way to get us to the goal.  When your way doesn’t work, don’t be disheartened.  You must be willing to try another way.  Don’t be discouraged when someone says, “no.”  Be willing to ask someone else.  Always be willing to start at the bottom.  Being willing does not mean you will stay there.  A closed door does not mean you have been cut off permanently.  It is a challenge, an obstacle, a tool to be used.  The keys to all doors are within you.  If you have faith in yourself, practice and patience will make you a master locksmith.

I’m often amazed when I find myself engaging in the same behavior or thought patterns time after time, year after year and then realizing that it isn’t working.  Why do we continue to engage in behaviors and thought patterns even though we’re experiencing anxiety, communication breakdowns, anger, depression?  Sometimes we even experience physical problems related to poor living habits or abusing our bodies (overload of sugar, fats, etc.) that we continue to engage in even though we know it’s bad for us.  We must be willing to try another way.  Re-frame our thinking and establish new strategies and new ways of living.

Social anxiety along with the fear of negative evaluation can be detrimental to our interpersonal relationships not only with those we are meeting for the first time, but also with our spouse or significant others.  Excessive attempts to hide self whether consciously or subconsciously often prevent the emotional and spiritual intimacy that is vital to a successful marriage relationship.  This is often manifested as the inability or unwillingness to express opinions and diminished spontaneity. 

This system of beliefs is associated with self talk that goes something like this:  “Based on my experience, if people really knew me, they would reject me; Therefore, I will attempt to hide my true self and avoid scrutiny.” 

So what is the solution?  Tell yourself the truth about negative evaluation.  The truth is that sometimes others may have a negative evaluation of us.  The truth is that MOST of time MOST people are accepting and are not engaged in negative evaluation of us.  The truth is even if they do engage in negative evaluation of us it doesn’t necessarily mean  it’s justified or true. We can learn to view ourselves as unique creations of God with our own flaws, our own quirks and  come to realize everyone doesn’t always have to approve of us.  It’s OK.  Learn to tell your self  that “it’s ok.”

If you have additional questions or thoughts about this topic, drop me a line rwcreasy@gmail.com

Once the faulty cognitions have been identified, the therapist may coach the client on implementing effective reframing techniques, which can assist the patient to substitute more reality, oriented interpretations for overly negative thoughts. The goal is to help the client learn to identify and alter dysfunctional beliefs which predispose him/her to distort life experiences. Cognitive Therapy, in contrast to psychoanalytic therapy, focuses on the here and now problems. However, childhood experiences may have relevance when used to clarify present observations. According to Beck, the general assumptions on which cognitive therapy is based, include the following:

• Perception and experiencing in general are active processes, which involve both inspective and introspective data
• The client’s cognitions represent a synthesis of internal and external stimuli
• How a person appraises a situation is generally evident within their cognitions (thoughts and visual images)
• These cognitions constitute the person’s “stream of consciousness” or phenomenal field, which reflects the person’s configuration of individual self, his work his past and future
• Alterations in the content of the person’s underlying cognitive structures affect his or her affective state and behavioral pattern
• Through psychological therapy a patient can become aware of their cognitive distortions
• Correction of these faulty dysfunctional constructs can lead to clinical improvement

Schemas

Beck refers to cognitive structures that organize and process incoming information as schemas. They represent thought patterns usually acquired early in an individual’s development. Relatively stable cognitive patterns form the basis for the regularity of interpretations of a particular set of situations. The term schema is used to designate these stable cognitive patterns. The schema is the basis from which the client or individual molds data into thoughts. Schema forms the basis for screening out, differentiating, filtering, and coding stimuli that confront the client. Individuals use schemas to categorize, organize, and evaluate their life experiences. According to Beck’s experience with substance abusers, schemas generally fall into two categories: (1) “I am unlovable” or (2) “I am helpless.” Offshoots of these two schema could be described as “I am trapped,” “I am inferior,” “I am ineffective,” “I am powerless,” “I am unwanted.” These types of schema are often associated with individuals suffering from substance abuse primarily because the individual believes the drug(s) will in some way provide solutions to their negative schema through faulty information processing.

Faulty Information Processing (Cognitive Errors)

Beck believes that individuals suffering from substance abuse make “systematic errors” in their cognitions, which actually serve to perpetuate negative ideas and thoughts regardless of the contradictory evidence available to the contrary. Beck has identified the following as common systematic errors:

• Arbitrary inference—basing a conclusion in the absence of evidence to support the conclusion or when the evidence actually contradicts the conclusion.
• Selective abstraction—focusing on a detail taken out of context, ignoring other important features of the situation.
• Overgeneralization—construction of a general rule on the basis of isolated incidents and then applying that rule across the board to related and unrelated situations.
• Magnification and minimization—placing an inordinate amount of significance to an event that is clearly distorted.
• Personalization—refers to the client’s proclivity to relate external events to himself when there is no basis for making such a connection.
• Absolutistic, dichotomous thinking—is the tendency to place all experiences in one of two opposite categories; for example, perfect or defective, clean or filthy, saint or sinner. Basically this is an either/or cognition.

Addictive beliefs include the following:

• I need the substance (drug) if I am to maintain my psychological and emotional balance
• When I use, I can function better in social settings as well as increase intellectual capacity
• I expect that when I use, I will derive pleasure and excitement from the drug that I cannot find anywhere else
• The drug will provide me with energy and increased power
• The drug will sooth and calm me down
• The drug will relieve my boredom, anxiety, tension, and depression
• Unless something is done to satisfy my craving, it will continue indefinitely and possibly get worse.

In addition to addictive beliefs, the user may also exhibit a variety of permission-giving-beliefs and entitlement thinking which minimizes risks in the patient’s mind. Examples of these beliefs include, “Since I’m feeling bad, it’s OK to use,” “I’ve been having a hard time so I deserve to use and get relief,” “The satisfaction I get is worth the risk of relapsing.”

Core addictive beliefs activate emotions that may eventually lead to the addictive behavior.

Core Beliefs

I am trapped / alone.

Addictive Behavior

Visits Crack House

CBT is aimed at modifying each of the categories of beliefs: anticipatory, permissive, as well as the underlying core beliefs that potentiate these drug related beliefs. When the addicted person’s core beliefs interact with life stressors, they produce anxiety, worry, dysphoria or anger. These stressful or stimulus situations activate drug related beliefs that lead to craving. Beck asserts that basic faulty, incorrect beliefs and automatic thoughts about drugs, their perceived benefits and uses, may account for increased substance abuse.

Case Formulation

It’s important to obtain a thorough case history which examines all relevant childhood information and family dynamics. The essential components of case conceptualization include relevant childhood data, current life problems, core beliefs or schemas, conditional assumptions, compensatory strategies (survival techniques), vulnerable situations, automatic thoughts and beliefs (specifically related to drug use), emotions, behaviors. This helps the therapist to conceptualize the basis for the client’s core belief system and assumptions. By understanding the client’s conditional assumptions and belief system, it helps the therapist to understand and identify the compensatory strategies the client may have developed as a result of childhood experiences. For example, if the father of the client was an alcoholic, verbally abusive and humiliated the client as a child, the client may have developed a core belief system that says, “I’m unloved, unwanted.” This leads to the conditional assumptions, beliefs and rules that say, “If I do everything perfectly, then people will like me and I’ll feel comfortable,” or if I show others how I really feel, they will abandon me.” The compensatory strategies or “survival personality” that flows out of this type of thinking could be “I’ll use drugs when I am uncomfortable because they will make the pain go away,” or engage in isolation and withdrawal or “Don’t do anything unless you are 100% sure you can succeed,” or “Don’t show others how you really feel.” Establishing a complete case formulation helps set direction for therapy sessions and provides the specifics necessary to develop meaningful assignments and goals for the client.

Homework

Homework or assignments for the client to complete outside of the therapy session is a valuable component of CBT for the substance abuser. As in all other applications of cognitive therapy, homework assignments allow the client to apply and practice the skills learned during sessions. Homework assignments can be useful to reinforce and embed the self-guided techniques of Socratic questioning, (e.g. “What evidence do I have for this thought or belief?”) within their everyday lives. The authors provide several examples of homework assignments that can assist the therapist and patient with recognizing faulty thoughts and how to substitute rational cognitions. The Advantages/Disadvantages Analysis Chart allows the client to document in a chart the advantages and disadvantages of using and abstaining. This can help the client identify, review, and recall in very specific terms what the pros and cons are of using or abstaining.

The Daily Thought Record (DTR) is an effective tool, which serves as a standardized form for listing and modifying maladaptive thoughts. In the case of cocaine addiction, it is useful for modifying addictive beliefs that lead to urges and craving. Specifically, the DTR has five columns labeled, situation, emotions, automatic thoughts, rational response and outcome. The patient is instructed to document their experiences of urge and craving using the chart. They are asked to describe their situation and the actual event leading to the unpleasant emotion or stream of thoughts. Based on the situation, they are then asked to record their automatic thoughts that preceded their emotions. They are asked to document their emotions such as hate, anger, rage, frustration, depression, or sadness. Recording rational responses reinforces positive reframing. Reframing is a salient goal of CBT because of the negative, often untrue and unrealistic cognitions that arise automatically.