Portland Psychotherapy provides effective, evidenced-based counseling and therapy to all members of our community. We also provide training to therapists and conduct scientific research - so we know what works.
Did you make a new year’s resolution at the start of this year?
Or have you ever made one in the past?
Like most of us, you probably started off with a lot of enthusiasm and lofty goals.
But how many times have you actually succeeded in sticking to the resolution? How many times have you reached your final goal?
And if you failed, have you ever wondered what exactly has gotten in the way?
There is no shame in admitting it. You are in good company.
Even with the best intentions and motivations, we all have a tendency to lose sight of our goals and falter at making the changes that we desire.
Why is that?
An Unsound Relationship with Discomfort
One of the biggest obstacles to making lasting change is having to repeatedly face discomfort. Often, we try to white-knuckle our way through it, only to find that will power and muscle are not enough.
The real problem is that our relationship with being uncomfortable is unsound. We have grown up with the notion that discomfort is something negative—a bad thing—and therefore, something that we have to avoid or get rid of as fast as possible.
The reality is that any change you make in your life, even a positive one—moving into a new house, starting a new relationship or job, or traveling abroad—comes with inherent discomfort.
But if discomfort is something that must be avoided, what do you give up as a result? Make discomfort the enemy long enough and you may even lose sight of what really matters to you in life.
Learning to See Discomfort in a Different Light
Many years back, I realized that much of my life centered around being comfortable. I had a good job and friends, but I lacked passion and meaning. It was as if I was living on autopilot.
It was then when I realized in order to have the life I wanted, I needed to adopt a new motto – “get comfortable with the uncomfortable.”
I started to see discomfort as just an inherent part of change and growth—as something welcomed, neither good nor bad. From then on, when I felt discomfort, I stopped looking for ways to get rid of it. Instead, I reminded myself that it was simply a part of the process.
The lesson for you?
When you learn to see discomfort differently and start to actually invite it into your life, you can better connect with the things that are meaningful to you.
If you no longer have to avoid discomfort, what might you spend your energy doing?
Creating a Different Relationship with Discomfort
What steps can you take to become more comfortable with being uncomfortable?
As odd as it may sound, in order to try creating a different relationship with discomfort, you actually have to actively pursue the things that you know will make you uncomfortable.
Ask yourself: “Are there things I always wanted to do but did not do because I felt too awkward or embarrassed to do them?”
For some, it may be taking a dance class, singing karaoke, or doing improv. Remember, the important thing is that whatever you decide, it is something that matters to you.
The next step is to pursue these activities while noticing how it feels to be uncomfortable. You will likely hear some of the same old discouraging thoughts: “I can’t”, “I look silly.”
But what happens if you continue anyway and invite discomfort and all its friends to the party? Could you learn to engage differently with discomfort, embrace it, and in turn, grow and enrich your life? The only way to know is it to try!
Therapy is a great way of exploring your relationship with discomfort, how you responded to pain and discomfort in the past, and how you can get more in touch with the things that are meaningful in your life now. I would love to help you find the right balance and perspective.
Many people drink as part of socializing with others and feel it helps them loosen up, have a better time, and overcome any social anxiety they may feel. They may think alcohol helps them stay connected with people and have better relationships. Yet, after reflection, some people find that alcohol use actually interferes with their relationships.
However, quitting or cutting back drinking is often difficult. It can be an isolating experience for someone who has been a “social drinker”. In addition, people who normally drink during social occasions can often find themselves coping with increased anxiety when attempting to connect with others. This makes quitting or cutting back alcohol hard when you start to think you might need to.
Why it’s hard to stopping being a social drinker
People often meet for drinks after work. This is a common way that professional adults are able to form interpersonal connections with colleagues. It is also a common way that people meet their future intimate partners. Many people find friendships and dating often involve drinking alcohol.
Given this situation, the exciting nightlife in cities such as Portland—with its wide variety of craft beers and breweries—can make it even more difficult to avoid being around alcohol if trying to quit. In turn, this can make it even harder to refrain from drinking alcohol if you have a drinking problem (and simply too easy to slip back into depending on alcohol to feel okay).
It’s really is hard to go against the grain, and the social pressure to drink can be very strong. However, anyone grappling with an alcohol problem knows that it is necessary to resist that peer pressure.
If you have ever felt “different” from everyone around you in a social situation where you are the only one not drinking, you know this is hard. It’s also another reason why you need support to stay the course.
Alcohol is no longer helping my relationships. What should I do?
It is not easy to change any habit—especially one that involves using alcohol (or drugs) to ease anxiety or depression. If you have relied on alcohol to help you relate to other people, you may find it difficult to feel the same level of comfort in your relationships without alcohol.
A therapist can assist you in identifying how alcohol is affecting your life and your relationships, and how quitting drinking can make a difference in your life. Portland Psychotherapy has therapists who are knowledgeable, and can help you get control over your drinking and get your life back on track.
Excessive drinking is a safety issue in more ways than one. According to the Centers for Disease Control (CDC), 10,265 individuals were killed in drunk-driving accidents in 2015 alone. Use of Uber or Lyft may help one avoid driving while intoxicated, however, drinking has other risks we often don’t think about.
Safety Risks of Excessive Drinking
Drinking past the recommended alcohol consumption limit is linked to numerous other safety risks besides car accidents. Injuries resulting from falls are more likely in people who are impaired by the effects of over-drinking. Excessive alcohol consumption is also closely-linked to fatal swimming and boating accidents, as you can easily misjudge your ability to do either when intoxicated. Of course, you are also at higher risk of ending up in jail.
Therefore, it is a good idea to understand the concept of Blood Alcohol Content (BAC). In determining whether an impaired driver is drunk, BAC is measured by the police officer who suspects an intoxicated driver. If the BAC is at least the legal limit of 0.08, a DUI charge will be issued.
Importantly, maintaining your BAC under the legal limit is required when planning to drive home after a party where alcohol has been consumed. However, it is important to realize that you can actually become impaired by alcohol with a lower BAC than 0.08 and even charged with a DUI when you are below the legal limit. This is because some people have a more pronounced physiological reaction to alcohol than others.
Calculating your BAC
BAC charts and calculators require an understanding of the alcohol content of a “standard” drink. The following is representative of the alcohol content of a “standard” drink:
12 ounces of beer (5% alcohol)
5 ounces of wine (12% alcohol)
5 ounces of distilled spirits (40% alcohol)
It is a good idea to keep both ounces and percentages in mind when calculating the amount of ingested drinks needed to remain under 0.08 BAC. It is also an equally good idea to recognize that you can still become impaired from alcohol even if you are under 0.08 BAC. Your BAC level at any point in time is not necessarily an indicator of whether you are addicted to alcohol. Instead, it is just an indicator of your level of intoxication—and, therefore, your probable safety in walking, driving, or engaging in any activity that requires quick reflexes (like sports) or complex problem solving.
There are many BAC calculators available online, but I recommend the website, http://bloodalcoholcalculator.org, as a useful resource (as it offers both a BAC chart and calculator).
Your BAC and getting help from a therapist
If it is hard for you to maintain the recommended BAC or you often drink to excess, you may need the help of a therapist to address your drinking problem. Tolerance to increased alcohol ingestion and binge drinking are two signs that you need help to deal with your alcohol consumption. One way to know you have developed tolerance is if you have a blood level of .08 or higher and yet don’t feel any signs of intoxication.
Besides helping you deal with your over-drinking, a therapist can help you to explore other factors (e.g., stress, emotions, family history, and personality) that may be fostering a loss of control over your drinking. It’s never too early (or late) to address a drinking problem.
Most people who drink excessively experience times where they know it is causing problems for them. From too many hang-overs to conflicts with family members and friends, drinking frequently to excess can interfere with your relationships, impact your work and other activities, and basically disrupt your life. Is this you or someone you know?
When a heavy drinker receives feedback from others that they have a problem with alcohol consumption, that feedback often is advice to entirely cease alcohol consumption immediately. But, that just exacerbates the problem. Indeed, it can make a person who enjoys drinking (and/or relies on alcohol as a stress-reliever) feel stuck to the point where that drinker just gives up trying to quit. Long-term habits are truly hard to break, and choosing to entirely stop drinking all at once is not possible for the majority of over-drinkers. You are not a failure.
Abstinence from alcohol – Is this necessary for me?
“How can I make my drinking more manageable without stopping altogether?” This is a question that I often hear in working with people who are struggling to change their relationship with alcohol. My experience is that many people who are heavy drinkers feel that just ceasing entirely from drinking is not a realistic option for them. Likewise, they feel frustrated that the “cold turkey” and “just stop drinking” option is the one most often presented to them.
I don’t argue for (or against) the merits of embarking on the path of total abstinence from drinking for an adult who has had a drinking problem. This can be the right path for one person, but the wrong path for someone else. The important thing is to recognize if you have a drinking problem, so you can take steps to address it.
What if I can’t just stop drinking?
Those with repeated difficulty sticking to their plans of limiting their drinking often experience increased feelings of shame—as well as feeling hopeless about changing their alcohol over-consumption. Working with a trained therapist to change your relationship with alcohol may be the best option if you have been unable to make that change alone.
We—at Portland Psychotherapy—are here to help you figure out the best way for you to take control of your drinking, and find better ways of coping with the pull of negative patterns that push you toward drinking to excess. You do not have to do it all by yourself, and we can help you stick to your goals.
Does valuing happiness help us live a joyful life, or does it backfire?
Happiness seems to have a high currency in America. Over the past few years, the number of popular books written on how to increase it has skyrocketed. To name a few: 10% Happier, The Art of Happiness, Authentic Happiness, The Happiness Advantage, The Happiness Project, 52 Lists for Happiness, Choosing Happier, Flourish. Even the US Declaration of Independence declares the pursuit of happiness as an “inalienable right.”
But what is the consequence of valuing happiness? On the one hand, valuing happiness could lead a person to work harder to attain it. On the other hand, valuing happiness could lead a person to feel unhappy if they don’t reach their standards.
In 2011, a group of researchers decided to put this question to the test. They asked adult females who had recently experienced a stressful life event, such as a divorce or accident, to indicate how much life stress had impacted them and how much they highly valued feeling positively (e.g. “feeling happy is extremely important to me”).
As expected, the participants who highly valued happiness tended to have worse overall wellbeing, including more symptoms of depression, and a lower ratio of positive to negative emotions. Interestingly, the researchers only observed this relationship when participants had lower, but not higher, levels of life stress.
Why did life stress affect this relationship between valuing happiness and wellbeing?
Imagine you just went through a tough breakup. You probably wouldn’t expect to feel happy, let alone feel disappointed by negative feelings. Yet, imagine celebrating a best friend’s birthday party. If you didn’t feel happy in this context, you might feel bummed, especially if you highly valued feeling happy.
In the next study, the researchers had female participants either read an article on the benefits of happiness (“valuing happiness condition”) or making accurate judgments (“control condition”). Then, the participants watched either a sad or happy film clip. Compared to those in the control condition, those in the valuing happiness condition felt worse after watching the sad, but not positive, film clip. Feeling disappointed seemed to play a role in this result: valuing happiness led people to feel disappointed during the sad clip, which, in turn, led them to feel unhappy afterwards.
Does this mean that people should stop valuing happiness?
Not exactly. For one, while the researchers did find paradoxical costs of valuing happiness, they studied people who valued it to a high degree. Other researchers have similarly found that highly valuing happiness is linked to depressive symptoms amongst people who previously struggled with major depression. Yet, valuing happiness to a more moderate degree could help people be happier by motivating them to practice different techniques aimed at increasing happiness. In other words, if people have the right ‘happiness building tools,’ some researchers think that valuing happiness to a certain degree could promote it. More research is needed in order to better understand whether there are conditions under which people could benefit from valuing happiness.
Overall, this research does suggest that a cultural fixation on happiness could have costs, especially if it leads people to feel disappointed with experiencing negative emotions. Research increasingly suggests that accepting negative emotions has benefits, and therapies that encourage acceptance of emotions (e.g. Acceptance and Commitment Therapy) appear effective.
Hello friends and colleagues. Below is an update about new events at Portland Psychotherapy in 2017.
New providers at Portland Psychotherapy help us expand our services:
2017 was a year of change! We welcomed three new full time licensed clinicians to our team this year. We were thrilled to have Kyong Yi, LCSW join our team this summer. Kyong came to us with years of experience working in the VA and community health organizations. Kyong has devoted much of her professional life to serving disenfranchised populations and has a wealth of experience working with individuals struggling with a variety of difficulties including trauma/PTSD, difficulties with anger, substance use/abuse, and depression. She is also our new Director of Clinical Operations.
We are also very excited to have Angela Izmirian, PhD join us as a licensed psychologist. Angela’s expertise in and passion for serving marginalized communities, including immigrants, ethnically-diverse populations, and gender and sexual minorities will enable us to expand the ways in which we can reach out to and serve diverse members of our community. Angela also conducts transgender assessments and provides the documentation required for hormone therapy and surgery. She also provides couples therapy based on Emotion-Focused Therapy principles.
Bryce Doehne, PsyD is the newest licensed psychologist to join our team and we are so pleased to have him! Bryce spent much of his training and early career working in university counseling centers and also at Fremont Community Therapy Project, a feminist and trauma-informed training clinic in Seattle, WA. Being a military veteran himself, Bryce has developed expertise in working with individuals who have experienced trauma and substance abuse. Bryce also has an interest in working with some of the struggles that men often face, including the discomfort or stigma that is often faced when accessing mental health services.
We now offer medication management services
At Portland Psychotherapy, our focus has always been on providing quality, science-based psychotherapy. However, we have found it increasingly difficult to access qualified medication providers when needed. In response, we have contracted with Meghan O’Neil, MD, PhD to provide medication management services on a part-time basis at Portland Psychotherapy. Dr. O’Neil’s approach to medication and mental health care is a great match with our focus here at Portland Psychotherapy, with an emphasis on collaboration and letting science guide treatment decisions. We are happy to have her on our team and hope that she will also be able to be a resource for some of your clients for medication evaluation and management.
Upcoming training events
We are pleased to continue to host workshops based on topics that colleagues like you have suggested. If there are any speakers you would like us to bring out, please let us know! Upcoming workshops include:
This year we hired our first full time research coordinator, Christina Chwyl, to help with data collection and research tasks. Christina came to us after graduating from Stanford and has done a fantastic job in her new role. Publications from the past year include:
Publications from 2017
Luoma, J.B., Guinther, P., Potter, J., & Cheslock, M. (2017). Experienced-Based Versus Scenario-Based Assessments of Shame and Guilt and Their Relationship to Alcohol Consumption and Problems. Substance Use and Misuse.
Luoma, J. B., Hayes, S. C., & Walser, R. (2017). Learning Acceptance and Commitment Therapy (2nd Edition): A Skills Training Manual for Therapists.
LeJeune, J.T. & Luoma, J.B. (2017). Using social enterprise concepts to create a sustainable culture to fund research in a fee-for-service setting. In R.T. Codd (Ed.), Practice-Based Research: A guide for clinicians. Routledge Press.
Platt, M., Luoma, J.B., & Freyd, J. (2017). Shame and dissociation in survivors of high and low betrayal trauma. Journal of Aggression, Maltreatment & Trauma, 1, 34-49.
Our First Clinical Director
After spending the last ten years or so building Portland Psychotherapy, we’re now at a place where we can pause to reflect on where we have been and where we want to go next as an organization. One outcome of this was our decision to hire our first Director of Clinical Operations (DCO), Kyong Yi, LCSW. Kyong has comes to us with a wealth of administrative and management skill, and splits her time between clinical and administrative roles. We couldn’t think of a better person for this role.
Your support, in all of its form, is essential in the work that we do and our ability to fulfill our mission. Thank you so much!
Clear communication is key in any relationship, but it’s hard to know what you actually need to communicate. As the years go by, expectations change, patience wavers, and we use fewer words to convey our needs and feelings. But our longest relationships need more thorough communication to survive.
Think about a parent and a child. I love my mother, but I expect more from our relationship than my acquaintances. I have little patience when she misunderstands me repetitively and I don’t always tell her what I need in clear language. When I perceive her as unhelpful or negative, I can feel like exploding!
Now think about a romantic partner. We choose our partners for the connection we share and times when we feel they understand us. Partners can know us better than some of our blood relatives. So what happens when we get into an argument with our partner?
Typically, all we really want is to know we’re connected to our partners, for them to say, “Yes, I’m still here for you. I still love you.” We want a hug, a kiss, a sign they’ll show up when we need them the most. But we’ve learned not to ask for those things because it makes us feel vulnerable. But if this is the person you love, someone you want to spend the rest of your life with, then they’re the perfect person to share your vulnerability with.
Phrasing and emphasis are also important to ensuring clear communication. Often we focus on demands and the negative aspects of disagreements in order to keep our vulnerabilities from showing. Instead of saying “You need to come home on time so we can eat dinner together. Why are you so careless?” try “I miss eating dinner and sharing my day with you. At times I’m hurt when you stay at work too long because it feels like you’re choosing work over me and our time together.” Finding and expressing the underlying emotional conflict can help partners understand how much they value their relationship and gives them a path toward reconciling disagreements through reestablishing connections and continued emotional investment in each other.
The next time you have a disagreement with your partner or just feel disconnected from them, ask yourself these questions:
What just happened?
Did your partner not text you goodnight? Did you argue over dinner plans? Is this a repeating argument? If so, you may have an unmet need (words of affirmation, quality time, etc.). This is an opportunity to explore your relationship expectations and how your relationship fits those expectations. Remember, sometimes our expectations are reasonable, and at other times they are not.
How am I feeling inside?
Anger and frustration can be secondary emotions (a reaction you have to another emotion). A primary emotion may be driving that anger and frustration. If you have trouble finding the right words, think about which emoji you would use if you wanted to text your best friend about your feelings. (Still having difficulty describing your emotion? Click [here] for an extensive list). Naming our emotions can help us understand what we might need from our partners.
How can I express this to my partner without using blaming or criticizing language?
This is an opportunity to share vulnerability accurately with your partner. Remember, it’s not about placing blame on them or yourself. Reconnecting and finding a solution together is the essence of reconciliation, and it takes clear and calm communication to succeed.
We’re constantly growing and changing as people, both physically and emotionally. Relationships are the same, and sometimes we need to find or create opportunities to reacquaint ourselves with lost or loose connections. For help, try exploring the questions in the Gottman Institute’s Love map.
A shared vocabulary and understanding of supplemental information can be a map for finding common ground. Gary Chapman’s The Five Love Languages is a great start for ways to express and reciprocate needs and wants in any relationship.
Most fights are a protest over emotional disconnection. In Hold Me Tight, Dr. Sue Johnson shows how attachment styles play out in relationships as “demon dialogues,” as well as tips for being more accessible, responsive, and engaged with your partner.
Radically Open Dialectical Behavior Therapy (RO-DBT) is a new evidence-based therapy for people who are overcontrolled. A counterintuitive idea behind the therapy is that it’s possible to have too much self-control. Self-control refers to our ability to restrain acting on our urges, emotions, and wants in favor of longer term goals. Most of the time, self-control is good, but some people can suffer from excessive self-control. For these people, inhibiting and controlling impulses and emotions has become so habitual and automatic that they have problem relaxing control when needed. This can result in overcontrolled people being overly inhibited, perfectionistic, cautious, and feeling exhausted by social interactions.
Where does overcontrol come from?
Overcontrol comes from a combination of genetic/biological factors and social and family experiences. Bio-temperamental factors include high threat sensitivity, low reward sensitivity, high inhibitory control, and high detail-focused processing. In more plain language, this means that people who eventually become overcontrolled are born with a tendency to:
notice the difficult things in life
be more sensitive
be more anxious
feel fewer positive emotions
have higher capacities for self-control
tend to notice details that others are less likely to notice.
These biotemperamental factors combine with experiences with family, school, peers, or culture to produce overcontrol. Life experiences that contribute to overcontrol are those that teach the person that:
it’s very important to not make mistakes
showing weakness or vulnerability is dangerous or bad
it’s important to stay in control at all times
winning or succeeding is very important
Some people tend to have more of the biotemperamental factors, while some have more of the environmental factors, and some people have a lot of both. The more of these factors the person has, the more extreme their overcontrol is likely to be.
What does overcontrol look like?
It’s important to note that overcontrol is not just one trait, but a confluence of traits that all come together in this overarching concept. Some people will have more of the traits than others, but there are a number of things that overcontrolled people tend to have in common:
Overcontrolled people have a hard time relaxing their habitual emotional inhibition. People who are overcontrolled tend to be good at inhibiting their emotion-based impulses (for example, delaying gratification) and avoiding expressing emotions they don’t want to express (for example, by masking inner feelings). This often becomes so habitual that they can’t voluntarily relax inhibitory control in situations that call for flexibility, such as those that call for open expression of emotion or unrehearsed responses, for example dancing, parties, meeting new people, during play, or on a romantic date. High inhibitory control often leads overcontrolled people to prefer structured situations and order and to avoid novelty or situations where there are not clear rules about how to behave or where the outcome is uncertain. They will often find being around others for long is exhausting. This can also lead to perfectionism, a strong sense of duty or social obligation, rehearsing extensively before social situations, and high moral certitude (for example, feeling like there’s a right way to do things).
Overcontrolled people often feel lonely and lack a sense of belonging or closeness. They may have friends (perhaps even a lot of them), but don’t feel like any of those friends truly understand them. Alternately, they may not feel particularly close to anyone or may avoid social situations for the most part. They often feel like they are different from others and feel unsure about how to make friends or get closer to people. It’s also common that they may be unsure if relationships are really worth the trouble or effort.
Overcontrolled people tend to mask their expression of emotions or only share socially-acceptable emotions. This can often result in expressions of emotion that are not well-matched to the context, for example having a flat facial expression when a co-worker expresses excitement or gives them a complement. Or they may tend toward insincere or incongruent expression of emotion, for example, smiling when upset or laughing at a joke they did not find funny. As a result, many overcontrolled people may have difficulty knowing what they feel or tend to be stoic and not report distress.They may also engage in a lot of social comparison and, as a result, tend to be quite critical of themselves or others.
Overcontrolled people often find feedback difficult and are rigid and rule-governed. They are often closed off to new experiences, reluctant to try new things if unsure of the outcome, and avoid uncertainty or unplanned risks. They can be suspicious of the motives of others and tend to hide their true feelings until they get to know someone better. They may tend to have a knee-jerk reaction to defend themselves from critical feedback or may do things to avoid getting feedback because it’s so painful.
How does RO-DBT work?
RO-DBT emerged from 20 years of research into how to help people who suffer because of excessive overcontrol. The treatment pulls together experimental, longitudinal, and treatment outcome research in the form of this novel treatment. This website has an overview of the research behind RO-DBT. The most common mental health problems characterized by overcontrol are chronic depression, anorexia, and obsessive-compulsive personality. RO-DBT is meant to reach out these folks who are often suffering in silence, with few, if any others knowing how bad they are hurting.
RO-DBT is strongly informed by basic research on the facilitative and communicative functions of emotions in facilitating close social bonds. According to the theory, bio-temperamental differences combine with experience to lead overcontrolled individuals to engage in behavior that interferes with the formation of close social bonds, resulting in social isolation, loneliness, and distress. RO-DBT focuses on changing social signaling so that emotional expression is more appropriate to the social context. More appropriate emotional expression then results in increased trust and desires to affiliate from others and thereby increased social connectedness.
RO-DBT aims to develop radical openness, which has three components:
Acknowledging stimuli that are disconfirming, unexpected, or incongruous, which are often associated with distress or unwanted emotion. This is in contrast to automatically explaining, defending, accepting, regulating, distracting, or denying what is happening in order to feel better.
Self-inquiry, which involves asking oneself good questions in order to learn. This involves intentionally seeking ones’ personal unknown in order to learn from a constantly changing environment.
Responding flexibly by doing what is effective in the moment, in a manner that signals humility and accounts for the needs of others.