Lesser Known Causes of Obesity

We hear it in the news every day.  There is an obesity epidemic.  We are obese.  We just keep getting fatter and fatter.  

Who's responsible?  We must find someone to blame.  Why not blame the fat people?  Many people in Western society seem to have opted for distancing ourselves from the intolerable and projecting it onto “fat” and "fat people".  Our society's rage against fat as sin today may be comparable to the Victorian attitude about sex. Our desperation to avoid the stigma of fat is reflected in how we spend our money. 

In 2012 in the U.S. alone, the weight-loss industry raked in $61 billion on weight loss foods, food replacement products (i.e. Jenny Craig, Weight Watchers), books, surgeries, diet programmes, and diet supplements (in 1980 that number was $10 billion). 

After all, we can't control our age, our height, our colour, our socioeconomic status at birth, our parentage, our increasingly poisonous environment - we need something to claim control over - right?  If we can't control our body weight, there's no hope for us - right?  Wrong.

Obese people have been found to expend less energy while sleeping and resting than those who are not obese, making it easier to gain weight on lower caloric intake than those with higher resting energy expenditure rates:

"Resting energy expenditure (REE) was investigated by indirect calorimetry in relation to body composition and to different degrees of obesity in order to assess if a defective energy expenditure contributes to extra body fat accumulation …. The analysis showed a negative impact of obesity on REE beyond body composition variables."  (⁶Verga, p. 47)

Recent research by 12 Dallman suggests that high levels of stress over a long period of time (such as those caused poverty, chronic trauma and childhood abuse) can create changes in the brain that causes the body to redistribute its fat stores to the abdominal area and increases sucrose (sweets) appetite. 

Pagato, et al, 2012 observed that

• PTSD alters functioning of the HPA axis, which regulates cortisol secretion Cortisol hypothesized to promote obesity
• Cortisol secretion linked to stress-related weight gain
• People with PTSD have lower circulating cortisol relative to healthy controls

Ironically, the stigma from being fat, especially as a child, and the consequent vulnerability to ongoing bullying and abuse by peers can set this viscous cycle in motion or exacerbate it early on.

Additional causes of obesity unrelated to compulsive eating were also found by studies from the ⁷National Institutes for Health, and by ⁴Heitmann.  Obesity has been shown to have a significant genetic component according to cross-sectional twin and family studies done by ²Coady. And this genetic component is compounded by the tendency of obese people to mate with each other, as they are often excluded from mainstream dating circles.  From  ³Hebebrand:

"Our results indicate that assortative mating is common among parents of extremely obese children and adolescents, ascertained between 1995 and 1997. In addition, the parental loading on the tenth decile is most prominent for the most obese children."  (p. 345)

Major Cause of Obesity Epidemic: Weight-Loss Attempts

• Research on 17,000 children showed that twins who embarked on one intentional weight loss episode were two to three times more likely to become overweight compared to their non-dieting twin counterpart. Furthermore, the risk of becoming overweight increased in a dose-dependent manner, with each dieting episode. #1

• A 1999 report on 4,193 women and 3,536 men participating in the Finnish Twin Cohort Study revealed that dieters were several times more likely than non-dieters to experience major weight gain (more than 22 pounds) during a follow-up lasting 15 years. (pp.31) #2

#1. Alison E. Field, S. Bryn Austin, C. Barr Taylor, Susan Malspeis, Bernard Rosner (2003)

#2. Korkelia, M., A Rissanen, J Kaprio, TIA Sorensen, & M Koskenvuo (1999)

According to a 2007 Meta-Study (a study of 31 other studies, internationally)

• Diets do lead to short-term weight loss, on average of 5%–10% of the person's body weight

• These losses are not maintained

• The more time that elapses between the end of a diet and the follow-up, the more weight is regained.

• Among patients who were followed for two or more years, 83% gained back more weight than they lost

• In studies with the longest follow-up times (of four or five years post-diet), the weight regain trajectories continued to increase suggesting that if participants were followed for even longer, their weight would continue to increase. #3

#3 Mann, T., Tomiyama, AJ, Westling,E, Lew, AM, Samuels, B. (2007) Medicare’s Search for Effective Obesity Treatments in American Psychologist Vol. 62, No. 3, 220–233

Putting people on caloric restriction regimens is bound to fail, as their bodies will tell them that they are not getting enough to eat (they will have a constant nagging hunger that will only ease up when they eat).  Checking for medications that cause weight gain, educating about food additives such as trans fatty acids or trans-fats, explaining about the connections between genes, stress, childhood abuse and body size to de-stigmatise, and encouraging an increase in activity levels with guidance on how to incorporate regular exercise into daily routines is the only humane prescription for obesity when it is not related to overeating.

References:
²Coady, S.A., Jaquish, C.E., Fabsitz, R.R., Larson, M.G., Cupples, L.A., & Myers, R.H. (2002). Genetic variability of adult body mass index: a longitudinal assessment in Framingham families. Obesity Research, 10, 675-81.
^1aColditz, G.A. (1992). Economic costs of obesity. American Journal of Clinical Nutrition, 55, 503-507.
¹²Dallman, M.F., Pecorary, N., Akana, S.F., la Fleur, S.E., Gomez, F., houshyar, H., Bell, M.E., Bhatnagar, S., Laugero, K.D., and Manalo, S. (2003) Chronic stress and obesity: A new view of "comfort food".  Proceedings of the National Academy of Sciences of the USA, 100/20, 11696-1170^1
11 Trust for America's Health Report. (2005). F as in Fat: How obesity policies are failing in America.
¹⁰Farley, Tom,  (2005). Prescription for a Healthy Nation : A New Approach to Improving Our Lives by Fixing Our Everyday World. Boston: Beacon Press
⁸Gallagher, D., Testolin, C., Heshka, S., & Heymsfield, S.B. (n.d.). Body mass index: Differential misclassification of under and over-fatness. New York City: Obesity Research Center, St.
³Hebebrand, J., Wulftange, H., Goerg, T., Ziegler, A., Hinney, A., Barth, N., Mayer, H., & Remschmidt, H. (2000). Epidemic obesity: are genetic factors involved via increased rates of assortative mating? International Journal of Obesity Related Metabolic Disorders, 24, 345-53
⁴Heitmann, B.L., Harris, J.R., Lissner, L., & Pedersen, N.L. (1999). Genetic effects on weight change and food intake in Swedish adult twins. American Journal of Clinical Nutrition, 69, 597-602.
^1bMetropolitan Life Insurance Company (1983). Metropolitan height and weight tables. New York: Author.
⁷National Institutes for Health (2001). Understanding adult obesity. NIH Publication No. 01-3680. Washington, DC: U.S. Government Printing Office.
⁵U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (1996). Physical activity and health: A report of the surgeon general. Washington, DC: U.S. Government Printing Office.
⁶Verga, S, Buscemi, S., & Caimi, G. (1994). Resting energy expenditure and body composition in morbidly obese, obese and control subjects. Acta Diabetologia, 31(1), 47-51.
 
  

Dieting is Bad for You

Dieting is Bad for You. But I Don't Diet Anymore - I know Better!

 

Don't be fooled - If you're "only trying to eat healthier," ask yourself these questions:

1. Does this "new way of eating lifestyle" require that I change my eating habits to omit or considerably limit one of the three major food groups that all humans need to survive: carbohydrates, proteins, or fats?
2. Does this "fitness fat-burner menu" cause me to wait to eat for long periods while hungry or to stop eating before my physical appetite is satisfied?
3. Does this "high nutrition program" require that I eat according to externally dictated menus and schedules, which distract me from my inner rhythms of hunger and satiation?

Food Group or Caloric Restriction = Thin = Better Health?

Thin, very temporarily yes. Better Health -No - Plus, studies show that the best way to gain weight AND to develop an eating problem is to restrict your diet (see below). 

Major Cause of Obesity Epidemic: Weight-Loss Attempts

• Research on 17,000 children showed that twins who embarked on one intentional weight loss episode were two to three times more likely to become overweight compared to their non-dieting twin counterpart. Furthermore, the risk of becoming overweight increased in a dose-dependent manner, with each dieting episode. #1

• A 1999 report on 4,193 women and 3,536 men participating in the Finnish Twin Cohort Study revealed that dieters were several times more likely than non-dieters to experience major weight gain (more than 22 pounds) during a follow-up lasting 15 years. (pp.31) #2

#1. Alison E. Field, S. Bryn Austin, C. Barr Taylor, Susan Malspeis, Bernard Rosner (2003)

#2. Korkelia, M., A Rissanen, J Kaprio, TIA Sorensen, & M Koskenvuo (1999)

According to a 2007 Meta-Study (a study of 31 other studies, internationally)

• Diets do lead to short-term weight loss, on average of 5%–10% of the person's body weight

• These losses are not maintained

• The more time that elapses between the end of a diet and the follow-up, the more weight is regained.

• Among patients who were followed for two or more years, 83% gained back more weight than they lost

• In studies with the longest follow-up times (of four or five years post-diet), the weight regain trajectories continued to increase suggesting that if participants were followed for even longer, their weight would continue to increase. #3

#3 Mann, T., Tomiyama, AJ, Westling,E, Lew, AM, Samuels, B. (2007) Medicare’s Search for Effective Obesity Treatments in American Psychologist Vol. 62, No. 3, 220–233

Fat Phobia Kills

A study of 36,000 students in Minnesota found that negative body image is associated with a higher suicide risk for girls #4

#4. American Association of University Women (1990). Shortchanging girls, shortchanging America: Full data report. Washington, DC: American Association of University Women.

Overweight girls are far more likely to engage in dangerous practices (fasting, smoking, vomiting, taking laxatives) to lose weight than normal weight girls #5

#5. Wertheim, E., Paxton, S., & Blaney, S. (2009)

The Mayo Clinic researchers note that many adolescents with eating disorders have had a history of being overweight or obese #6

#6. Sim, L.A., Lebow, J, & Billings, M, (2013)

A longitudinal study published in 1999 showed that girls who dieted severely were 18 times more likely to develop an eating disorder #7

#7.  Patton et al (1999)

Even here in Aotearoa New Zealand:

Studies indicate that although 75% of 15 year old girls were ‘healthy weights’ 68% of them wanted to weigh less #8

#8. Worsley, Worsley, McConnon & Silva (1990)

Of the girls that reported dieting, most had started prior to the age of 13 years. #9

#9. Fear, Bulik & Sullivan (1996) 

We have known since the 70's that dietary restriction sets a dangerous trend, And we now know that this trend is far more "dangerous" than the "obesity epidemic" that gets so much more press but that fails to mention that the health risks of obesity are much more related to a lack of physical exercise than to BMI. It is perfectly possible to be "fit and fat"" where it is less possible to be "fit and dieting."

Why Do We Keep Trying to Lose Weight by Restricting Food Types or Intake?

In spite of all this, our drive to diet and get thinner and thinner is getting worse not better. And our children and teenagers continue to get the wrong messages

• Parental messages about body image and teasing by others (e.g. peers and/or family) have been highly correlated with body image dissatisfaction and eating disorder symptoms #10

#10. Thelen and Cormier, 1995

Because Dieting is Addicting

Compulsions and addictions are defined by one's inability to stop behaviour in spite of known harmful consequences. Given all of the evidence above, why would anyone want to deliberately deprive themselves of food anymore? We know it causes eating disorders, suicidality, and ultimately either death or greater weight gain - this evidence isn't even new. Yet we keep doing it - why?

Dieting, like many addictions, creates false promises. Like gamblers who know full well that the odds are against them, most dieters think they can buck the odds because the false promise - thinness and an end to weight discrimination - is too seductive to ignore or dismiss. The pain of continuing to suffer teasing, discrimination, and judgments overshadows the likelihood of dieting failure. No one wants to really believe they can't diet their way to thinness - it feels too hopeless, too awful. And although exercise offers an escape from most of the physical health risks of a high body weight, it can't promise a quick perfect body. And we humans are famous for looking at the short term results and ignoring the long term, if it doesn't suit us. A gambler makes one big win, then continues to gamble until it's all gone and then some - this is the same thinking as "diet think."

More Myths

BMI, or the Body Mass Index, was originally developed as a statistical tool to study large populations over time. It is completely irrelevant to individual weight and does not even distinguish between weight caused by fat or muscle. Similar to that old fashioned standby, the Metropolitan Life Height and Weight Charts, the original uses for which these devices were developed has gotten completely distorted. Met Life was originally an actuarial study - a statistical population study based on people who buy life insurance. What happened to scientific measures - controlled, double-blind studies that limit the variables they measure? When it comes to weight, our scientific standards seem to take a back seat. This is because no one, including doctors, is immune to cultural pressures, assumptions and stereotypes. Although medical practitioners the world over are trained to used the BMI now as they were the Met Life Charts in the past, they are rarely taught that they are highly inaccurate in evaluating individual weight and fitness.

One of the medical criteria of anorexia nervosa: body weight 15 % below a weight that is considered "normal", is met by the majority of models and beauty contestants.

So, What Size Should I Be?

Since there are no clear markers for healthy body weight that are free from highly questionable social standards, I would maintain that healthy body weight is highly individual and relative, given the various causes of weight gain. 

Perhaps it is best to consider the size a person naturally returns to after a long period of both non-compulsive eating and consistent exercise commensurate with the person' s physical health and condition. We must learn to advocate for ourselves and our children to aspire to a naturally determined size, even though that will often mean confronting misinformed family, friends, and media advertising again and again.

If you want to know if you are fit, ask yourself how you feel. Do you have energy or do you drag through the day? Are you physically active at least a half hour a day (this means pushing yourself to do something that causes you to pant and sweat)? If not, consider increasing your level of physical activity in such a way that it is woven into your day (e.g. walking or cycling instead of driving).

The benefits of regular physical activity have been demonstrated scientifically again and again - as have the disadvantages of restrictive dieting. It makes sense that we need to be active - we were hunter- gatherers for 100,000 years and had to travel huge distances to follow the edible flora and fauna. We're supposed to move around - and then we're supposed to eat! 

Are you Overeating?

Do you feel overstuffed a good deal of the time, or do you rarely let yourself feel hungry? Do you eat to cope with issues that have nothing to do with hunger? 

What is Non-Compulsive Eating?

Simply stated, non-compulsive eating means eating when you are hungry and stopping when you are satisfied. This involves being able to distinguish emotional hunger from physical hunger, and satiation from over-fullness. This approach, combined with regular physical activity, over the long term,will bring about a healthy ratio of fat to muscle, even if you don't end up looking like a fashion model.

Click here to find out about distance learning programs for therapists and here to find out about general training and supervision options.

Fight the Brain or Change the Brain

Recent research in neuroscience tells us what we had thought impossible is now possible. Early traumatic implicit (non-verbal bodily held) learning – the kind of learning that drives most forms of psychological distress, can actually be erased without touching the explicit (verbal – story) memory it was associated with. First let’s take a look at what this means.

Implicit learning is laid down in the nervous system – it is emotional and non-verbal. Here are some common examples:

I am inherently bad/dirty/stupid/ugly…etc.

Love is dangerous/painful/violent/exploitive and it’s best to avoid all risk or to expect all relationships to be like that

To love is to be mistreated/to mistreat

If I try I will fail, so best not to try

Dependence is wrong – it’s best not to have any needs

These kinds of “beliefs,” or “scripts” can drive large areas of life. They are usually laid down due to early (as in childhood) repetitive emotionally charged or even traumatic experiences and so tend to be immune to logical questions or arguments. 

This is because they are actually held in the body and nervous system rather than in the “thinking brain” and are faster and more automatic than logical thinking because they were originally somehow tied in to perceptions around survival (the messages may have originally been communicated by needed childhood caregivers, for example).

Fighting the Brain

Since most forms of psychotherapy are verbal, we have believed up until now that the only way to cope with this kind of dysfunctional learning was to challenge the logic of such beliefs and set up competing neural pathways that would eventually, through a great deal of practice, become available as the “preferred” neural pathway.  This is the foundation of much of cognitive and behavioural psychology.

Nevertheless, competing new beliefs learned logically in adulthood can never completely replace implicitly held beliefs laid down and reinforced in childhood, and so relapse must be constantly guarded against, especially when something associated with the earlier learning reappears in the current environment (e.g. a boss or spouse implying the same message).

The most common way set up competing beliefs is via Cognitive Behavioural Therapy, whereby the dysfunctional beliefs are deliberately challenged with new thoughts and learnings which are then rehearsed in new behaviours repeatedly until the old beliefs lose their original power. Psychoanalytic or psychodynamic interpersonal therapies also challenge old implicit learning via the therapeutic relationship itself, whereby repetitive experiences of (hopefully!) non-exploitive, consistent, secure attachment with the therapist replace the old beliefs that were based on exploitive, inconsistent, insecure early attachments.  

Example:

CBT: Old implicit learning: “If I try I will fail, so best not to try” as applied to job hunting (for example). CBT points out the illogic of the assumptions and encourages rehearsing new alternate thoughts such as “if I try, even if I fail, I can still learn something of value – and sometimes I will succeed.”  Behavioural rehearsal might involve the assignment of applying for xyz jobs and keeping track of any learnings or successes to challenge the old learning. Through  repetitive practice the new learning creates a new available pathway that offers an alternative to the older learning – however it doesn't replace it, and confirmations of the old learning (such as failures that don’t result in positive learnings) can always send the person back to the old learning.  I call this approach “fighting the brain.”

Changing the Brain

In their recent book, Ecker, Ticic and Hulley (2012) present the basic components necessary to erase dysfunctional implicit learning, and then examine numerous contemporary forms of psychotherapy to determine which types incorporate these components. Not surprisingly, most do. However, some forms of therapy are more efficient, systematic, and deliberate in their use of these components than others, making for a considerable difference in the likelihood of success and the length of time it takes to get there. The components are as follows:

1.       Identify and access the memories of the original experiences that laid down the implicit dysfunctional beliefs

2.       Retrieve the accompanying  learning simultaneously with the memories:  both emotional and  schematic

3.      At the same time as the feelings, memories and beliefs are retrieved, provide repeated experiential disconfirmation of the dysfunctional learning

a.      Disconfirmation must “make sense” emotionally

b.      Original learning plus disconfirmation must be repeatedly paired within a 5 hour window

c.       After 5 hours a built-in mechanism re-locks the synapses

Each of these steps correspond precisely to phases 4 through 7 desensitisation stage of the standard 8 phase EMDR protocol, even though EMDR was developed 20 years prior to the current confirming discoveries in neuroscience.

My main concern here is that this “new” approach, if applied systematically, will probably have similar limitations and cause similar results to those that have emerged from years of research and practice in EMDR. It will seem miraculous when applied to dysfunctional learning caused by a single –incident trauma; but it won’t be so simple when dealing with the many ego states that develop in response to repeated developmental trauma and dysfunctional implicit learning.

When ego states are split off by trauma, they are sometimes unable to “share” information from one state to another. This is what enables many survivors to function at a much higher level than they might otherwise if the full impact of the traumas were experienced by all parts of self equally. This also means that it is essential, when applying the above steps, to make sure that the ego states that hold the implicit dysfunctional learning are the same ego states that are exposed to the disconfirmation of that learning.

I think we will find, as we did with EMDR, that more complex forms of traumatic implicit learning are most effectively addressed with a combination of trauma processing (or Implicit memory “erasure”), somatic mindfulness, and ego state work.

References:

Ecker. B, Ticic , R, & Hulley, L. (2012). Unlocking the Emotional Brain. New York: Routelege

Shapiro, F, & Forrest, MS, (2004) EMDR: The Breakthrough Therapy for Anxiety, Stress and Trauma. New York: BasicBooks

Tronson, N. C.; Taylor, J. R. (2007). Molecular mechanisms of memory reconsolidation. Nature Reviews Neuroscience 8 (4): 262–275

HUGE news: Judge Rules Causal Link Between Sexual Abuse and Schizophrenia Must be Aknowledged by Insurance Company

This is HUGE! For those not from New Zealand, ACC (Accident Compensation Corporation) is a government-contracted insurance company that covers counselling and psychotherapy for those who can demonstrate  "mental injury due to sexual abuse." It's one of the many reasons I moved to New Zealand as I figured a country that not only recognises that: abuse exists, can be forgotten,and then return in memory; but that actually compensates the people who suffer because of this, can't be all bad. Two days ago...

"A judge has ruled in favour of an ACC claimant in a case expected to have "enormous" ramifications for the way mental health patients are treated.

In the decision, released recently, Judge Grant Powell in the Wellington District Court agreed with a psychiatrist who said a man's schizophrenia had been caused by trauma from sexual abuse in childhood.....

"(The) judge agreed with a growing body of research that says traumatic events can cause psychosis.

The research includes the work of clinical psychologist John Read, who has been at the forefront of research to show a relationship between childhood sexual and physical abuse and psychotic symptoms, including schizophrenia."  Thank you John Read for years of painstaking ground-breaking (and myth-busting) work. .Click here for more on this

Healing from Childhood Abuse, Trauma and Neglect (Part 1)

When searching for counselling and therapy to heal the wounds of trauma, childhood abuse, and/or childhood neglect one can be faced with an overwhelming myriad of choices.   Most treatment techniques (both  medical and psychological) that are studied scientifically take into  account that a significant percentage (actual numbers vary based on condition or treatment being studied) of those being studied get better spontaneously simply because they believe they are being given a  (called the placebo effect).

A number of new approaches that take into account the recent discoveries of neuroscience, made possible by modern brain imaging techniques, have been shown either scientifically (in placebo controlled randomised blind or double-blind studies) or anecdotally (based on empirical observations and patient/client reports) to be highly effective in a shorter period of time than conventional "talking only" therapy. All of these approaches, of course, need to be integrated by a skilled and experienced clinician, into an overall treatment style and plan that will include talking therapy as well as a healthy respect for the power of the therapeutic relationship and the need for the therapist to earn the client's trust by creating safety.

Below I list some of the approaches that have been shown to be effective  with survivors of adult trauma and childhood physical, sexual, and emotional or psychological abuse, plus a link to another blog entry I wrote on effective  approaches for those suffering from the effects of "poor affect regulation",  commonly caused by emotional neglect or the unavailability of reliable  soothing in early childhood.  I only list those methods that I have personally learned and tried and observed to be effective, and the reasons (if known) that they work. 

Affect regulation treatment approaches are also useful with survivors of trauma and/or childhood abuse. The basis for this is  described in a separate blog entry (Learning to Comfort and Soothe) as they are more generic therapy approaches used for a broader range of problems and causes.  Since writing that entry, I have been learning about "memory reconsolidation" which claims that rather than going through the painstaking process of learning to "regulate" out of control feelings, one can "re-write" the implicit memory itself so that feelings become self-regulating, as they would have been if the original "dysfunctional implicit memory" hadn't been laid down in the first place. I will explore this in depth in another blog entry (coming as soon as I finish writing it).

I mention anecdotal or scientific (placebo-controlled) in brackets next to the name of each approach to identify the type of documentation of  effectiveness. I include approaches that have primarily anecdotal evidence because it is extremely difficult to measure approaches to complex trauma and dissociation in a laboratory setting. In my opinion, there are too many uncontrollable variables once you try to measure treatment effects with this population, especially since it isn't ethical to in any way limit access to anything that might help simply because it could confound the scientific evidence of your study.  The DNMS, Sensorimotor Psychotherapy,  and Ego State Work, for example, have ample anecdotal evidence presented in scientific journals as controlled case studies, and are based upon modern scientific insights into the brain,  but that is not the same as evidence based on rigorously controlled scientific studies.

Ego State Therapy (anecdotal)

Founders: John and Helen Watkins

The concept of segmentation of personality into discreet parts of self has been around for many years, but has only recently been validated scientifically by new brain scanning technologies. These technologies, by measuring blood flow patterns in the brain, demonstrate how ego states are formed by neural clusters repeatedly firing together (and therefore "wiring together"). 

Such neural nets form the basis for most implicit learning - such as learning how to ride a bicycle - a skill that improves and eventually "clicks" as the neurons, which fire together in the same pattern whenever riding is practised, form a network with a particular skill set. When such a neural net forms in the context of a relationship, it will develop a unique point of view and way of behaving.

Ego states exist as a collection of perceptions, cognitions and emotions in organised clusters. An ego state may be defined as an organized system of behaviour and experience, whose elements are bound together by a common principle. Ego states may also vary in volume. A larger ego state may include all the various behaviours activated in one's occupation, whereas a smaller ego state might be formed around a simple action, such as using a mobile phone. They may encompass current modes of behaviour and experiences or include many memories, postures, feelings, etc., that were learned at an earlier age.

The human mind is a collective "family of self" within a single individual. How well these "family" members get along, and how effectively they cooperate can vary considerably from individual to individual. 

This segmentation has been called many names over the years, depending upon which psychological theory is being used. In Freudian language we are all divided into Ego, Id and Superego; Jungians refer to "complexes" which are described almost identically to ego states; Transactional Analysts talk about the internal Parent, Adult and Child; and Psychosynthesis refers to "sub-personalities." Ego states exist on a continuum of separateness, with the most extreme dividedness being caused by the most extreme early relational trauma.

Although everyone has ego states, those states formed in response to loving supportive experiences do not tend to require psychotherapeutic intervention. When ego states are more split off and engage in internal battles, Ego State Therapy can be employed to help resolve some of these conflicts, often using techniques found in conflict resolution, group or family therapy, to enable a kind of internal diplomacy. This approach has demonstrated that complex psychodynamic problems can often be resolved in a much shorter period than with analytic therapies. 

PLEASE NOTE: The techniques described here have been integrated into PSI^TM (PsychoSomatic Integration), an overall approach I teach for working with trauma and abuse survivors. PSI^TM is described here in more detail.  

More approaches to come....to be continued

Self Empowerment: Actualizing the Power Within

To experience empowerment we must act on a sense of self worth, value and give voice to our own needs, and give equal validity to our own needs as to others'. As we develop a sense of empowerment, we begin to discover that a conflict of needs actually can present us with a creative challenge to imagine solutions that can empower all parties involved (rather than fearing that a conflict of needs must necessarily result in a "win-lose" battle).  I offer the following vignette as an example:

Mary does child care every night so John can go out with the "boys".  Mary becomes more and more resentful of John and their young children.  Finally, Mary initiates an assertive "conflict".  She says:

"I understand that you work hard all day and need time in the evenings to relax and unwind, but I've never pointed out to you that for you to relax and unwind by going out every night, you are counting on me to stay home with the kids, which is what I do all day.  So I don't get to relax and unwind and I become more resentful toward you and the kids and unpleasant to be around.  I need escape time too.  I'd like us to work out a way that we can both get what we need."

John agreed that Mary had become very unpleasant to be around (and didn't hesitate to tell her so.)  But after a number of arguments, they came around to agreeing on an experiment.  The experiment was that once a week John would go out while Mary watched the children, once a week Mary would go out while John watched the children, and once a week they both went out while Mary's mother watched their children.  The other two evenings they all stayed home as a family.  After two weeks of this experiment, not only did Mary feel better, but John felt better as well because he was feeling closer to his children and getting less resentment from his wife--and he still had time to see his friends.

The word "compromise" does not adequately describe the process of creating a "win-win" solution.  Compromise implies that neither side really gets what they want, whereas in "win-win" solutions, both sides get as much if not more than they wanted originally.  Assertiveness means acting from a place of respect – for self and other – and assuming equal value to the needs of self and other.  This presents many dilemmas that can also be seen as possibilities.  Power--the power of creative problem solving and acting--is mobilized rather than suppressed.

Power

Traditionally power has meant different things for men and women, taking on more positive connotations for men.  Think of the following words, first for men and then for women.  Pay attention to the feelings they evoke:

Men	Women
Powerful	Powerful
Aggressive	Aggressive
Forceful	Forceful
Ambitious	Ambitious
Assertive	Assertive
Competitive	Competitive
Authoritative	Authoritative

      

1. Women have traditionally been expected to defer to men, and have internalized the dominant cultural expectations of females as submissive and powerless

and

 2. There is something wrong with the present system of power distribution for all people, which we, as women, may be particularly sensitive to, having so deeply learned to respect the importance of other people's needs.

 As we endeavor to compete with men as their equals, some of us feel there is something sour about climbing up a ladder on top of other worthy people's heads, something deceitful about the notion of inferiority and superiority in our fellow human beings. We see that to gain others must lose, and having been relegated to losing for thousands of years, we may not feel comfortable inducing that experience in others.

When some people have less power than others do because external forces (e.g. money, status, physical strength, military force) block them, many problems arise for both the "winners" and the "losers".  The "losers" become afraid to express their needs because they fear (often rightfully) that what little they have will be taken from them.  They then become afraid to even feel their needs, to admit to themselves that they want something.  They become immobilized.  And, in certain critical ways, they stop growing; cease to thrive; development (the Power from Within) is blocked. The "winners" then miss out on the experience of sharing with equals and become self-preoccupied.  Their development is also blocked.

Let's consider these questions:

1. How do we reclaim our rights to power and effectiveness in the world without doing so at the expense of others?

2. How can we, as women, integrate the profound knowledge we gain from mothering and being nurtured by our mothers -- i.e., that we are each special, unique, and worthy in our own right, into a culture where value is so often seen in material terms?

We may want to begin by developing our own vocabulary to describe our experiences and perceptions.  Without words to communicate our experiences, we are trapped and limited.  If power only means the power to force others to do our will, we will feel that power is foreign to us, awkward and unfamiliar.  But power means many things, and many aspects of power can feel right for us.

I offer the following words and phrases to begin reclaiming our own vocabulary taken from Simos 1987 - (see below*)

 Power Over: the ability to force others to do your will through physical or financial coercion.  The power inherent in social or economic positions, or physical size or strength, regardless of skill or ability.

 Shared Power: power whose goal is to uplift or teach others to bring them to parity, as with a parent/child, teacher/student, or psychotherapist/client relationship

 Referred Power: the power others give us because they value, respect, and/or are attached us

 Expertise Power: the power others give us because they count on our knowledge and judgment

 Power With: the power to be effective interpersonally, to persuade, to inspire (not “command” or force) respect

Power From Within: the power of growth and development inherent in all living things.  It is the power to change, to overcome obstacles, to face our own fears, to learn new skills, to fail, and to try again.

Power can be used to destroy or create, to belittle others and over-inflate the self, or to belittle the self and over-inflate others.  We may call the use of power to harm or belittle the self passive power, and to harm or belittle others aggressive power. In contrast, assertiveness can be seen as the use of power to enhance and respect both self and other.  Assertiveness training, then, can be a way for women to reclaim their rights to power and effectiveness in the world without doing so at the expense of others.

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 * new vocabulary words taken from Miriam Simos (Starhawk) Truth or Dare, Harper & Row Publishers, New York, 1987

 Suggested Reading

Jean Baker Miller, M.D. (1976). Toward a New Psychology of Women. Boston: Beacon Press

Pamela Butler (1981) Self-Assertion for Women. New York: Harper & Row Publishers

Margaret McIntosh () Feeling Like a Fraud a Work In Progress Paper of the Stone Center for Developmental Studies at Wellesley College, Wellesley, Mass., 02181

Miriam Simos (Starhawk) (1987) Truth or Dare. New York: Harper & Row Publishers