Every few weeks, I will post my thoughts from various books, articles, and discussions – as an extension of my desire to understand better the relationship between human behavioral health and counseling/psychotherapy. This blog is NOT intended to diagnose, treat, or replace person-to-person psychological, medical, or legal professional consultation.

Daring Greatly

Posted by on Jul 24, 2016 in Research | 1 comment

Daring Greatly

My adult son called a few weeks ago and asked if his mom and I would join him for a few vacation days beside the ocean. My first thought was, “An adult son wants to spend some vacation time, by the ocean, with his mom and dad?” My second thought was, “What a fine job his mother and I did parenting this child?” Of course I knew better, but it was still a nice thought. My third thought was, “By the ocean? Heck yeah!” Knowing myself, that it’s hard for me to spend unstructured time without a book in my hands (you’re thinking compulsive, right?), I took Brene’ Brown’s Daring Greatly (2012). Brene’ Brown, PhD, is a research professor at the University of Houston Graduate College of Social Work, especially noted for her research on vulnerability, courage, worthiness, and shame. Brene’ is also a prolific author (for example, I Thought It Was Just Me (2007); The Gifts of Imperfection, 2010; Rising Strong, 2015) and public speaker, whose 2010 TEDxHouston (Technology, Entertainment, Design) talk is one of the most watched talks on

Brene’s research debunks the cultural myth that “vulnerability is weakness.” Instead, she writes, “Vulnerability is the birthplace of love, belonging, joy, courage, empathy, and creativity….If we want greater clarity in our purpose or deeper and more meaningful spiritual lives, vulnerability is the path….I define vulnerability as uncertainty, risk, and emotional exposure. With that definition in mind, let’s think about love. Waking up every day and loving someone who may or may not love us back, whose safety we can’t ensure, who may stay in our lives or may leave without a moment’s notice, who may be loyal to the day they die or betray us tomorrow – that’s vulnerability. Love is uncertain. It’s incredibly risky. And loving someone leaves us emotionally exposed. Yes, it’s scary and yes, we’re open to being hurt, but can you imagine your life without loving or being loved?….The profound danger is that…we start to think of feeling as weakness.” “To feel is to be vulnerable.”

Because vulnerability is so threatening, we protect ourselves. We fiercely (!) protect ourselves. Brene’ calls it “armoring” ourselves. She writes: “As children we found ways to protect ourselves from vulnerability, from being hurt, diminished, and disappointed. We put on armor; we used our thoughts, emotions, and behaviors as weapons; and we learned how to make ourselves scarce, even to disappear. Now as adults we realize that to live with courage, purpose, and connection – to be the person whom we long to be – we must again be vulnerable. We must take off the armor, put down the weapons, show up, and let ourselves be seen.”

Three forms of armoring, or shielding, are discussed; what she calls the “common vulnerability arsenal.” They are, in her words: foreboding joy, perfectionism, and numbing.


Foreboding Joy (“the paradoxical dread that clamps down on momentary joyfulness”)

“In a culture of deep scarcity – of never feeling safe, certain, and sure enough – joy can feel like a setup. We wake up in the morning and think, ‘Work is going well. Everyone in the family is healthy. No major crises are happening. The house is still standing. I’m working out and feeling good.  Oh, shit. This is bad.  This is really bad. Disaster must be lurking right around the corner’….We’re always waiting for the other shoe to drop….Once we make the connection between vulnerability and joy, the answer is pretty straightforward: We’re trying to beat vulnerability to the punch. We don’t want to be blindsided by hurt. We don’t want to be caught off-guard, so we literally practice being devastated….And our (media-driven) culture assists in this doom-filled rehearsal (with) a stockpile of terrible images that we can pull from at the instant we’re grappling with vulnerability.”

Basically, Brene’s “foreboding joy” is what we mean by the term “catastrophize.” Her antidote? Practicing gratitude. “(T)he shudder of vulnerability that accompanies joy is an invitation to practice gratitude, to acknowledge how truly grateful we are for the person, the beauty, the connection, or simply the moment before us. Gratitude, therefore, emerged from the data as the antidote to foreboding joy.”


Perfectionism (“believing that doing everything perfectly means you’ll never feel shame”)

“Perfectionism is, at its core, about trying to earn approval. Most perfectionists grew up being praised for achievement and performance (grades, manners, rule following, people pleasing, appearance, sports). Somewhere along the way, they adopted this dangerous and debilitating belief system: ‘I am what I accomplish and how well I accomplish it. Please. Perform. Perfect.’ Healthy striving is self-focused: How can I improve? Perfectionism is other-focused: What will they think?” Once again, perfectionism is the “belief system…’If I look perfect and do everything perfectly, I can avoid or minimize the painful feelings of shame, judgment, and blame.’”

Brene’s antidote? Appreciating the beauty of cracks. “Regardless of where we are on this continuum, if we want freedom from perfectionism, we have to make the long journey from ‘What will people think?’ to ‘I am enough.’ That journey begins with shame resilience, self-compassion, and owning our stories….(W)e have to be willing to give ourselves a break and appreciate the beauty of our cracks or imperfections. To be kinder and gentler with ourselves and each other. To talk to ourselves the same way we’d talk to someone we care about.”


Numbing (“the embrace of whatever deadens the pain of discomfort and pain”)

“(S)tatistics dictate that there are very few people who haven’t been affected by addiction. I believe we all numb our feelings. We may not do it compulsively and chronically, which is addiction, but that doesn’t mean that we don’t numb our sense of vulnerability. And numbing vulnerability is especially debilitating because it doesn’t just deaden the pain of our difficult experiences; numbing vulnerability also dulls our experiences of love, joy, belonging, creativity, and empathy. We can’t just selectively numb emotion. Numb the dark and you numb the light.”  Brene’ is reminding me of the distinction Stephen C. Hayes, PhD, makes between the “pain of presence” and “pain of absence.” In trying to avoid painful thoughts, feelings, body sensations, and behaviors, we also and necessarily absent ourselves from living the life we would like to be living.

Brene’s antidote? Aligning life with one’s values and setting boundaries. Brene’ writes, “As I asked (research participants) more pointed questions about the choices and behaviors (they) made to reduce anxiety, they explained that reducing anxiety meant paying attention to how much they could do and how much was too much, and learning how to say, ‘Enough.’ They got very clear on what was important to them and when they could let something go….When asked about the process of setting boundaries and limits to lower the anxiety in their lives, (this group) didn’t hesitate to connect worthiness with boundaries. We have to believe we are enough in order to say, ‘Enough!” Again, Brene’ is reminding me of a definition by addiction specialist Patrick Carnes, PhD, about boundaries. “A boundary – is a relationship with yourself!”

So there you have it. My 2016 summer vacation by the ocean – with my wife, and my son – and, Brene’ Brown. 

Bill Bray, Colorado Springs, CO

“This is Stupid!” (Or, Maybe Not)

Posted by on May 1, 2016 in Research | 0 comments

“This is Stupid!” (Or, Maybe Not)

“THIS IS STUPID…!” That’s what a client told me recently in the midst of doing EMDR Therapy. Undoubtedly, I’ve had many clients who probably thought what I was doing was “Stupid!”, but this was the first client who verbalized their doubts and frustration. I shouldn’t be surprised to hear such a response. The very nature of psychotherapy is difficult and challenging; but, it’s still difficult for a therapist to hear. Most therapists are giving their very best efforts to be helpful. Some deconstruction and contextualization of the situation are in order. First, a word about EMDR Therapy.

My website is replete with information about EMDR Therapy; from a separate web page to official websites. The reader is encouraged to vet this remarkable therapy. Succinctly, ­Eye Movement Desensitization and Reprocessing (EMDR) was developed in the 1980s by psychologist Francine Shapiro, PhD. As with many discoveries, Dr. Shapiro made the chance observation that eye movements can reduce the intensity of disturbing thoughts, under certain conditions. This humble beginning launched years of experimental and clinical research, and has now evolved into one of the leading and most recognized treatments for trauma throughout the world. My succinct description of EMDR to clients goes something like this: “Research suggest that when distressing events are paired with bilateral stimulation–visual, tactile, and/or auditory–there is the potential that those events will be desensitized and reprocessed.” Although no one knows how any form of psychotherapy works neurobiologically in the brain, EMDR appears to be similar to what occurs naturally during dream or REM (rapid eye movement) sleep. Therefore, EMDR Therapy can be thought of as a physiologically based therapy that helps a person see disturbing material in a new and less distressing way. Again, the reader is urged to read the seven or eight paragraphs on the EMDR page of this website.

Since EMDR Therapy often (not always) asks clients to think of their distressing event while following side-to-side movements with their eyes, you might think that my client’s “THIS IS STUPID!” was referring to this process. At first, that’s what I thought. In his new book Why Therapy Works; Using Our Minds to Change Our Brains (2016), Pepperdine University professor and psychologist Louis Cozolino, PhD, talks about his initial disdain for this kind of therapy. He writes:

“Like many other forms of treatment, EMDR consists of exposing the client to feared memories in a structured, sensitive, and caring manner. But unlike other methods, it adds a series of eye movements or other forms of sensory stimulation to the process. I dismissed it for a long time because it seemed somewhat faddish, and I thought that waving a finger in a client’s face seemed unbecoming of a professional. There was also a certain strange…feel to the whole thing that put me off. In my decades of doing therapy, I had seen hundreds of fads come and go, and I was waiting for this one to go away as well. Not only did it not go away, but clinicians I respected began saying positive things about it.”

Dr. Cozolino proceeds to talk about his training and personal experience of EMDR – as a client. Asked by his therapist to “come up with some troubling thing in (his) life that (he) wanted to work on,” he picked a rather innocuous (he thought) issue: his negative reaction to monthly faculty meetings at Pepperdine.  What ensued was not only surprising, but meaningful. He writes:

“Two things about this experience were quite compelling. The first was that instead of working hard to rethink and organize my memory, it was if I was watching these internal events taking place on a screen. The (process) unfolded before me as if I was a witness (to the experience). The second compelling aspect of the experience was that in the faculty meeting in the week that followed, I felt unburdened of the extreme emotions that had plagued me in the past. The meeting was as boring and unproductive as ever, but clear of the baggage that I always brought in with me. I was impressed with the results. EMDR had opened a new window in the world of memory.”

Like Cozolino, you might think my client’s statement–“THIS IS STUPID!”—was referring to the “process” of EMDR Therapy. I quickly realized this was not the case, based on what was said next:


I realized in that moment that a little more preparation, indeed education, was needed before continuing EMDR Therapy. We used the following therapy session to process my client’s resistance. The conversation focused on the relationship between trauma and memory. The remainder of this post represents the content—and sequence—of that discussion. Because I tend to convey such information in footnotes, my resource partners–on this occasion–included Louis Cozolino, Peter Levine, and Dan Siegel.

FIRST, Explicit and Implicit Memory

“Broadly speaking, there are two types of memory: those that are explicit and those that are implicit, the former being conscious and the latter relatively unconscious. These two memory systems—each of which has at least two broad subcategories—serve separate functions and are mediated by distinct neuro-anatomical brain structures” (Levine, 2015).

           – Explicit Memory: Declarative and Episodic

Declarative memories are conscious memories about which we can tell (declare) factual information. “Most lay persons, as well as many therapists, tend to think of memory primarily as this concrete form….”

Episodic or autobiographical memory is the awareness of ourselves within the context of a declarative, or factual, memory situation.

NOTE: Explicit memory is the kind of memory my client referenced when saying, “THIS IS STUPID! YOU CAN’T CHANGE THE PAST! YOU CAN’T CHANGE MEMORY! IT’S WHAT FACTUALLY HAPPENED!” A deeper understanding of memory was needed for therapy to proceed.

           – Implicit Memory: Emotional and Procedural

“In contrast to the conscious explicit memories…implicit memories cannot be called up deliberately….Instead, they arise as a collage of sensations, emotions, and behaviors….They are primarily organized around emotions and/or skills, or ‘procedures’ – things that the body does….Like bookmarks, emotions are charged signals that select a particular procedural memory out of a book of possible motor memories. They prompt…action” (Levine, 2016).

Because trauma is largely physiological (flight-fight-freeze), trauma therapy–like EMDR—pays special attention to physical sensations, impulses, emotions, and behaviors – all implicit memories.

NEXT, the Malleability of Memory

“In memory research, the initial impact of an experience on the brain has been called an ‘engram.’ If you visited the Eiffel Tower with a friend and were talking about existential philosophy and Impressionist paintings as you were having your picnic, your engram might include the various levels of experience: semantic (factual something about philosophy or art or knowledge about the Tower), autobiographical (your sense of yourself at that time in your life), somatic (what your body felt like at the time), perceptual (what things looked like, how they smelled), emotional (your mood at the time), and behavioral (what you were doing with your body)” (Siegel, 1999; 2012).

NOTE: Both kinds of memory—explicit and implicit memory—are involved in the above example.

“Some authors use the notion of ‘trace theory’ to describe the encoding, storage, and retrieval processes of memory. In this view, your engram or memory trace has both a ‘gist’ (the general notion that you were in France at the Tower) and specific details. With time, the details of an experience may begin to fade away….The gist, however, may remain easily accessible for retrieval and quite accurate. When we try to retrieve an ‘original memory,’ in fact, we may be calling up the gist at first (“I was at the Eiffel Tower when I was in my early twenties”) and then later trying to reconstruct the details. This reconstruction process may be profoundly influenced by (present factors). Memory is not a static thing, but an active set of processes….Remembering is not merely the reactivation of an old engram; it is the construction of a new neural…profile with features of the old engram and elements of memory from other experiences, as well as influences from the present state of mind” (Siegel, 1999; 2012).

LASTLY, the Malleability of Memory – Illustrated

Louis Cozolino (2010) illustrates further the malleability of memory in a story he calls “The Magic Tricycle,” which I included in my November, 2014 blog post. I shared it with my client that day, and share it again here, verbatim.

“Sheldon was a man in his late 60s who came to therapy for help with his many anxieties and fears. As a child, his parents had hidden him from the Nazis in a storage room behind the home of family friends. One day, after finding out that she and Sheldon’s father would be taken to the concentration camps, Sheldon’s mother told him to be a good boy, said goodbye, and left….Describing these days, Sheldon recalled alternating states  of terror and boredom, during which he would either sit and rock or ride his tricycle around in slow tight circles. The slightest noise would startle him and he feared that each passing siren might be the police coming for him. Each day, exhausted by fear, he would eventually fall asleep.

The intervening decades had not diminished the impact of his experiences during the war; 60 years later, he still found himself reflexively rocking or walking in small slow circles when he became frightened….In repeatedly recalling these experiences in treatment, he sometimes mentioned how he wished he could have left the house where he was hidden and traveled down the narrow streets to his grandmother’s house….

One day, I asked him for permission to change his memories just a bit. After a few quizzical looks he agreed to close his eyes and tell me the entire story again, at which point I would interrupt him and make some suggestions. As he came to the part of the story where he rode around in circles, I asked him, ‘What would you do if this was a magic tricycle and it could take you through walls without getting hurt?’ I felt Sheldon had sufficient ego strength to allow him to simultaneously engage in the role-play while staying fully in touch with present reality.

After some hesitation, Sheldon said, ‘I would ride right through the house and out onto the sidewalk.’ ‘Fine,’ I said. ‘Let’s go!’ Sheldon had been primed for our imaginary therapy play because he had spent many enjoyable hours of storytelling, cuddling, and laughing with his grandchildren….

After some mild hesitation, he pedaled though the house. As he got close to the door, however, he said, ‘They’ll see me and kill me.’

‘What if the magic tricycle has the power to make you invisible?’ I asked.

‘I think that’ll do,’ said Sheldon, and he pedaled through the front of the house and out on the sidewalk. Once he got out of the house, he knew what to do….(W)hen he finally got to his grandmother’s house she was home and, as always, happy to see him. He told his grandmother about his invisible tricycle and how scared he was in his hiding place. He went on to tell her of the end of the war, his travels, and raising his family. Finally, almost like a prayer, Sheldon told her how, many years from now, she would have the most beautiful great-great-grandchildren living in freedom, redeeming her suffering.

Over the next few months, whenever Sheldon experienced his childhood fears and anxieties, we would revisit his story and modify different details. These changes seemed to grow more detailed and more vivid in his mind. His imagination gave him the power to master many of his past fears. Because memory is modified each time it is remembered, Sheldon’s brain was able to gradually contaminate his painful childhood with his present safety and joy….He even began to tell his grandchildren stories about a little boy with a magic tricycle who accomplished great things with his courage and wit….Nothing had changed about his childhood except that now, when he remembered his hiding place, he also remembered his magic tricycle.”


Not only does the research suggest that we can change a traumatic memory “implicitly,” we can also update a traumatic memory “explicitly.” The result with my client? They wanted to continue the EMDR Therapy we started.

Bill Bray, Colorado Springs, CO

Sad, or Mad?

Posted by on Mar 6, 2016 in Research | 0 comments

Sad, or Mad?

I’ve said before that my blog posts usually reflect what I’m currently reading; many times re-reading. And, my reading often aligns with the issues clients bring into therapy. As you read through this post, it should not be hard to guess the kinds of issues I’ve been addressing lately with clients.

In her book The Good Divorce (1994)—see July, 2013 blog post—professor and sociologist Constance Ahrons, PhD, talks about the negative effects of persistent anger in divorced couples. In a section she dubs “Acrimony Takes Its Toll”, Ahrons writes:

“There is no way to talk about divorce without talking about anger. It’s a universal reaction and it’s inevitable. But that doesn’t mean you should feel free to express your anger without restraint. If you throw more fuel on the inner fires, they’ll flare higher and higher and you’ll be stuck with the damage. When we focus on our rage, we stifle our ability to get on with life.

(In my research) those who stayed angry…stayed mired in the past instead of moving on to the present….In a real sense, they were actually more attached to their exspouses than were cooperative (exspouses). The ex became the target of any situation that created anger. Every time they felt hurt, they blamed it on their ex. ‘If it weren’t for the divorce, I wouldn’t have to date, or work, or take care of myself.’ Bad day? It was their exspouse’s fault. Messy apartment? Burned dinner? Broken zipper? Child failing at school? The holder of injustices—or the hostility junkie—needs to place blame on something tangible. The ex is an easy target, a habitual target, even a socially sanctioned target.

Continued, unrelenting hostility and anger are a clear indication that the losses that are an inevitable part of any divorce haven’t been mourned. Rage wards off not only the fears of facing sadness but ultimately the sadness itself. What almost always lies beneath rage is grief. If the loss of one’s dreams was allowed to surface, was felt and accepted, the rage would dissipate and life would go on. For many people, maintaining the continuing anger acts as a defensive shield….

(For example) Julie, the exwife of Paul, fifty-one….had to deal with the loss of her marriage and her terror at finding herself alone. She got seriously depressed. ‘The next few months were hell. I didn’t know what was happening to me. There was nothing I wanted to do. I lost any interest in how I looked and spent days just going from the bed to the couch and back, not even bothering to get dressed. I felt old, ugly, and utterly alone.’

With the help of a therapist, Julie mourned not only her relationship with Paul, but also her many losses. She grieved about ending her time as a wife and as part of a couple. Other role losses were more developmental. She mourned her youth, and her children leaving home. As she grieved she found new interests, new joys in life. Her depression resolved; she and Paul were then able to resume a cordial, sometimes friendly, relationship.

Julie had gone through two of the most common reactions to being left, and discovered that where anger is mobilizing, depression is paralyzing. Anger often masks depression, and when angry feelings abate, the depression emerges. In fact, some…couples stay furious as a way to maintain their energy over months or even years postdivorce.”

The point I wish to emphasize from the above excerpt:

“What almost always lies beneath rage is grief. If the loss of one’s dreams was allowed to surface, was felt and accepted, the rage would dissipate and life would go on.”

Thus, a compelling reason for permitting oneself to feel “sad”.

HOWEVER, there are equally compelling reasons for sometimes permitting oneself to feel “mad”.

In his book Why Therapy Works (2016), clinical psychologist and professor at Pepperdine University, Louis Cozolino, PhD writes:

“Rage is an extreme expression of the fight-flight response triggered by a threat to a loved one or an offense against something we hold dear. Rage correlates with surges of adrenaline that lead us to be able to do things we wouldn’t ordinarily be able to….Although rage is usually seen as counterproductive, it can also serve us….Because…rage is so destructive and so many people are sent to therapy for anger management, the idea of using rage constructively almost never comes up. But rage is one of the antidotes to parasympathetic lockup – where fear conditioning keeps people from realizing their anger, assertiveness, and power….

(For example) Sandy came to see me for help in ‘getting his life on track.’ He was in the process of extricating himself from an emotionally and physically abusive marriage that had gone on for a dozen years. Besides his two young daughters, he could not see anything positive that had come from the relationship, and he felt exhausted and demoralized after so many years of hostile criticism, physical attacks, and what he called emotional sabotage. Beyond laying all of the blame on his soon-to-be ex-wife, he also described a pattern of relating to business associates in the same timid, unassertive, and deferential manner as he had with his wife….

As I got to know Sandy, he described a physically and emotionally abusive father who was a constant source of fear until the time he left home for college. He also described his loyalty to his passive and saintly mother, who tried to hold the family together at the expense of her own physical health and emotional well-being. This led Sandy to identify with his mother and adopt…her avoidant behaviors in the face of conflict….

(Because Sandy’s) anger, assertiveness, and power had been inhibited…I wondered whether his (anger) was still accessible. And if so, was it strong enough to counterbalance his parasympathetic inhibition?….I asked Sandy to close his eyes and imagine the following scenario:

On the way home from picking your daughters up at school, you stop for gas. While the car is filling up, the girls ask for a snack, so the three of you walk into the convenience store. As the girls are searching the shelves for snacks, you notice that your seven-year-old, now at the other side of the store, is being grabbed by a man who is trying to pull her out of the store. She calls out ‘Daddy, Daddy!’

Before I even ask Sandy what he is thinking and feeling, I can see the tension in his body as he leans forward, and his eyes well up with tears. I ask him what he is experiencing….What do you feel in your body?….What do you imagine you will do when you get to him?….What if he is stronger and bigger than you?”

(Because this is more of a G-Rated than R-Rated blog post, I’ll spare readers the expletives that Sandy told Dr. Cozolino. Needless to say, Sandy’s anger potential was alive and well!)

Cozolino concludes:

“I told Sandy, ‘This is the (assertive) part of you we need in order to rewire the fear that is stealing your life away from you. You have to take care of yourself like you do for your daughter’….The truth for all of us is that when we are not allowed to be angry as children, we have to bury our anger. But when we bury our anger, we also bury our assertiveness and our power. This may have been what we needed to survive living with an abusive parent, but it is exactly what we need to change once we escape. In order to change, we have to summon the courage to rage against the machine in our head so we can activate our bodies and emotions. An amygdala can be like an overprotective parent whom you have to break away from in order to have a life.”

Because I do so much trauma therapy with clients—whose fight-flight reactions have been inhibited, resulting in an immobilization or “freeze” response–, Cozolino’s words have rung true these past few weeks:

“When we are not allowed to be angry as children—or, even feel our feelings— we have to bury our anger. But when we bury our anger we also bury our assertiveness and our power.”

So, which is it? Sad, or Mad? It’s both – depending on when each is needed.

Bill Bray, Colorado Springs, Colorado

Understanding Your Partner’s Temperament

Posted by on Jan 24, 2016 in Research | 0 comments

Understanding Your Partner’s Temperament

In July of 2012, I posted a blog based on the book Understanding Your Child’s Temperament (1997, 2005) by the esteemed pediatrician at The Children’s Hospital of Philadelphia, William B. Carey, M.D. I frequently use the book in therapy, and strongly recommend it to parents. Borrowing an excerpt from my 2012 blog:

“Categorizing nine possible ways of looking at temperament (what he defines as behavioral patterns, or ‘styles of behavior’), Carey identifies the following nine temperament traits: Activity, Regularity, (Initial) Reaction, Adaptability, Intensity, Mood, Persistence and Attention Span, Distractibility, and Sensitivity. To facilitate my information-giving with kids and families, I grouped Carey’s nine categories into a poorly-clustered mnemonic aid, using the first letter of each trait: A-R-R / A-I-M / P/D/S. The first two clusters conjured up for me images of pirates (A-R-R) taking A-I-M at another ship; but don’t ask me what P-D-S means: public display of savagery, maybe?” (Recently, a client simply and adroitly suggested that “pirates display savagery.) Continuing with the excerpt from my 2012 blog:

“At any rate, Carey urges parents and other caregivers to record observations of their child(ren)’s temperament traits (behavioral patterns). Urging the use of a separate piece of paper for each trait, Carey writes: ‘As objectively as you can, watch, listen, and describe the pattern of how your child responds to particular people, settings, and circumstances. Think of this notebook as a journal you might take on a trip. Or, think of yourself as a reporter who does not know this child, as someone who is an impartial, detached, but watchful witness.’ The result is what Carey calls a ‘Temperament Profile.’ He admits that ‘all nine traits are present in children to varying degrees,’ but it’s the variations you’re looking for in each category; the highs and lows and average variations per category. Once we have a clearer understanding of a child’s temperament, we can begin to improve our fit with better parenting and/or caregiving techniques. Carey observes: ‘You cannot…hammer the undesirable traits out of a child through rigid discipline, bribery, attempts at reasonable persuasion, or other tried-and-failed methods. You can learn to accept those traits and—at the same time—develop alternate ways to manage your child’s temperament to reach the immediate objective: reduced stress and increased harmony in parent-child interactions.”

The more I use and think about Carey’s “Temperament Profile” vis-à-vis the parent-child relationship, the more I intuit its value for other relationships; like an adult, romantic relationship. To borrow another excerpt from my 2012 blog: “In an era when science is enabling us to understand human experience in new ways, it is important to examine the common debate about much of development and personality can be attributed to ‘nature’ or genetics, as opposed to ‘nurture’ or experience.” Think for a moment how the hardwiring of “nature” or genetics is currently playing out in your adult, couple relationship(s); for example, when the traditional wedding vows really mean “To have and to mold from this day forward.” Could it be that some of the frustrations we experience in our partner are due to a temperamental hardwiring, versus their willful resistance? Could better “Understanding Your Partner’s Temperament” influence a more harmonious relationship? I think so. I propose so, because those children grow up to be adult, romantic partners. To tweak Carey’s advice: “You cannot…hammer the undesirable traits out of a (partner) through (rigidity)….You can learn to accept those traits and—at the same time—develop alternative ways to (peaceably live with your partner’s) temperament.”

Because Dr. Carey proposes “behavior(s)” as a window, or clue, into understanding the hardwiring of temperament, consider his nine proposed traits, and descriptions. I take the liberty to exchange the word “children” with the word “partner.”

Activity – “The activity characteristic of temperament refers to physical motion during sleep, play, work, eating, dressing, bathing, and other daily circumstances….(Is your partner) highly active?….Or is… physical motion generally low in most circumstances?”

Regularity – “(Regularity) is better observed as consistency, organization, or predictable patterns of…behavior, such as completing tasks on schedule….(Is your partner) predominantly regular and predictable, like clockwork, or if…reactions and activities are difficult to anticipate?”

Initial Reaction – “What is (your partner’s) initial reaction to new people, situations, places, foods,…and procedures?….(How) bold or hesitant…when faced with unfamiliar, novel environments?….At one end…is the (partner) who accepts and approaches ordinary degrees of novelty with little hesitation or plunges in quickly. At the other end is the (partner) who does not engage in new situations or withdraws from them entirely, at least for a while.”

Adaptability – “Adaptability is the longer-term adjustment that follows the initial response….It shows a range between flexibility and rigidity in adjusting to the environment after the initial response has occurred.”

Intensity – “Intensity refers to the amount of energy in (your partner’s) response, regardless of whether it is positive and happy, or negative and fussy.”

Mood – “(Is your partner’s) predominate mood…positive, negative, or somewhere in between?….(What) we are describing here is the (partner’s) observable reaction style, whether pleasant and friendly or the opposite. We are not attempting to estimate internal feelings of happiness, contentment, sadness, or depression, which may be quite different.”

Persistence and Attention Span – “Persistence refers to (your partner’s) tendency to stick with the activity despite obstacles or interruptions….Attention span is demonstrated by how long (your partner) sticks to an activity or pursues  a task when there are no interruptions. Persistence is similar to attention span and differs only as to the impact of the interruption.”

Distractibility – “Is your (partner) easily distracted by stimuli around (them)? Or…usually tune out surrounding sights, sounds, lights, or people and continue…without interruption?….(Look) for a dominant pattern in your (partner’s) response to interruptions and distractions.”

Sensitivity – “Sensitivity refers to (your partner’s) sensory threshold, or the amount of stimulation from outside factors—such as noises, sights,, smells, and lights—needed to rouse a response. This is not the same trait as distractibility, which refers to whether stimuli interfere with (a person’s) behavior…at that given moment….All five senses give clues to the…sensitivity trait….(Look) for a dominant pattern….(Is your partner) acutely aware of, and responsive to, sensory stimuli inside and outside (their) body? (Or) fairly average in sensory responses? Or does it take a greater amount of stimuli to jolt a response?”

On a separate piece of paper using the rating scale below, rate your partner on each of the nine, albeit brief, temperament descriptions. For example, write the number besides each of the nine temperament traits that you perceive in your partner.


Not Sure     A Little Bit     Moderately     Quite a Bit     Extremely

Now, rate yourself on the nine traits. Have your partner do the same, then compare results. The outcome could make for a profitable discussion.

Bill Bray, Colorado Springs, CO


Posted by on Dec 6, 2015 in Research | 0 comments


“Anyone who has been plagued by that age-old question—‘What is his deal?’—could benefit from a crash course in attachment theory.” That’s one of the back cover credits from Elle magazine.

Another back cover credit from a more scholarly source reads: “Cinderella’s prince passionately turned his kingdom upside down simply to find her perfectly shaped foot, and they lived happily ever after. This book is for the rest of us. In Attached, Levine and Heller distill years of attachment theory research on the nature of human relationships into a practical, highly readable guide, allowing its users to prevent or untangle doomed relationships and to predict and enhance those that will well and fit for a lifetime.” – John B. Herman, M.D. associate chief of psychiatry and distinguished scholar of medical psychiatry, Massachusetts General Hospital, and associate professor of psychiatry, Harvard Medical School.

A third back cover credit from one of the primary researchers in adult attachment research—Phillip R. Shaver, Ph.D., distinguished professor of psychology, University of California, Davis—reads: “Based on twenty-five years of research, laced with vivid and instructive examples, and enriched with interesting and well-designed exercises, this book provides deep insights and invaluable skills that will benefit every readers.”

My personal credit contribution—for what it’s worth—might read: “Currently, in my clinical work with couples, there are two primary reads that I try and get into the hands of every twosome. One of those ‘must-reads’ is Attached; The New Science of Adult Attachment and How It Can Help You Find—And Keep—Love (2010) by Amir Levine, M.D. & Rachel Heller, M.A. The feedback I receive from couples has been 100% ‘Thank You!’ Not only does attachment theory guide my in-session practice of couple therapy, I refer to the reading of Attached as ‘therapy outside of therapy.’ ‘Read it and discuss it as a couple’ is the commitment I try and secure from new clients.” (By the way, the other ‘must-read’ for me is The Seven Principles for Making Marriage Work, 1999; 2015, by John Gottman, Ph.D.; see my August, 2014 blog post).

Attached (2010) is organized into four sections. In the remainder of this blog, I’ll include a few excerpts and headings from each section to give you a kind of SparkNotes feel for this exceptionally helpful resource.


“Adult attachment designates three main ‘attachment styles,’ or manners in which people perceive and respond to intimacy in romantic relationships, which parallel those found in children: Secure, Anxious, and Avoidant. Basically, secure people feel comfortable with intimacy and are usually warm and loving; anxious people crave intimacy, are often preoccupied with their relationships, and tend to worry about their partner’s ability to love them back; avoidant people equate intimacy with a loss of independence and constantly try to minimize closeness….All people in our society, whether they have just started dating someone or have been married for forty years, fall into one of these categories, or, more rarely, into a combination of the latter two (anxious and avoidant).” (p. 8) By the way, “intimacy” often connotes “sexual intimacy,” but should not be defined so narrowly. Think of intimacy as multifaceted; “closeness,” whatever the nature of the closeness.

“It was John Bowlby’s stroke of genius that brought him to the realization (that)….We’ve been bred to be dependent on a significant other. The need starts in the womb and ends when we die….This mechanism, called the attachment system, consists of emotions and behaviors that ensure that we remain safe and protected by staying close to loved ones. The mechanism explains why a child parted from his or her mother becomes frantic, searches wildly, or cries uncontrollably until he or she reestablishes contact with her. These reactions are coined ‘protest behavior,’ and we all exhibit them as grown-ups.” (p. 12)

“While the teachings of the codependency movement remain immensely helpful in dealing with family members who suffer from substance abuse (as was the initial intention), they can be misleading and even damaging when applied indiscriminately to all relationships….The emphasis on differentiation that is held by most of today’s popular psychology approaches to adult relationships does not hold water from a biological perspective. Dependency is a fact; it is not a choice or a preference.” (p. 26)

Your Relationship Toolkit: Deciphering Attachment Styles (Part One)

“Step One: What is My Attachment Style…Following is a questionnaire designed to measure your attachment style – the way you relate to others in the context of intimate relationships. The questionnaire is based on the Experience in Close Relationships (ECR) questionnaire….The ECR allowed for specific short questions that targeted particular aspects of adult attachment based on two main categories: anxiety in the relationship and avoidance. Later, Chris Fraley from the University of Illinois (and colleagues) revised the questionnaire to create the ECR-R….For a fully validated adult attachment questionnaire, you can log on to Dr. Chris Fraley’s website at: htttp://” (pp. 39-40)  I often ask couples to take this online questionnaire and bring back the results to the next therapy session. It only takes a few minutes.

“Step Two: Cracking the Code – What is My Partner’s Style?”…Figuring out other people’s attachment styles is usually trickier than identifying your own….Luckily, without knowing it, most people give away almost all the information you need to determine their attachment style in their natural, day-to-day actions and words….Following is a questionnaire designed to help you establish your partner’s or date’s attachment style.” (pp. 49; 51; see chapter for questionnaire)

The Three Attachment Styles in Everyday Life (Part Two)

“Living with a Sixth Sense for Danger: The ANXIOUS Attachment Style” (p. 77)

“Keeping Love at Arm’s Length: The AVOIDANT Attachment Style” (p. 109)

“Getting Comfortably Close: The SECURE Attachment Style” (p. 131)

When Attachment Styles Clash (Part Three)

“All three cases we’ve described have one thing in common: While one partner truly wants intimacy, the other feels very uncomfortable when things become too close. This is often the case when one of the partners in a bond is avoidant and the other is either anxious or secure – but it’s most pronounced when one partner is avoidant and the other is anxious. Research on attachment repeatedly shows that when your need for intimacy is met and reciprocated by your partner, your satisfaction level will rise. Incongruent intimacy needs, on the other hand, usually translate into substantially lower satisfaction. When couples disagree about the degree of closeness and intimacy desired in a relationship, the issue eventually threatens to dominate all of their dialogue.  We call this situation the ‘anxious-avoidant trap…” (pp. 156-157)

“Perhaps one of the most intriguing findings in adult attachment research is that attachment styles are stable but plastic. This means they tend to stay consistent over time, but they can also change….Here we want to offer couples a chance to work together to become more secure.” (p. 163) You’ll definitely want to read Chapter 9 (“Escaping the Anxious-Avoidant Trap: How the Anxious-Avoidant Couple Can Find Security”). Included is a “Relationship Inventory” which “will walk you through your past and present relationships from an attachment perspective.” (p. 166)

The Secure Way: Sharpening Your Relationship Skills (Part Four)

“Effective communication works on the understanding that we all have specific needs in relationships, many of which are determined by your attachment style. They aren’t good or bad, they simply are what they are. If you’re anxious, you have a strong need for closeness and have to be reassured at all times that your partner loves and respects you. If you’re avoidant, you need to be able to maintain some distance, either emotional or physical, from your partner and preserve a large degree of separateness. In order to be happy in a relationship, we need to find a way to communicate our attachment needs clearly without resorting to attacks or defensiveness.” (p. 222)


“We (have) allowed some deeply ingrained misconceptions to influence our thinking. The first misconception is that everyone has the same capacity for intimacy….It’s tempting to forget that, in fact, people have very different capacities for intimacy….The second common misconception…is that marriage is the be-all and end-all….that the decision to marry means they’re now ready for true closeness and emotional partnership….In this book, however, we’ve shown how mismatched attachment styles can lead to a great deal of unhappiness in marriage, even for people who love each other greatly….The third hard-to-shed misconception we fell for is that we alone are responsible for our emotional needs; they are not our partner’s responsibility….Again, we must constantly remind ourselves: In a true partnership, both partners view it as their responsibility to ensure the other’s emotional well-being.” (pp. 269-271)

Bill Bray, Colorado Springs, CO

Inside Out: Deep Down

Posted by on Oct 25, 2015 in Research | 0 comments

Inside Out: Deep Down

This blog builds on my previous post (“Inside Out”) about “emotion(s)”; specifically the difference between “categorical emotion” and “primary emotion.” My previous post lauds Disney/Pixar’s delightfully animated movie, Inside Out, which depicts how our brains process emotion. Briefly (to repeat an excerpt from the previous blog), the movie depicts:

‘Riley – a happy-go-lucky girl from Minnesota who is followed throughout the movie by five, basic animations of her emotions: Joy, Sadness, Disgust, Anger, and Fear. Each color-coded manifestation—Joy: Yellow; Sadness: Blue; Disgust: Green; Anger: Red; Fear: Purple—lives in the Headquarters of Riley’s conscious mind. Joy, the principal narrator (voice of Amy Poehler), works very hard to keep Riley in a happy state; which is not difficult to do in the secure setting of her Minnesota childhood home. All is about to change.

When Riley turns 11-years-old, her beloved father takes a new job in San Francisco. Sadness begins tainting some of Riley’s happy memories, which understandably triggers the other basic emotions. Led by Joy and Sadness, an odyssey ensues to restore Riley’s happy equilibrium. Things get worse, much worse, before there’s any sign of improvement. Emotions and memories ebb and flow, and threaten to swallow up the happy-go-lucky girl from Minnesota, who is now distancing from parents, friends, and hobbies.

While Joy spends most of the movie trying to keep Sadness away from Riley, the denouement of Inside Out unfolds when Riley is finally allowed to feel her feelings. What pretention, distraction, compulsion, and suppression were unable to do – empathy and compassion accomplished.’

While the movie brilliantly depicts the importance of emotions to mental health and well-being, it primarily emphasizes the importance of “basic” or “categorical” emotions; such as feelings of anger, sadness, happiness, and the like. In other words, “categorical” emotions are what we generally mean when we talk about emotions; the emotional descriptors that emerge when we become conscious of our feelings. But, research identifies another kind of emotion—a deep(er) down emotion–which the Inside Out movie does not purport to address. It has been called by some researchers, “primary” emotion.

Whereas “categorical” emotion implies the conscious awareness of how we feel, “primary” emotion denotes the nonconscious, physiological processes that precede conscious feelings. I noted these nonconscious, physiological processes in my previous blog; referencing the analogy of William James who argued that we don’t run from a bear because we’re afraid. Instead, we are afraid because we run. This is to say:

“Before we are consciously aware of a particular feeling, our bodies have already begun to react.”

While researchers differ in wanting to call these nonconscious, physiological processes “emotions”–for example, Joseph LeDoux (2015) prefers “defense responses”, while Antonio Damasio (1994; 2013) prefers “somatic markers” and “action programs”), modern neuroscience seems to agree that emotions are prompted by bodily responses; what some call “primary” emotions.

Psychiatrist Curt Thompson, M.D. (2010) gives the following example:

“Imagine for a moment sitting with friends in their living room. The sky is bright outside their picture window, and you’re immersed in a warm, friendly conversation. You are comfortable and relaxed…feeling contented and happy in the presence of your friends….

As you talk, you and your friends hear something rap on the window. How do you react? Your initial response is driven by primary emotion. When startled, parts of your peripheral nervous system respond without your conscious awareness. This means your breathing and heart rates, along with your blood pressure, muscle tone, and sweat rate, elevate. In addition, your brain signals your adrenal glands to increase the production of stress hormones.

Brain time is measured in microseconds to nanoseconds, so long before you become consciously aware that something has hit the window, your central nervous system is collecting and synthesizing data from several sources and preparing your physical response….Your brain does not ‘think’ of this event initially in terms of something hitting a window so much as it registers a cumulative shift in the patterns of electrical firing throughout the various neural networks that have been activated in response to this particular stimulus.

Actually, what happens next will depend a great deal on what has hit the window. Let’s say a small bird accidentally flew into it and glanced off the glass. You might all briefly turn your attention to the noise, but if the bird flies off unharmed, your attention will quickly return to your conversation and your physiological readings return to normal within a few seconds.

How does your response differ if…the rapping noise comes from another friend greeting the rest of you just before he enters the house and joins you in the living room? In this case, your primary physical/mental responses are likely to be more lasting and eventually lead to a predictable feeling of pleasure at the arrival of your friend. Long before you are consciously aware of feeling pleasure, however, your body is sending the basic signals that predispose you to have that particular feeling….(Y)our brain is able to compare this particular state (happiness) to other times when you have experienced it. It ‘remembers’ those occasions through the circuitry responsible for implicit memory.

But what if the knocking comes from a stranger wielding a handgun? You experience an entirely different set of emotions in this scenario. Those emotions quickly cascade into a state you might describe as fear. Your body registers signals that lead to feelings caused by fright, comparing your fear to other situations that stirred up this feeling….

This constant monitoring and shifting in energy is the activity around which the brain organizes itself. This is emotion. (My note: Or, what researchers LeDoux and Damasio might call the bodily precursors to consciously apprehended emotions.)  The origin of our word ‘emotion’ is grounded in the idea of e-motion, or preparing for motion. This is why the phenomenon of emotion is deeply tied to ongoing action or movement. We cannot separate what we feel from what we do….

Primary emotions are experienced through your sensory perceptions (such as heaviness in your chest or tingling in your hands or feet) and more diffuse mental imagery; they are further expressed by other physical behaviors. For example, as part of your primary response, you may cross your arms, set your jaw, or tighten the muscles in your back or neck. You may lift your eyebrows, groan, frown, or smile. These physical phenomena in turn reinforce the sensory feedback loop by sending messages back to the brain that inform it of its ongoing state. (My note: What Antonio Damasio calls “somatic markers.”)

Eventually, as these moments expand into longer, more intensified time periods, we become aware (if we are paying attention) of the qualitatively distinct states of feelings we call ‘categorical emotion.’” Which brings us full circle to Inside Out.

In the movie Inside Out, Riley’s emotions began “deep down” inside, then “consciously surfaced” as joy, fear, anger, sadness, then joy again. Therapy asks clients to pay attention to both levels of emotion; not just “on the surface,” but “deep down.”

Bill Bray, Colorado Springs

Inside Out

Posted by on Aug 23, 2015 in Research | 0 comments

Inside Out

And the Oscar for Best Picture goes to…’Inside Out!’” Pixar/Disney’s delightfully animated movie release, depicting how our brains process emotion. Don’t laugh. Chicago Sun-Times movie critic, Richard Roeper, says, “’Inside Out’ is a bold, gorgeous, sweet, funny, sometimes heartbreakingly sad, candy-colored adventure that deserves an Academy Award nomination for best picture. Not just in the animated category (but) in the big-kid section, right there with the top-tier live-action films. It’s one of the best movies of the year, period.” “Rotten Tomatoes,” the online source devoted to film reviews and news, gives “Inside Out” a 98% positive rating based on the reviews of hundreds of professional critics and publications. All I know is that one month ago, I sat in a movie theatre in front of three people, trying very hard to contain my Glad and Sad emotional responses to “Inside Out” (which are represented in the movie by two of five, main color-coded manifestations). I left the theatre thinking that I had just witnessed an animated, neurological allegory about our emotional brain.

I debated how much of the plot to summarize, but opted for brevity. Here goes.

Riley is a happy-go-lucky girl from Minnesota who is followed throughout the movie by five, basic animations of her emotions: Joy, Sadness, Disgust, Anger, and Fear. Each color-coded manifestation–Joy: Yellow; Sadness: Blue; Disgust: Green; Anger: Red; Fear: Purple–lives in the Headquarters of Riley’s conscious mind. Joy, the principal narrator (the voice of Amy Poehler), works very hard to keep Riley in a happy state; which is not difficult to do in the secure setting of her Minnesota childhood home. All is about to change.

When Riley turns 11 years old, her beloved father takes a new job in San Francisco. Sadness begins tainting some of Riley’s happy memories, which understandably triggers the other basic emotions. Led by Joy and Sadness, an odyssey ensues to restore Riley’s happy equilibrium. Things get worse, much worse, before there’s any sign of improvement. Emotions and memories ebb and flow, and threaten to swallow up the happy-go-lucky girl from Minnesota, who is now distancing from parents, friends, and hobbies.

While Joy has spent most of the movie trying to keep Sadness away from Riley, the denouement of “Inside Out” unfolds when Riley is finally allowed to feel her feelings. What pretention, distraction, compulsion, and suppression were unable to do – empathy and compassion accomplished. Feelings were felt, and memories were modified by Riley’s evolving maturity. The scene with her parents is one of the most moving moments you’ll ever experience. Forgive the hyperbole. This was the moment that I tried my best not to become a blubbering mess. It wouldn’t have mattered because the three people behind me were sniffling loudly.

Hopefully, I’ve encouraged you to see the movie. It’s worth it. It’s entertaining. It’s also informative in how our brains process emotion; an animated, neurological allegory.

Two things. One, the movie depicts the power of empathy to heal hurts and painful memories. In his book Anatomy of the Soul (2010), a book in which Dan Siegel, M.D. pens one of the credits, psychiatrist Curt Thompson, M.D. writes:

“But memory is in fact not like (a safe deposit box). Every time we remember something, the memory changes, for the neural networks that are associated with that mental image are either reinforced to fire in a similar but slightly different fashion, or they are shaped and altered to fire differently. A simple example might help….Perhaps when you were a young girl, your mom reacted with sympathy and warmth whenever you were sad after coming home from school or playing with friends. Each time she responded to you that way, a constellation of neurons was activated, and that network was reinforced and strengthened. You came to expect that your mom would validate you, even when you were unhappy.

If, on the other hand, every time you told your mom you were sad, she looked at you with derision, you felt ashamed as well as sad. Each time the two of you repeated this dance, your memory was strengthened and the association between shame and sadness became stronger.

Even as an adult, then, you are likely to avoid the conscious awareness of sadness at all costs, so that you may avoid the accompanying feeling of shame. This won’t be good for your friendships, marriage, or parenting, as it will be difficult for you to be empathetic with others’ sadness. If, however, you encounter a therapist or a good friend who, when you feel sad, responds with empathy and comfort, your memory of the feeling of sadness will change, even if ever so little at first.

You will not have changed the facts of your past, but you will change your memory of it. You will also change your future because now that you have experienced a different reaction to your sadness, you can anticipate a different response….

Simply put, your right brain, with its nonverbal awareness, can be ‘surprised’ by an encounter with another person’s right brain. If, when you feel sad, you see a look of compassion rather than impatience or disgust, your right brain will register that response as novel and likely respond with a different output of its own.”

This is exactly what happened when Riley’s anger and sadness were met with compassion and empathy. What pretension, distraction, compulsion, and suppression were unable to do, compassion and empathy accomplished.

Secondly, the movie emphasizes the importance of emotions to mental health and well-being. However, an important distinction needs to be made which the movie does not purport to address directly: the difference between “categorical emotion” and “primary emotion.” “Inside Out” emphasizes “categorical” (“basic” or “discrete”) emotion, which is generally what we mean when we talk about emotions; for example, the emotional categories portrayed in the movie, like joy, sadness, anger, and fear. Categorical emotions emerge when we become aware (conscious) of our feelings.

However, “before we are consciously aware of a particular feeling, our bodies have already begun to react,” and that refers to “primary emotion.” The movie implies it, but does not directly intend to address it. Dan Siegel, M.D. does make the distinction between the two kinds of emotion in his book The Developing Mind (2012). So does Curt Thompson in his book. But, I’m partial to a brief explanation from The Emotional Brain (1996) by New York University neuroscientist Joseph LeDoux, PhD. Asking the question “What is an emotion?”, LeDoux references the famous American psychologist-philosopher William James who attempted to answer the question with another question: “Do we run from a bear because we are afraid, or are we afraid because we run?” James proposed that we are afraid because we run. In LeDoux’s words, “The (conscious) aspect of emotion, the feeling, is a slave to its physiology, not vice versa: we do not tremble because we are afraid, or cry because we feel sad; we are afraid because we tremble, and sad because we cry.” Siegel similarly observes that “the body’s response lets us know how we feel.”

Modern neuroscience has helped us to understand that brain time is measured in nanoseconds; that before we become consciously and instantaneously aware of a feeling, the body has already mobilized for a physical response via breathing and heart rates, blood pressure, muscle tone, etcetera. Curt Thompson writes: “This is emotion. The origin of our word ‘emotion’ is grounded in the idea of ‘e-motion,’ or preparing for motion. That is why the phenomenon of emotion is deeply tied to ongoing action or movement. We cannot separate what we feel from what we do.”

Hats off to the movie “Inside Out” and its brilliant depiction of emotion; specifically, “categorical emotion.” But, the implications of “primary emotion?” Well, that might need to be the subject of my next blog?

Bill Bray, Colorado Springs, CO

Adverse Childhood Experiences (ACE)

Posted by on Jul 5, 2015 in Research | 2 comments

Adverse Childhood Experiences (ACE)

Several weeks ago, I attended a two-day workshop in the beautiful university town of Boulder, Colorado. I always like visiting Boulder for its “uniqueness”. Readers who’ve been there will understand what I mean by that. The workshop leader was Carol Forgash, LCSW; a specialist in trauma therapy. Among the more helpful features of the workshop was learning about the Adverse Childhood Experiences (ACE) Study conducted as a collaborative research effort between the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, and Kaiser Permanente in San Diego, California. The two principal investigators were Robert F. Anda, MD, with the CDC, and Vincent J. Felitti, MD, with Kaiser Permanente.

Over 17,000 Kaiser patients participating in routine health screening volunteered to participate in The Study; one of the largest investigations ever conducted to assess the associations between adverse childhood experiences and later-life health and well-being. Specifically, the data–which continues to be analyzed–reveals sobering proof of the health, social, and economic risks that result from childhood trauma in the United States. This is to suggest, according to The Study, that some of the worst health and social problems in the nation can arise as a consequence of adverse childhood experiences.

While the ACE Study proper was conducted in the mid-1990s, some of the concepts had their beginnings in 1985. Dr. Felitti, a specialist in Preventive Medicine, initially intended to help obese people lose weight. Surprisingly, ironically, those patients most likely to drop out of of his weight loss program were those who were successfully losing weight! Upon closer examination of almost 300 such patients, Dr. Felitti learned that many had been using obesity as a defense against unwanted sexual and/or physical attack. Many of these individuals has been sexually and/or physically abused as children. While obesity initially presented as “the problem,” it was often found that “the problem” served as the unconscious “solution” to other, more covert problems; namely, abuse! This was unexpected. And, as is often the case, many of these patients were reluctant from telling anyone about the abuse–including medical personnel–because of familial and social taboos.

As the ACE Study began to take shape, the research team found that in the majority of situations, several ACEs existed in a child’s home. A simple scoring system was developed–called the ACE Score–in which one point was given (0-10) for each category of exposure to childhood abuse and/or neglect before age 18. Although 1/3 of participants (remember, we’re talking 17,000) reported no ACEs, 2/3’s reported ACEs – which often turned out to be cumulative. Researchers discovered that the higher the score, the greater the exposure–and risk–of negative consequences throughout life – including early death.

The ACE Questionnaire/Scoring reads as follows:

While you were growing up, during your first 18 years of life:

1. Did a parent or other adult in the household often or very often…swear at you, insult you, put you down, or humiliate you?  or,act in a way that made you afraid that you might be physically hurt? Yes No (If yes, enter 1 __)

2. Did a parent or other adult in the household often or very often…push, grab, slap, or throw something at you? or, ever hit you so hard that you had marks or were injured? Yes No (If yes, enter 1 __)

3. Did an adult or person at least 5 years older than you ever…touch or fondle you or have you touch their body in a sexual way? or, attempt or actually have oral, anal, or vaginal intercourse with you? Yes No (If yes, enter 1  __)

4. Did you often or very often feel that…no one in your family loved you or thought you were important or special? or, your family didn’t look out for each other, feel close to each other, or support each other? Yes No (If yes, enter 1 __)

5. Did you often or very often feel that…you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or, your parents were too drunk or high to take care of you or take you to the doctor if you needed it? Yes No (If yes, enter 1 __)

6. Were your parents ever separated or divorced? Yes No (If yes, enter 1 __)

7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or, sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or ever repeatedly hit at least a few minutes or threatened with a gun or knife? Yes No (If yes, enter 1 __)

8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? Yes No (If yes, enter 1 __)

9. Was a household member depressed or mentally ill, or did a household member attempt suicide? Yes No (If yes, enter 1 __)

10. Did a household member go to prison? Yes No (If yes, enter 1 __)

Now add up your “Yes” answers: _____ This is your ACE Score. 


For additional information about the ACE Study, see

Bill Bray, Colorado Springs, CO

Perhaps the Best Parenting Advice – Ever!

Posted by on May 17, 2015 in Research | 0 comments

Perhaps the Best Parenting Advice – Ever!

It was several years ago while browsing through a used book store, that I happened upon the book. Hardback. Green cover. Red ribbon book marker, like those found in Bibles. Were it not for the tattered “green” cover, I might have mistaken it for a Bible. Upon closer inspection, the title read: Children: The Challenge. Copyright: 1964. Retail price: $9.95. Sale price: $4.95. A “good deal” by most standards. Even now as I craft this blog post, the book continues to lose bits and pieces of its aging green cover. The author? Rudolph Dreikurs, MD, the Viennese-born psychiatrist who migrated to the United States in the late 1930s. The “good deal” instantly became a “good steal.”

Dr. Rudolf Dreikurs was born in Vienna, Austria in 1897. He graduated from the medical school of the University of Vienna, after which he spent five years doing his internship and residency in psychiatry. In the process, Dr. Dreikurs became interested in the teachings of renowned Austrian psychiatrist Dr. Alfred Adler, with whom he became a close collaborator. Dreikurs moved to the United States in 1937 until his death in 1972. At the time of death, he was Professor Emeritus of Psychiatry at the Chicago Medical School and Director of the Alfred Adler Institute of Chicago.

Developing the Adlerian system of psychology into a pragmatic method for understanding misbehavior in children, Dreikurs (and Adler) believed that “encouragement” was essential to improving human behavior and relationships. Simply entitled “Encouragement”, chapter three begins:

“Encouragement is more important than any other aspect of child-raising. It is so important that the lack of it can be considered the basic cause for misbehavior. A misbehaving child is a discouraged child” (author’s italics).

“A misbehaving child is a discouraged child.” 

Whatever else modern research adds or subtracts from this statement, discouragement and misbehavior are indeed linked. Dreikurs continues:

“Each child needs continuous encouragement just as a plant needs water….However, the techniques of child-raising that we use today present a series of discouraging experiences…..Children respond to their various predicaments with a tremendous desire to gain skills and to overcome the deep sense of their own smallness and inadequacy. They so dearly want to be an integrated part of the family. However, in their attempts to gain recognition and to find a place, they meet with constant discouragement….

Three-year-old Paul was putting on his new suit so that he could go to the store with Mother. ‘Come here, Paul. Let me finish for you. You are too slow.’

Paul is made to feel inefficient in the face of Mother’s magic ability to do things quickly. Discouraged, he gives up and lets Mother dress him.

In a thousand subtle ways, by tone of voice and by action, we indicate to the child that we consider him inept, unskilled, and generally inferior. In the face of all this he still tries to find his place and make his mark….

Whenever we act to support the child in a courageous and confident self-concept, we offer encouragement. There is no pat answer to the problem. It involves careful study and thought on the part of the parents. We must observe the result of our training…and repeatedly ask ourselves, ‘What is this method doing to my child’s self-concept?’

The child’s behavior gives the clue to his (sic) self-estimate. The child who doubts his own ability and his own value will demonstrate it through his deficiencies. He no longer seeks to belong through usefulness, participation, and contributions. In his discouragement, he turns to useless and provocative behavior. Convinced that he is inadequate and cannot contribute, he determines that at least he will be noticed, one way or another. To be spanked is better than to be ignored. And there is some distinction in being known as ‘the bad boy.'” (Dreikurs is reminding me of the “Law of the Soggy Potato Chip”, attributed (I think) to psychologist Fitzhugh Dodson. Give a child the choice between a crisp potato chip [positive attention] and a soggy potato chip [negative attention], s/he will choose the crisp potato chip. But, give a child the choice between a soggy potato chip [negative attention] and no potato chip at all (ignored), s/he will choose the soggy potato chip. In other words, anything is better than being ignored.)

In chapter four of Children: The Challenge, Dreikurs discusses four “mistaken goals” which often motivate a child’s misbehavior in lieu of encouragement: undue attention, control, resentment, and inadequacy. Significantly, these four “mistaken goals” can be reduced to three of four categorical emotions: MAD, SAD, and SCARED. Conversely, “encouragement” promotes GLAD.

Chapter six of Children: The Challenge, discusses “The Use of Natural and Logical Consequences” versus the ineffectiveness of punishment, and even reward.

Today, we may be more familiar with the helpful concepts and methodologies of Foster Cline, MD and Jim Fay–namely, “Love and Logic”–but many of the original concepts and methodologies clearly belong to Rudolph Dreikurs and Alfred Adler.

Bill Bray, Colorado Springs, CO

Mental Associations – Matter!

Posted by on Apr 17, 2015 in Research | 0 comments

Mental Associations – Matter!

In their book Buddha’s Brain; The Practical Neuroscience of Happiness, Love, & Wisdom (2009), authors Rick Hanson, PhD and Richard Mendius, MD observe:

“When two things are held in mind  at the same time, they start to connect with each other.” 

Think of this in terms of good news/bad news. First, the good news. Hanson and Mendius write:

“Positive experiences can…be used to soothe, balance, and even replace negative ones. When two things are held in mind at the same time, they start to connect with each other. That’s one reason why talking about hard things with someone who’s supportive can be so healing: painful feelings and memories get infused with the comfort, encouragement, and closeness you experience with the other person. 

These mental minglings draw on the neural machinery of memory. When a memory–whether implicit or explicit–is made, only its key features are stored, not every detail….When your brain retrieves a memory, it does not do it like a computer does, which calls up a complete record of what’s on its hard drive (e.g., document, picture, song). Your brain rebuilds implicit and explicit memories from their key features, drawing on its simulating capacities to fill in missing details….And your brain is so fast that you don’t notice the regeneration of each memory.

This rebuilding process gives you the opportunity, right down in the micro-circuitry of your brain, to gradually shift the emotional shadings of your interior landscape….Then, when the memory leaves awareness, it will be consolidated in storage along with those other associations. The next time the memory is activated, it will tend to bring those associations with it. Thus, if you repeatedly bring to mind negative feelings and thoughts while a memory is active, then that memory will be increasingly shaded in a negative direction….On the other hand, if you call up positive emotions and perspectives while implicit or explicit memories are active, these wholesome influences will slowly be woven into the fabric of those memories.

Now for the bad news. If two things, held in mind at the same time, begin to connect with each other, consider the downside of association. In his book, The Brain That Changes Itself (2007; definitely a book worth reading), Columbia University psychiatrist and researcher Norman Doidge, MD gives one such example from Internet pornography’s effects on the brain. In a chapter entitled “Acquiring Tastes and Loves,” Doidge writes:

“The current porn epidemic gives a graphic demonstration that sexual tastes can be acquired. Pornography , delivered by high-speed Internet connections, satisfies every one of the prerequisites for neuroplastic change….During the mid- to late 1990s, when the Internet was growing rapidly and pornography was exploding on it, I treated or assessed a number of men who all had essentially the same story. Each had acquired a taste for a kind of pornography that, to a greater or lesser degree, troubled or even disgusted him, had a disturbing effect on the pattern of sexual excitement, and ultimately affected his relationships  and sexual potency.

None of these men were fundamentally immature, socially awkward, or withdrawn from the world into a massive pornography collection that was a substitute for relationships with real women. These were pleasant, generally thoughtful men, in reasonably successful relationships or marriages….A number of these men also reported something else, often in passing, that caught my attention. They reported increasing difficulty in being turned on by their actual sexual partners….When I asked if this phenomenon had any relationship to viewing pornography, they answered that it initially helped them get more excited during sex but over time had the opposite effect….Their sexual fantasy lives were increasingly dominated by the scenarios that they had, so to speak, downloaded into their brains, and these new scripts were often more primitive and more violent than their previous sexual fantasies. I got the impression that any sexual creativity these men had was dying and that they were becoming addicted to Internet porn.

The changes I observed are not confined to a few people in therapy. A social shift is occurring….The addictiveness of Internet pornography is not a metaphor. Not all addictions are to drugs or alcohol. People can be seriously addicted to gambling, even to running. All addicts show a loss of control over the activity, compulsively seek it out despite negative  consequences, develop tolerance so that they need higher and higher levels of stimulation for satisfaction, and experience withdrawal if they can’t consummate the addictive act. All addition involves long-term, sometimes lifelong, neuroplastic change in the brain.”

Because two things held in mind at the same time begin to connect with each other, it is ironic to think that chemical messengers such as dopamine (excitement) and oxytocin (bonding)  become triggered more by the titillation (pseudo-intimacy) of images and objects than the real thing. 

Mental associations do matter. 

 Bill Bray, Colorado Springs, CO