Psychodynamic Therapy and DBT: A Pretty Sweet Match

/ Molly Merson, MFT/
Psychodynamic Therapy and DBT: A Pretty Sweet Match

Since I work with attachment trauma, lots of folks who come to see me have intense emotions that can feel like they're coming out of nowhere and wreak terrible havoc.

(Like Daenerys' dragons… pic from HBO of course)

These intense feelings can be so overwhelming to your body and your mind that you can't think anymore. All you can do is feel. And when all you can do is feel, you want to do something, anything, to make the feeling go away.

So maybe you cut. Or you drink. Or you call your ex over and over again until she blocks you or refuses to pick up. Maybe you check out, numb out, binge out, freak out– whatever you do,  you're just trying to get rid of the intensity of the emotion that feels like it's going to overtake you.

Dialectical Behavior Therapy (DBT) is one treatment approach for addressing these intense emotions.

DBT skills development can help you regulate your emotions and tolerate your distress, and has been helpful for many people I work with and for myself personally. There are several DBT centers in the East Bay and San Francisco, all of which have their own personality and style but go through the same training through Behavioral Tech.

While I highly recommend DBT for many, it is one part of a multifaceted treatment plan. If you are experiencing overwhelming emotions and subsequent impulsivity, I highly recommend you try a concurrent DBT treatment with your psychodynamic or analytic talk therapy. With DBT or another mindfulness practice such as body movement (like dance, lifting, stretching), meditation, being in nature, or spiritual prayer, you can learn to regulate the overwhelming feelings so that you are able to take in in more of the deep work you're doing with your therapist, which can help you feel more connected to others and to your joy and desires.

Maybe we can think of it this way: If we can imagine your psyche and soul as an fruit tree, I see DBT as shaping and pruning the limbs of your tree. In order to get the sweetest fruit, i.e. your joy and hope coming to fruition, it's important to prune the limbs of your tree so that those fruits can grow and ripen. Any master gardener will tell you that pruning is one of the most important elements of harvesting amazing fruit.

That said, as with anything growing in the ground, the roots also need constant and consistent tending. This is where dynamic and analytic therapy comes in.

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Resilience as “Hope With Teeth,” via Pussy Riot and “The Chi”

/ Molly Merson/
Resilience as “Hope With Teeth,” via Pussy Riot and “The Chi”

In my recent piece, “The Necessary Precariousness of Hope,” I explore some of what makes hope so difficult and yet so necessary. Hope involves a capacity for being able to bear the unknown and unlikely, as Rebecca Solnit has said– which can be a beautifully expansive and playful experience given the best circumstances, and extraordinarily challenging in the most oppressive circumstances. The topic of hope was slowly rising in my mind when I went to see a band called Pussy Riot, a Russian feminist punk band whose lyrics fight for the rights of women and queer people amidst an oppressive political state.

In all honesty, the only thing I thought I knew about Pussy Riot prior to last week was what I just wrote above. But when I saw they were coming to San Francisco, I jumped on the chance to get tickets. (Bonus points for an early show, home by 10pm!)

The band I saw that evening was not the band I expected, which traditionally consisted of two main members (who have spent time in prison for protesting Putin) and 11 side members. The San Francisco show featured one person with a feminine-sounding, possibly Russian-accented voice and another person behind a mixer with a masculine-sounding voice. Both of their faces were covered by colorful woven ski masks. The music was not punk rock as I know it– it was more like fun, dance-y electronic beats. I learned from the vocalist that evening that “anybody can be Pussy Riot.” So I don’t really know who was behind those masks. Apparently, they could have been anybody.

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The Necessary Precariousness of Hope

/ Molly Merson, MFT/
The Necessary Precariousness of Hope

It’s hard not to listen when the universe sends us its messages. When I hear on several occasions, “Where’s the hope in what you are saying?”, I can’t help but pay attention.

Here are a few recent examples: Last week on social media, several friends and I were exploring the intertwined history of constitutional rights and racism, when one person said, “I agree with what you are saying, but where is the hope?” The other day, a case conference facilitator suggested the same thing as my group gathered to hear notes from my colleague’s work: “Listen for the hope in this session.” And last week a patient said to me, “Your plants look so healthy; I kill all of mine.” When I responded to him about the way life and death seem so close together, something inside me felt like I missed something important. Later, I realized that I missed a chance to name his hope that I could help him become healthy, just like my plants. So, I am asking myself, where is the hope in my words, work, and actions; and what is hope, really?

In my work as a psychoanalytic psychotherapist helping to unpack the deeper issues beyond behavior change, and as a person in society working toward uprooting and exposing white supremacy, I get down in the dirt quite often. To me, coming face to face with truths is a liberating and hopeful practice, even though this practice often feels painful and disorienting. Exposing something we wish to hide from ourselves that perpetuates destructive (and deadly) patterns is a powerful endeavor, which often feels terrible. After all, there are often several reasons we keep these truths inaccessible, including that we may discover we’re implicated in our own trauma and painful experiences, as well as the trauma and pain of others. Most of us are hardly ever sure we can bear knowing this kind of truth.

Even when we come into direct contact with the pain of being human, there is still room for hope. But it feels important to me to distinguish hope from something more like an idealistic optimism. Author Rebecca Solnit describes this well: She says that optimism and despair are two sides of the same, predictive coin. They both imply an expectation that we know how things will turn out: They will either be all good or all bad, without any room for uncertainty.

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The problems of suicide, and how Freud helps us think about depression.

/ Molly Merson, MFT/
The problems of suicide, and how Freud helps us think about depression.

I was featured today on a podcast with my colleague Rebecca Wong, where we journeyed together through a beautiful and winding conversation about politics, good-enough parents, historical and cultural trauma, loss, and the infancy of the internet. It was one of those conversations that felt like sitting in a cozy chair chatting with an old friend over a glass of strong whiskey in front of a crackling, warm fire. (If you’d like to listen, here is the link: https://www.practiceofbeingseen.com/episode/50)

As is often the case when listening back on a conversation that’s been recorded, when the episode aired today I had a chance to hear the person I was a month ago: what was on my mind, where both our minds took us, what was happening in the cultural milieu, and the ideas we were shaping together in that organic space and time. But today, I am a different person, of course; I have had new experiences, thought new thoughts, made new links, and have had time to let our conversation percolate. At the time, and today, our conversation about suicide left me with a strange feeling. I will try to articulate that feeling well enough here today.

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Self Care as Interconnected Care (plus 9 ways to stay connected)

/ Molly Merson, MFT/
Self Care as Interconnected Care (plus 9 ways to stay connected)

Self-care is a popular topic, and has become the go-to for anyone stressed out by life. One Google search pulls up almost 97 million results! 

(Hang on. I’m a bit floored by that.)

Okay, whew. I’m back. So, I’m not going to read millions of articles, but I suspect most of them hold a basic assumption that self-care is important so that you can get back to your job, family, or other capitalist expectation without feeling depleted. That’s fine, and actually probably helpful for many people for a time. However, I suspect it ignores these important questions:

What if it’s your job that’s causing your stress? What if your stress is brought on by poor communication with your family? Lack of access to quality mental health care? Overwhelming debt due to school loans or a volatile housing market or medical costs or historical economic inequity due to racism?

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"What happened?!" When Social Anxiety Is Your Growing Edge

/ Molly Merson, MFT/
"What happened?!" When Social Anxiety Is Your Growing Edge

If you’ve ever spent a night (or a week) turning over and over in your mind what you might have said to someone that you regret, you are not alone. So many of us suffer from social anxiety, and from a gripping fear that we are “too much” of something that others cannot tolerate. 

Too moody?
Too intense?
Think too much?
Too political?
Too… weird?

Yeah, all those are things lots of us worry about.

When the What happened?! anxiety hits, it can be really hard to remember that every interaction is a dynamic interaction. We are dynamically experiencing our relationships, meanings, interpretations, sensations, and identities all the time. In social interactions, we are functioning on a spectrum of risk-taking where, by saying what we feel, we might end up feeling like we said the wrong thing.

(It’s okay. Really. We are ALL susceptible to this.)

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"Sunday Neurosis," or, What happens to us during the holidays?

/ Molly Merson, MFT/
"Sunday Neurosis," or, What happens to us during the holidays?

"Sunday neurosis" was a term coined by psychoanalyst Sandor Ferenczi to describe the anxiety and stress we feel on Sundays right before we have to go back to work on Monday. I hear a lot of people in my practice talk about this, and I'm not immune to it either – that feeling on Sunday nights of all the anticipated problems in the week ahead seeming to spiral towards you, as though Sisyphus has let go of that damn boulder once and for all and, whoops, looks like you're going to be the one carrying it now if it doesn't smash you first!

This feeling of anxiety and stress is true for so many of us who work the traditional Monday through Friday schedule. This is also something that happens to many of us during the holidays. Some people experience a "vacation brain" that can be blissful while it's happening, but excruciating to come back from. While Ferenczi didn't acknowledge that this same type of anxiety can happen the day before you start your working life after a long holiday, it is incredibly common.

So what can you do about it? 

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On Mass Shootings, Projection, and Owning Your Shit

/ Molly Merson, MFT/
On Mass Shootings, Projection, and Owning Your Shit

Another day in America. Another massacre. 27 worshippers at the First Baptist Church in Sutherland Springs, Texas were gunned down by a white man during Sunday service. This on the heels of so many mass shootings in our country, and so very little actionable response on the part of our policy leaders and governance. It is frustrating, heartbreaking, and if you’re feeling helpless and despairing right now, you wouldn’t be the only one. It feels like we are all being forced to reckon with this chaotic, terrible violence that is so difficult to understand.

My heart is with the people who have survived the shooting, and who knew and loved those affected. Since I have the luck to have not been directly affected, what I can offer is an opportunity to think about what is happening in our country when it comes to guns, mass shootings, violence, and white men.

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How White Therapists Perpetuate Racism (Even When We Try Not To)

/ Molly Merson, MFT/
How White Therapists Perpetuate Racism (Even When We Try Not To)

I created this video one afternoon to get down some of my thoughts about a group I've been considering forming for therapists to address racism (our own, and structurally) and whiteness (our own, and structurally).  I think it is necessary that therapists explore what it really means to be practicing a craft that is a historically white/European modality - specifically, psychodynamic and psychoanalytic psychotherapy. We studied in white space, we trained in white space, our exams were epitomes of white spaces- and now, as licensed therapists, there are subtle and obvious ways we practice our indoctrination, within a greater system of whiteness. Now, after having the chance to watch this video, I have become aware of the racism inherent in being white and speaking about racism, and the several "slips" I have made in this video that ultimately do the opposite of what I was attempting. This brings several questions and paradoxes to mind.

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How to be a therapist when the world is on fire

/ Molly Merson, MFT/
How to be a therapist when the world is on fire

Last week, I wrote an article for Medium called "How to be a therapist when the world is on fire." It is a small window into the way I work as a therapist, and the urgency of connectedness and redefining the "container" when the world is on fire. I mean this both as a metaphor and, particularly in the current state of our country and planet, quite literally. 

We are all impacted, albeit in different ways, by what is happening in our communities. While therapists by necessity and design are often one layer removed from our patients' pain and experience, when we are both impacted by environmental tragedies that layer can become thin and transparent. There is important work to be done in this realm, if we can manage to continue to think clinically.

The world is on fire around us. None of us are spared completely, but some of us are in more pain and devastation than others. In some cases we just can’t do therapy right now because the immediate need to save your physical body is too great. In some cases, we can. When the walls are burning, this is when we are forced to redefine the container. - Molly Merson, MFT How to be a therapist when the world is on fire
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