Opening Up, How and Why

Face of an Old Man with Shadow

James Pennebaker is a social psychologist and researcher who for the last 40 or so years has studied how and why sharing deep thoughts and feelings about one’s life experiences is good for one’s health.  He wrote an excellent book in 1990 about the nature of self-disclosure and how to do it entitled Opening Up: The Healing Power of Expressing Emotions.    In this post, I explore the importance of finding your way to share deep thoughts and feelings with oneself through writing, with trusted others through conversations and with God through prayer.  Opening up is not a new strategy for mental health and wellness, but it is a difficult skill to practice and maintain, in part, because the risk of opening up in the wrong way and with the wrong people can be devastating.  On the other hand, according to Pennebaker and many others, safe and prudent self-disclosure is quite natural for social beings like humans and more importantly self-disclosure heals.

Anxiety, Stress and Self-Disclosure

Pennebaker begins his book sharing various examples of the natural instinct among humans to confess.  He calls it a natural urge among our species.  Why does he say confession is natural?  It it is natural because our bodies do not store stress or secrets very well.  Our bodies and minds want to get rid of stress and keeping secrets about painful relationship betrayals is stressful and often leads to the development of an anxiety disorder.

The stress I’m referring to is not the normal anxiety of life.  Normal anxiety, as Rollo May would say, is inescapable, stimulating, life giving and a source of creativity.  Normal anxiety keeps us alert and helps us feel alive.  It’s a good thing.  In contrast, neurotic anxiety, as May described it, is what I believe effective self-disclosure reduces or eliminates.  Pennebaker points out many times in his book how his research showed that self-disclosure of traumatic experience led to few doctor visits for his research subjects.

This makes a lot of sense to me as a therapist because I see patients and clients do all sorts of destructive thing to themselves and in their relationships in order to avoid neurotic anxiety.  I see it on a daily basis.  For example, some of us repress memories.  We constrict our faces and body language to hide our discomfort and emotional pain.  We turn to substances of all kinds to relax and distract our bodies and minds from intense work of hiding our thoughts and feelings.  We do all sorts of exhausting things to avoid Neurotic anxiety and inhibit ourselves.  The sad consequence of such commitment to neurotic anxiety is that our closest friends and family cannot tell how we’re doing, so they assume everything is fine.  Self-disclosure acts as an antidote for isolation of this kind.

Necessary for Survival

Learning to open up is difficult.  If one will remain open to the idea that self-disclosure is necessary for survival, then there is hope for recovery.  Humans have developed an amazing system to expel neurotic anxiety and stress, a system John Bowlby in the 1950’s called the “attachment system.”  It is a system of self-disclosure and comfort seeking through building relationships that allow you to share deep fears and vulnerable thoughts with a few available people throughout life (It is unclear to me if Pennebaker was familiar with Bowlby’s work when he wrote Opening Up, but I suspect he is very aware of attachment theory by now).  Self-disclosure taps into the resources of our attachment system.  Here’s how to try it.

How to Open Up through writing

Pennebaker recommends addressing past or recent trauma in a solitary fashion by either writing or through prayer as an easy place to start. (If you appreciate the Judeo-Christian traditions of prayer I recommend reading Psalm 13 and 31 as good examples of King David self-disclosing through prayer).  Another great example of literary self-disclosure can be found in Shakespear’s plays.  Read any of his characters soliloquys or watch any modern cinematic adaption of them to get a sense of this way to open up.

The key to opening up through writing is expressing deep thoughts and feelings.  It’s not enough to write down the facts of a traumatic experience.  It’s not enough to just write down feelings either.  Pennebaker makes it clear in his book that receiving the benefit of fewer health problems only seems to happen when we write about everything.  Consider it a “free writing” exercise like the ones your English teacher assigned you in junior high or high school.  No self-censuring allowed.

How to Open Up through talking with someone

Self-disclosing with people is the a good place to complete the stress and neurotic anxiety expulsion process.  I believe the human to human part of experience of self-disclosure is so important because it most directly engages our internal attachment system.  It’s just very difficult to get all the naturally occurring comfort chemicals and neurotransmitters in our brains to release unless we are in the presence of another person.  As a therapist I know full well that not everyone has a good support system.  Sometimes we don’t have the right support available to open up with, like a good listening friend or family member.  When that is the case, a support group or a therapeutic group is a very good alternative.  Individual therapy is another great option.  Here in San Antonio, Texas, there are some great groups led by non-profits like NAMI, Depression Bipolar Support Alliance, and local mental health friendly churches like City Church.  All of these groups can offer the stressed and inhibited person relief.  One doesn’t have to share everything right away to start receiving the health benefits.  In my experience, it is perfectly fine to start by sharing that it’s hard to share.  Baby steps are quite meaningful steps.

What psychologists, social psychologists, artists, and other wise sages have confirmed (probably since the beginning of written history) is that humans function best, even in adversity, when they can self-disclose, confess and open up to themselves through writing, to God through prayer, and to available others through taking the risk of self-disclosure.

If you would like to learn more about how to open up with others and through writing I encourage you to check out Pennebaker’s book.  If you’re interested in the Rollo May’s ideas about anxiety that I referenced, here is a fascinating 1978 interview with Psychology Today on Understanding and Coping With Anxiety.

©Ryan W. Gano – – 2016

photo credit: Experiments in Black and White via photopin (license)

Single Serving Group Therapy

paper cup on street

In David Fincher’s 1999 film Fight Club, the main character, played by Edward Norton, describes fellow passengers on business flights as “single serving friends.”  The conversations are rewarding, but do not repeat.  In this post I’m going to discuss single-serving group therapy and how helpful it can be, especially in a psychiatric hospital setting.

When I was in graduate school preparing for a career as a psychotherapist, I often thought about how difficult it would be to work in an inpatient psychiatric unit.  Three years into my stint at such a place, I am happy to report that almost none of what I thought might happen actually happened.  One of the best lessons I’ve learned in this environment is that depth psychotherapy in a group, sometimes called psychodynamic or attachment based therapy, works quite well with almost anyone, even in a single-serving group situation.

I first began learning how to lead a therapeutic group for an inpatient setting by reading Irvin Yalom’s Group Psychotherapy textbook.  His section on an “acute inpatient therapy group” provides an excellent template for such an environment.  Yalom writes, “You must help patients spot interpersonal problems and reinforce interpersonal strengths, while encouraging them to attend aftercare therapy, where they can pursue and work through the interpersonal issues identified in the group” (Yalom, 2005, p.493).

One way that I do this is by starting with my version of building a recovery plan. On the white board I write out: biological health, psychological health, social health, and spiritual health.  This is basically using the bio-psycho-social-spiritual model of care as the focus of a group discussion.  I then ask the group which area seems strongest to them right now and which area seems weakest to them right now.  Pretty soon the group is talking about interpersonal issues with their hospital psychiatrist, family members or God.  My job as I see it in such a group is to highlight the moments when group members are experiencing something similar and process what it’s like to feel understood and less alone.  Sometimes I ask other group members what it’s like to hear someone share their experiences.  By the end of group, most members report being able to easily begin creating a recovery plan that addresses all areas of health.  They also often report how good it felt to participate in a group focused on mental health concerns.  I always make sure to end group with an invitation for members to join the hospital’s free aftercare group where they can continue to work on their recovery if they choose.

What I find so interesting about this sort of group therapy experience is that it requires almost no prep time for me the therapist and it consistently receives high scores from patients when they report to their case managers what helped most during their hospitalization.

As a therapist who understands how the attachment system in the human brain works, I also believe that this sort of interpersonal group is successful because of how the group quickly becomes a safe haven for its members to risk with each other and receive comfort from the group. It’s amazing to me every time I see a deeply traumatized and severely ill patient open up and receive support from people he or she hardly knows.  I believe experiencing how to engage our attachment instinct in a safe and effective way is one of the best tools any human can learn to use.  It’s also easy to do in an adaptive way once you do it a few times in a therapeutic group.  It’s an instinct after all.

photo credit: Garbage via photopin (license)

Rollo May – Northern Star

Rollo May Picture
Rollo May

Rollo May is one of my therapeutic influences and from time to time I find it helpful to check in on my influences like you would a compass or a GPS if you were hiking.  I do this just in case I’ve wandered off course or need to be reminded about my vocation.  I find that getting back on track is easy when compass adjustments come often.

The writing of Rollo May is one of my professional compass points.  He wrote the first book in the United States about counseling way back in 1939 called “The Art of Counseling.”  He revised it in 1989 and I love it.  When I first read it as a therapist trainee, I used it as a template for my treatment plans with clients.  His four principles we specific enough to guide me in my work with clients and also  philosophical enough for me meditate on as a trainee, an intern, and now a fully licensed therapist.

As most authors of therapeutic books that were written long ago tend to do, Rollo May highlights common experiences like anxiety, depression, and interpersonal conflicts in deep and profound ways.  May also gets very specific about his view of correct counselor behavior.  A good example is that clients should do at least 2/3 of the talking and the mere process of talking out a problem in front of the therapist is healing.

Today I was reminded of an interview Rollo May did in 1987 with Kirk J. Schneider.  My favorite part of this interview is May’s critique of modern therapy’s gimmick-like quality.  The Interview was later published in the Journal of Humanistic Psychology.  I found a like to the article:  Rollo May on Existential Psychotherapy.