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By James Cowart, Ph.D. previous page
All children want to be loved and accepted and to live in an environment that is safe and predictable. When a child does not live in such an environment, because of problems with parents or because the peer group (or a sibling) constantly teases and torments the child for being different, then the child will unconsciously learn some way to survive in that world. (Children want to be like other boys and girls and so some of the following taunts are most detrimental: for girls - being "fat and ugly" for boys - being "weak or effeminate" and for either - being "stupid or lazy", the "wrong" color or the "wrong" height or the "wrong" shape, etc.)
Children in these types of environments learn survival methods of escape or avoidance of the traumatic situations and of the negative emotions aroused by those situations. For example, a child raised with an alcoholic parent may try and become the "perfect child" at home in order to avoid having the alcoholic parent become upset. All mistakes become unacceptable and a pattern of living is established that is impossible to maintain in adulthood (without much anxiety and depression). Another child in that same home may rebel and become the "black sheep", by staying away from home and finding a group of "rebel" friends who may be escaping as well by using drugs, having sex, etc. This pattern of living may well have some short-term positive effects for the child who may feel less anxious and more accepted, but again this pattern does not "work" in adulthood and the long-term consequences are all negative. A third child in that same dysfunctional home may try and avoid being noticed at home by becoming a "lone wolf", fading into the woodwork and spending a lot of time alone in his (or her) bedroom, etc. Such a child may learn a generalized avoidance of contact with others for fear of being emotionally hurt. Once again, this pattern may minimize the child's emotional pain in the short-run, but does not work in the long run.
Of course, not all psychological problems are produced by dysfunctional families. Even a "good family" can have some negative effects if too much emphasis is placed on "perfectionism" or maintaining a perfect image in the community, etc. In addition, if a healthy adult has been thoroughly traumatized (EG, raped, physically attacked or injured, etc.) or is experiencing current life stress that is extremely intense, a psychological disorder may still develop. Finally, if the effects of biological predisposition are extremely strong then less family dysfunction, past trauma or current life stress is needed to trigger a disorder. However, many times the following pattern seems to prevail: the adult encounters a situation that is similar in some way to situations when the adult experienced emotional pain in earlier life, the current situation produces negative emotion in the adult because of the similarity to the earlier, negative situations. At the same time the adult may automatically think of the words that were learned years ago to describe "the self", in this situation. These words may be toxic and produce more negative emotion. Finally the adult facing the current situation and the accompanying negative emotional states may respond in a manner to escape those negative emotions. However this response may well be self-defeating - in the long run.
Most people understand that their experiences in childhood and adolescence, as well as traumas in later life can have a large impact on development and psychological problems. CBT emphasizes that these self-defeating patterns are learned responses that can be changed. This way of looking at the situation is empowering and serves to combat the stigmatization that often accompanies psychological problems. People with Panic Disorder, Social Phobia, Major Depression or any other psychological disorder are not "weak or immoral"; they are people experiencing a real disorder because of some combination of earlier life experiences, biological predisposition and current life stress.
I use CBT because of the large base of evidence supporting its efficacy and effectiveness. I also use it because it allows patients to stop blaming themselves and instead start to do the hard work of learning more effective methods of coping. Patients do not have to learn all the principles of learning that underlie CBT in order to benefit from it. However, a basic understanding that a maladaptive pattern may have been "accidentally" learned and can now be unlearned is empowering and validating for most patients.
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