For all intents and purposes, the latter choice seemed like the most mature approach, so the decision was made to take a risk, confront the boss, and schedule an appointment. You enter the office knowing that this person is not the most understanding of creatures, so you may be more guarded than in other situations. After pouring your heart out, a resounding “request denied” reverberates through the air without having had the opportunity to plead your case. The impulse is to feel rejected, humiliated, misunderstood, and wonder if it a mistake to speak up or not?

When the boss was approached, there was already a built in fear of rejection due to a preconceived notion about (and expectation of) how this individual was going to react. In fact, the defensive posture and nagging apprehension may have generated a self fulfilling prophecy –”he/she doesn’t like me so what I have to say doesn’t really matter anyway” — which is an attitude that is bound to cause a breakdown in communication and inhibit the problem-solving process. (This association of thought patterns is generally a sure-fire way to guarantee defeat!) Now, it is not possible to predict exactly how a person is going to respond in any given situation, but if it is known, for example, that the boss does not function before 11:00am, scheduling an appointment before that time is doomed to yield disappointment. Understanding who you are dealing with (at least what has been apparent in the recent past) will aide in determining the most effective strategy.

The question about whether the above-mentioned approach was a mistake has yet to be answered though. Implied in the word “mistake” is that the outcome is somehow “wrong” if the wish is not gratified. There may have been circumstances unknown to the employee which may have created a disaster if the request had been granted. So the question remains, was it wrong to speak up, or did the experience provide an unexpected opportunity for growth. Since it is not possible to control our environment or others, the only thing we can master is our RESPONSE to a situation. Assuming that one is wrong reinforces the notion that attempting to get needs met (and/or confronting authority figures) will always end in disappointment. This thought process creates a template of helplessness and renders the individual a mere “victim” of circumstance.

Experiencing life from this vantage point (whether consciously or unconsciously), one can be left with feeling like there are no options. Thus, if this same person in the above-mentioned scenario opted to “do nothing” he/she would have been operating with the belief that trying to evoke change would be impossible. On the other hand, “doing nothing” could be seen as a prudent/cautious “wait and see approach.” Sometimes, when conflict is addressed in an emotionally charged atmosphere, little can be accomplished. Here again, what could be viewed as a “mistake” may in fact offer an effective alternative in solving a problem.

Last but not least, the decision to “quit” (escape) could suggest an inability to resolve differences and/or an unwillingness to negotiate. In fact, the anxiety or dysphoric mood resulting from the conflict may have given the employee the courage to leave an unfullfilling job (an option not previously considered because everything seemed to be status quo and the thought of starting over was not a thrilling prospect). After having perceived oneself to be psychologically and emotionally abused, the decision to quit would demonstrate great courage, strength and a healthy self respect.

In sum, there are generally several alternative solutions to any given problem. At face value, what may seem like a “bad” decision (mistake) at the time, could prove to be a blessing in disguise. Next time you find yourself in a quandary about what choice(s) to make, remember that no matter what the decision, there is always room for growth if you give yourself the freedom to interpret the consequence (action) from different (creative) angles.

To encourage active participation from the subscribing audience, I invite any feedback about this article and will answer questions confidentially either by written correspondence or by telephone.

Copyright © 1998,1999 Karen E Engebretsen-Larash, Psy.D, PA. All rights reserved

by Karen E. Engebretsen-Larash, Psy.D.

Making the decision to enter psychotherapy is courageous. It suggests a willingness to explore alternatives and a realization that previous attempts to resolve problems with currently available resources have failed. So, how does one go about finding the “right” therapist to aide in the process of identifying the conflicts and finding appropriate solutions? This is a complicated question because there are several variables which need to be considered.

The development of an effective therapy relationship is dependent upon the right therapist-patient mix as well as the type of services one wishes to obtain (e.g., individual psychotherapy vs group therapy vs couple’s therapy; symptom focused vs growth oriented). The various techniques used in each of these methods are based upon particular formulations of character development and coping styles. The model’s which are most commonly talked about include the Psychodynamic/Psychoanalytic (e.g., Freud, Jung), Cognitive (e.g., Beck, Ellis) or Behavioral (e.g., Azrin, Skinner) approaches. In general, clinicians tend to practice and utilize techniques based on their training and areas of expertise.

In recent years, variations of these original ideals have been proposed, but the same basic clinical applications still apply. If the goal is primarily symptom-focused (e.g., stop smoking, improve study habits) then cognitive and behavioral methods would generally be used in a short-term framework. A behavioral approach, (e.g., “Token Economy”) may be useful in helping children learn to modulate their negative responses by reinforcing the desired behavior with points or chips which can later be exchanged for something of value to them (extra hour of TV, new video game, etc). Although Psychoanalysis is generally associated with Freud’s couch, cigar and scheduled therapy visits of three to four times per week, contemporary treatment combines some of the early clinical concepts with alternative models of technique in order to address the pragmatic realities of insurance-modulated treatment decisions. Psychoanalytically-oriented psychotherapy is used in both short-term and long-term procedures depending on the goal. Both frameworks focus on exploring unconscious drives and unresolved childhood conflicts which seem to continually resurface in adult life and prevent healthy attachment and intimacy with others.

In reviewing the literature on the efficacy of psychotherapy, authors generally found a weak relationship between patient improvement and any particular therapy technique. Of course, there are no hard and fast rules for deciding upon a particular method of psychotherapy because each individual presents with a unique set of circumstances. Moreover, different approaches may be implemented as the goals of therapy change.

However, there were specific therapist factors thought be associated with successful treatment outcome. The overall consensus from the patients in these studies suggest that the therapist’s attitude, the quality of the therapist-patient relationship, the actual skill level or years of training, and recognition as an “expert” were found to be equally significant. Patients also felt it was important for the therapist to be warm and approachable, appear reasonably healthy, competent and confident themselves, convey a sense of hope, and offer purity of treatment. While it is difficult, if not impossible for a therapist to live up to all of these expectations, it is reasonable to hope that the therapist you choose will be aware of his/her own limitations and sensitivities to personal issues which would impede the therapy relationship.

In sum, the therapy relationship is based on trust which is earned over time. After all, when developing a relationship of any kind, it is in observing the congruence between promises and actions that trust is developed. A mutual respect between therapist and patient will hopefully create an atmosphere in which the patient can feel safe enough (over time) to explore ideas, feelings, and experience the emotional release needed to break through the sometimes massive barriers to intimacy. Therapists are faced with the delicate balance of sharing personal information about self – too much and it can feel intrusive and burdensome to the patient – too little and the therapist can be perceived as unfeeling and walled off from their own feelings. How can they help be of assistance if they cannot experience the intensity of their own anger, fear, rage, sadness and/or anxiety? The therapist’s theoretical orientation will also play a role in the choice of technique (including self disclosure) since the theory is used as a template to understand human behavior and relatedness.

Actually scheduling that first appointment can be scary. But don’t be afraid to ask questions about the therapist’s qualifications, training, fee structure or any other issues that may be of concern (including the therapist’s comfort level about working with culturally, socially, spiritually or sexually sensitive concerns). Therapy is a process and there may be times of great frustration. But keep in mind that it took many years for the problems to develop and it will take time to understand and go through the healing process.

Copyright © 1998,2001 Karen E Engebretsen-Larash, Psy.D, PA. All rights reserved

For three decades or more Picasso was a dominant figure in Western Art and considered to be one of the most prolific artists of all time. The diversity of his artistic expression – ranging from painting, drawing, engraving and collage to sculpture pottery and ceramics – was both autobiographical in nature and politically influenced. With the recent display of Picasso’s work during the Art Festival in Miami, Florida, it seems fitting to include an article about his life and work in this month’s issue of UniQue Magazine.

Although it has been claimed that art is a particular expression of society, art itself was the essence of this man. Never really concerned with creating masterpieces, Picasso focused on shedding light on the visions and sensations by which he was obsessed, and by putting all that he loved or hated into his pictures. He was known to be one of the prime movers in Fauvism, Expressionism, Cubism, Futurism, and Surrealism. And like the man himself, his creations were both unpredictable and complex. His eyes are unforgettable, so it is no wonder that “eyes” are a particular hallmark of his work. He has drawn and painted them in thousands of forms; with the precise exactitude of a photograph, or in the shapes of birds, boats, beetles or crosses. He places them anywhere, anyhow, yet all of his eyes “see.”

Pablo Ruiz Picasso was born October 25, 1881 in Malaga, Andalusia. The circumstances surrounding his birth were decidedly inauspicious. Because he failed to breathe, the midwife abandoned him as stillborn. As Pablo tells the story, an uncle (who was also a doctor), saved his life by blowing cigar smoke into his face (1).

Picasso seldom reminisced about childhood but documented isolated events in his memoirs. He recalled that his first words were “piz piz” (or lapiz, the Spanish word for pencil). His artistic endeavors were praised and encouraged by his father, and by the age of seven, he began formal art instruction with his father. By age fifteen, having brilliantly passed the entrance examination, he was admitted to La Lonja, the Barcelona school of fine arts. According to several sources, this left him with a lifelong uneasiness about his academic achievement and contributed to the swings of his “periods” and the constant struggle backward to a more childlike force. His subjects were his loves and he confirmed that women occupy an exceptional place in the world. He stated, “at the end, there is nothing but love” (2).

One can indeed trace the various moments of enthusiasm or disillusion which preceded or followed his relationships. Soon after he met Fernande Oliver in 1904, he entered the Rose Period in which his works were filled with delicate pinks. While still somewhat melancholic, the figures were more robust and family groups replaced the lonely prostitutes and beggars of his earlier work. Marcelle Humbert entered his life in 1911 when Fernande left him. He fondly called her “Eva” or “My Pretty One” and began to paint her name into several still lifes (e.g. Ma Jolie) signifying that she was the first woman to capture his affections (fig. 1). Picasso later married Olga Moklova in 1918 and she gave birth to his son Paul in 1921. There was also mistress Marie Therese Walter in 1931 who gave birth to Maia in 1935 and Dora Marr in 1936. He subsequently married Francoise who gave him two children, Claude in 1947 and Paloma in 1949. His last documented affair was with Jacqueline Roguer in 1954.

Picasso’s personality was multifaceted. He was a man of exceptional temperament, energy, and virility; passionate but self contained; ardent yet not very sensual. He was sincere when he least appeared to be; mockingly proud in public yet warm-hearted and jovial in private life. Though his insatiable curiosity kept him restless, he was skeptical, suspicious, and full of masculine uneasiness. The notion that Picasso desired peace for others but could not accept it for himself was evident in his statement, “For me, art is a search for salvation” (3). Picasso was concerned with something far greater than a form and the distinction between the “concrete” and the “abstract.” His goal: the search for the center of life, things, and their changeless background.

Picasso sought to give symbolic expression to the world beyond consciousness, and identified in a allegorical way with certain other solitary persons such as the anonymous acrobats he etched in the Saltambique series (fig. 2). It was as if he seemed to make the struggle of the matadors his own. This drama he created on canvas seemed to carry over and permeate every aspect of his life and work.

He illustrated the Crucifixion in a changing series of 39 works over 6 decades. “Ladders” which depict a passage between the human and the divine, and link death with infancy and birth, are a recurrent theme in his work. Also “women” are often shown weeping or shrieking in pain and agony. The “sun” and the “moon” take different shapes throughout his works as well. He infused violent life into morbid illustrations; yet in their brutal twisted way, the renderings were touched with compassion and majesty.

Guernica (fig. 3), one of his most famous paintings, was an example of how deeply he was touched by the devastation and destruction of the war. The theme faced two directions and was suspended between an age of prophecy and a hoped-for salvation. The “warrior” in Guernica is shown as a broken person or perhaps death. But the most important creatures he portrays in this painting are the “horse,” which transcends the usual boundaries between animal, deity and man, and the “bull.” Upon close examination, we can see the portrayal of confusion on the face of the bull as a possible mirror of the conflict within the painter himself – his self assertion and self confusion.

At age 25, Picasso began using exclusive shades of blue in which he depicted the color of night, ashes, melancholia and death. The cold blues and murky grays were in keeping with, and a reflection of his misery and disenchantment which was so prevalent during the “Blue Period.” He considers himself to have suffered greatly by the hands of women all his life, and it is thought that he perceived his mother to have had a profound negative influence on him which may account for his struggle with irritability, depressed moods and insecurity.

It is also interesting to note that creations during this short period gave slight distinction between sexes (perhaps an indication of uncertainty about his own sexuality). There was also ambiguity in is study of nudes: for instance, the underdeveloped Girl with a Basket of Flowers (fig. 4), and The Tall Pink Nude (fig. 5) where the artist gives the female model a distinctly masculine body. With their equally effeminate features, multicolored tights and loose floating dresses, both men and women appear to have stepped from the same world of fantasy and dream.

As we examine history and the rapid increase in technological development, we find confusion, upheaval, and a redefinition of morals and social values. Not only did Picasso experience instability with his female partners, he was greatly effected and influenced by the social and political unrest of the times. Since his private life was the focal point of his work, we can find equivalent changes in his life and creations. At times, he vacillates between sweeping lines of tenderness and tormenting sometimes savage passion and desire as seen in his Arabesques (fig. 6). There was always an apparent cross-fire between two opposite impulses: the urge to create something avant-garde and the longing to respect both tradition and nature. His work was rich with output but full of upheavals and undercurrents, as was this period of time. Picasso’s life and art was a direct reflection of contemporary ideology and his personality was shaped by the dynamic forces of the ever changing times.

References: (1) Frank Elgar, Picasso trans. Francis Scarfe (New York: Francis A. Praeger, 1956), p.7; (3) Elgar, p. 256; (2) Gaston Deihl, Picasso. (New York: Crown Publishers, 1977), p. 66.

Copyright © 1998,2011 Karen E Engebretsen-Larash, Psy.D, PA. All rights reserved

Now that the holidays are over and the decorations have been put away, reality has set in. It’s 2011, and like most of us, you probably made some new year’s resolutions as you watched the ball drop.

Each year, there is a hope that this one will be better than the last. Although we promise ourselves to make the necessary changes for a better life, the pocket-full-of good-intentions only last a few weeks (at best) and we end up disappointed once again. Unfortunately, we keep hoping for different results without making any significant changes. This is the definition of insanity – doing the same thing over and over and excepting different results. This article is intended to address this issue.

I believe the biggest reason failure occurs is because the focus is on changing ACTIVITIES (behavior) rather than SELF. For example, a desired goal might be to loose weight. Thus a rigorous schedule to increase the rate of exercise and decrease calorie intake is developed. But at the first hint of failure (or falling off the wagon so-to-speak), the resolution become null and void and old behavior patterns are resumed. As a result, those negative tapes start again which reinforces a sense of shame and defeat.

But lets consider what would happen if some additional questions were are asked in the planning stage such as: a) how may pounds do you want to loose (a specific goal is much easier to measure and it provides a concrete structure whereby progress can be assessed); b) what triggers the desire to engage in excess intake of food or substance; and most important, c) why do you want to loose weight anyway? Paying attention to one’s motivation is the key to success. If the goal is to please someone other than self, victory is less likely since the goal is outer-directed instead of inner-directed. What do I want and why?

These seem like relatively simple questions, but they can be powerful tools to help anyone stay on track for any behavior change program. As you review your own 2011 resolution list, I present you with this challenge. Instead of focusing on behavior modification, focus on YOURSELF by asking these questions: What do I want and why? What is important to me? What are my limitations? Are my relationships satisfying and if not, why? Do I pay attention to BOUNDARIES and respect myself enough to say NO when those boundaries are crossed? What tools do I already possess to help me feel good about myself? Do I have BALANCE in my life and if not why? Do I make time for leisure? Do I take time to PLAY and nurture the child within me? When you know who you are, and what you want, there is a much greater chance of being successful at whatever you tackle in life.

Remember, life is a journey with many possibilities. The very situation which appears to be a roadblock can be viewed as an obstacle or opportunity. Our attitude plays an important role in how we filter information and behave. If you think you’re going to be successful, you’re right. If you think you will fail, you’re right. What do you want and why? You are a UniQue human being with great potential. So enjoy this year and all it’s possibilities and enjoy YOURSELF!

Copyright © 1998,2011 Karen E Engebretsen-Larash, Psy.D, PA. All rights reserved

by Karen E. Engebretsen-Larash, Psy.D.

With the public eye on President Clinton’s extra-marital experiences, much more attention is being given to sexual expression and it’s role in American Society. Hours and hours of news commentary regarding this scandal have offered a variety of viewpoints which seem to be reflective of public conviction.

In fact, during casual conversation with friends and colleagues, I have heard statements like, “It is a travesty of justice. How could he do such a thing? He’s the President after all!” to comments on the other end of the spectrum such as “He’s a human being just like you and me. Why can’t everyone stay out of his bedroom and leave the poor man alone?”

The aim of this article is not to offer an opinion about the news media’s impression of Mr. Clinton’s predicament, nor is it intended to imply that he is “Sexually Addicted.” To give a diagnosis of Sexual Addiction on ANYONE requires an appropriate psycho-logical assessment of the individual. It is important to remember that, while there are some behaviors which may be considered normal in most people, these very same behaviors can be highly addictive for others.

So, how does one determine if their sexual experiences are “normal” or “addictive?” According to the leaders of the addictions field, Sexual Addiction can be defined as a destructive relationship with sexual activities and sexual relationships which deviates from mainstream experience WITHIN the expected boundaries of the particular sexual culture (heterosexual, gay, bisexual, lesbian or transgender). This relationship becomes central in the addict’s life and relies on sex for nurturing, comfort from pain, and relief from stress. The basic characteristics of addiction include: a) a powerlessness to stop at will; b) harmful consequences if the behavior is maintained; c) inability to manage other areas of one’s life; and d) withdrawal symptoms upon trying to quit.

According to Patrick Carnes, Ph.D. (nationally known author and Clinical Director for Sexual Disorder Services at the Meadows Institute, Wickenburg, AZ), research he found some interesting correlations between Sexual Addiction and trauma:

* 81% of sex addicts experienced sexual abuse (either in childhood or adulthood)
* 76% experienced physical abuse
* 97% experienced emotional abuse

He also found Sex Addicts to experience a variety of co-addictions:
* 42% are chemically dependent
* 38% have eating disorders
* 27% have work addictions
* 26% are compulsive spenders

Several questionnaires have been developed to determine the need for Sexual Addiction treatment. For example, Robert Weiss, LCSW, Clinical Director of the Sexual Recovery Institute, Los Angeles, CA has a brief 15 question survey which can be used to determine whether further evaluation is needed. Dr. Patrick Carnes and Robert Weiss, LCSW also created a gender-specific Sexual Screening Test for men (G-SAST) and one for women (W-SAST).

Treatment for sexual addiction involves the same concepts which are used to treat other forms of addiction (e.g., chemical dependency, eating disorders, etc.). The process is intended to help individuals break through their denial system by taking an honest look at the consequences and damage these unhealthy choices have caused. Therapy also includes involvement of family and significant others so that codependency and other issues can be addressed.

The National Council on Sexual Addiction and Compulsivity suggests that treatment generally works best when services are provided by a therapist who specializes in addictions since traditional psychotherapies have not proven to be as effective. Most major cities have outpatient programs which can be tailored to suit your clinical need and budget. There are also National Treatment centers (such as those listed in this article) which offer specialty programs for Sexual Addiction. Local 12-Step programs (based on the original AA model) can also provide additional support for those everyday challenges which could lead to relapse.

To obtain additional information about this article, treatment programs or 12-Step resources in your area, you may contact Dr. Karen.

Copyright © 1998,1999 Karen E Engebretsen-Larash, Psy.D, PA. All rights reserved