What is Superhero Therapy?

Superman-couch

Did you ever want to be a Superhero? Did you ever wish that you could possess magical powers, like Harry Potter, or travel around the world in a time machine, called the T.A.R.D.I.S. with an alien who calls himself The Doctor? What if you could, in a way?

Many of us wish we had some kind of magical or extraordinary abilities, and many of us strongly identify with fictional characters, like Batman, Superman, Buffy the Vampire Slayer, characters from Harry Potter, Firefly, and many others. Recent research findings suggest that identifying with fictional characters can actually be extremely beneficial as it can teach us empathy, remind us that we are not alone in our painful experience, inspire us to eat healthier, and allow us to better cope with difficult life transitions.

The goal of Superhero Therapy, therefore, is to help patients who identify with a particular fictional character to use that relationship with that character in order to identify and process their own experiences and feelings, as well as to encourage them to make meaningful changes in their lives. Thus, the goal of Superhero Therapy is to teach us how to become the very magical Superhero-Jedi that we need in order to become the very best versions of ourselves. Superhero Therapy refers to using examples of Superheroes, as well as characters from fantasy and science fiction in research supported therapy, such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

Why Superhero Therapy?

Many people have a hard time identifying their own thoughts and emotions, either because it’s too painful, or they’ve never thought about it. I see many patients with posttraumatic stress disorder (PTSD), including active duty service members, Veterans, and non-military civilians. I find that a lot of the time when I ask my patients how they felt at the time of the traumatic event, or even about which emotions they are experiencing in the present moment, many state that they aren’t sure or do not wish to answer.

However, discussing how a specific character felt at a given moment can be helpful in understanding our own emotions. For example, in the Defense Department’s recent efforts to assist Veterans with PTSD, they’ve contracted an independent company, Theater of War, to put on theatre plays for Veterans with combat-related themes, based on Ancient Greek plays. One of these plays, Ajax, for example, tells a story about a character struggling with his symptoms after the war and eventually committing suicide. Veterans and their spouses who saw the play reported that the play helped them understand their own emotions by relating to the characters. One Veteran in particular was moved by the play, stating: “I’ve been Ajax. I’ve spoken to Ajax.”

Talking about fictional characters’ emotional experiences might seem safer than talking about our own, so with my patients, that is where we often start, later drawing parallels to their own feelings and subsequently switching over to focusing on those. For instance, many service members and Veterans I’ve worked with strongly identify with Superheroes, in particular, Batman, Superman, and The Hulk. Let’s take a look at Superman.

Superman (real name Kal-El) is a comic book character who is an alien from another planet, Krypton, who was sent to Earth as a child. His Earth name is Clark Kent, and while in the Solar System, including Planet Earth, he appears to have superhuman abilities: he possesses super strength, super speed, he can fly, he can fight, he has X-ray vision, and many other cool powers. It is no surprise that Superman is a role model to many service members and Veterans, who believe him to be invincible. The phrase or a variation of the phrase I often hear in this population is “I wanted to be Superman… I failed.” This is a common response many people have, harshly judging their own experiences of having PTSD. This is a common dialogue I’ve engaged in with many of my patients:

Patient: “I just feel like such a failure.”

Therapist: “What makes you say that?”

Patient: “I wanted to be like Superman, you know? Strong.”

Therapist: “And now you don’t feel that way?”

Patient: “No, I have PTSD.”

Therapist: “And what does that mean about you?”

Patient: “It means that I’m weak.”

Therapist: “Wow, that’s harsh. Let me ask you this, did Superman have any vulnerabilities?”

Patient: “No.”

Therapist: “No?”

Patient: “Well, there’s Kryptonite…”

Therapist: “Right. What is it and what does it do?”

Patient: “Kryptonite is this radioactive material from Krypton, where Superman was born. It takes away his powers and can kill him.”

Therapist: “So Kryptonite makes him vulnerable?”

Patient: “Yes.”

Therapist: “And does this make him any less of a Superhero?”

Patient: “No, of course not… Oh, I see what you mean, that having PTSD doesn’t mean I’m not Superman.”

This is an example of how cognitive behavioral therapy (CBT) could look when using Superhero examples in session. CBT is a type of therapy that looks at the relationship between thoughts, feelings, and behaviors, which are bidirectional, meaning that they affect one another. In the example above, the patient’s thought: “because I have PTSD, that means I’m weak, and I failed in being Superman” is affecting his feelings (making him feel more depressed) and is affecting his behavior (for example, not wanting to socialize with others).

Some of the thoughts we have might not be 100% accurate, often leading to some painful emotions, and maladaptive behaviors. By challenging the validity of the thoughts (testing to see whether or not the thought is accurate), we can get out of the maladaptive loop. A CBT therapist’s job is to teach a patient how to implement the skill of challenging their own thoughts, to change the maladaptive behaviors in order to help the patient recover, as well as become their own therapist, to be able to help themselves in the future.

The other type of therapy that lends itself nicely to Superhero Therapy is acceptance and commitment therapy (ACT). I often describe it as Superhero Training, as ACT teaches us to become the very Superhero (or witch/wizard, vampire slayer, Jedi, or any other title that seems most helpful) that we wish to be by following our values, (the most important things to us, like family, friends, creativity, altruism, spirituality, and others), and by facing whatever dragons show up along the way (thoughts, feelings, personal stories we tell ourselves, such as “I’m a failure” or “I’m not good enough”) and practicing the Jedi-like skill of mindfulness.

Let’s take a look at how Harry Potter can be used in therapy to teach us some of these skills. Briefly, Harry Potter is a young wizard in training, whose parents were killed by Lord Voldemort, an evil wizard. Harry and his friends, Ron and Hermione, are studying magic at Hogwarts School of Witchcraft and Wizardry. When Lord Voldemort and his followers, the Death Eaters, start to come back to power, aiming to exterminate all non-magical humans (called Muggles), as well as all Muggle-born witches and wizards, it is up to Harry and his friends to stop them.

In the first book of the Harry Potter series, Harry, Ron, and Hermione find out that Lord Voldemort is attempting to come to power by trying to steal the Philosopher’s Stone, which grants immortality to its owner. In trying to stop him, Harry and his friends have to undergo a series of dangerous tests. One of them, the Devil’s Snare, is a magical plant that uses its tentacle-like branches to suffocate the person that touches it.

The Devil’s Snare presents a great ACT metaphor of acceptance and experiential avoidance: the plant seems to respond to tension levels, the more one struggles with it, the tighter its grip and the more likely it is to choke them. This is experiential avoidance, trying to escape the present experience, and just like the Devil’s Snare, in most cases, the more we try to escape, the deeper our struggle becomes. However, if we stop struggling and are willing to experience this discomfort (acceptance), then we are more likely to survive – when Hermione lets go of the struggle with the plant, for example, the Devil’s Snare releases her.

Here is how Superhero Therapy using ACT can look in a clinical setting. One of my clients was struggling with panic disorder and was too scared to go to places where a panic attack might take place and where escape might be difficult (this is called agoraphobia). The patient (let’s call her “Lucy”) stated that as a result of her fears of getting additional panic attacks she had to drop out of college, move back in with her parents, was unable to spend time with her friends, was unable to volunteer in a community theatre, which was something she really enjoyed, and essentially put her life on hold. While she did not have many panic attacks when staying at home, Lucy’s life became constricted, based solely around her anxiety disorder. Lucy stated that she would not be willing to go to unfamiliar places until her panic attacks went away completely and she was absolutely sure that they would not happen again. Her thoughts, such as “if I go out, I will have a panic attack” and “I’m weak” prevented her from living the kind of life she wanted.

In our sessions together we talked about the Harry Potter series; her favorite character was Harry’s friend, Ron Weasley. She said that she identified with Ron because of his fear of spiders. While Lucy herself did not have a fear of spiders, she stated that she could relate to Ron because “he knows what it’s like to be really scared, he gets so overwhelmed by spiders that he can’t even move. That’s exactly how I feel.”

In discussing Ron in therapy, Lucy was able to identify that as scared as Ron was of the spiders, when it was really important, specifically, when Hermione was Petrified (turned to stone) by an unknown monster in Harry Potter and the Chamber of Secrets, Ron (as well as Harry) followed the spiders into the Forbidden Forest in order to get the information needed to save Hermione and other Petrified students. This is a great example of the ACT concept of values. No one who read the books can deny that Ron was terrified when he followed and interacted with the spiders. He was probably also doubting his own abilities and might have had many insecure thoughts, such as “I will fail,” or “I’m not good enough,” or maybe even “I’m a coward.” And yet, despite his fear he was able to follow through, he was willing to experience whatever terrifying emotions and thoughts showed up in order to save his friend, showing true courage and heroism.

I will never forget the first time that Lucy and I drove around her block as a part of her facing her fears. She was trembling and was saying that she did not think that she could do it. However, she got behind the wheel, tightened her Gryffindor scarf, and turned on the engine. It took less than 5 minutes to go around the block and when we were finished Lucy was ecstatic. She was in tears, she was laughing, and saying, “I can’t believe I just did that!”

Lucy and I continued working on taking “superhero steps” in her valued direction and practiced driving to a movie theatre and other locations. Lucy still gets anxious sometimes but just like a true Superhero that she is, she courageously goes out with her friends, she’s back in school, and has even traveled abroad with her family.

I always say that the bravest people I know are my patients. It takes a lot of courage to experience overwhelming, and at times, incapacitating, anxiety, to come to treatment, and to face our fears. Many people believe that fear is bad, something that needs to go away for us to live a normal life. However, fear can actually be quite advantageous. In a recent Doctor Who episode, Listen, we learn that fear can be a Superpower. Doctor Who is a British science fiction TV show about an alien, who calls himself The Doctor. The Doctor travels around the universe in a time machine, called the T.A.R.D.I.S. (which stands for Time and Relative Dimension in Space) and saves those in need.

The Doctor is over 2,000 years old, and seems to know a thing or two about fear. His take is this: Fear is a Superpower. Fear causes the release of adrenaline, which makes us think faster and fight harder, suggesting that we don’t need to run away from fear, fear might actually be helpful.

The bottom line is that running away from fear and not living our lives according to our values isn’t helpful, whereas learning how to face our fears in the service of what’s most important to us, that’s what being a Superhero is all about.

The Roots of Self-Hatred and Fostering Self-Compassion in the Therapeutic Relationship

Depressed, ugly, unlovable, coward, idiot, defective—the list is endless. When people have a long history of punishing and berating themselves, they can become fused with the concepts these thoughts construct and take on the belief that their true self is faulty. Clients (and if we are honest, most of us) therefore walk around with notions of who or what they really are, and more often than not hate or shame themselves for it.

self-hatred-2 (2)But, whatever particular set of epithets our personal history has led us to fuse with, one thing most of us share is that we intensely dislike and often criticize ourselves for whatever self-concept we hold.

Most of these labels arose from painful moments in our history. The pain, and often shame, that these events elicited became attached to the memories of the events and the labels our behavior, experiences, or entire self received on those occasions. In turn, our very notion of self becomes aversive—something to move away from.

This can lead to self-hatred and self-shame and take many forms, including suicidal ideation, self-harming behavior, self-chastising or self-aggrandizing talk, putting on a mask and pretending, ruminating, self-shaming, and dissociating.

Fusion of our sense of self with content or labels of experience is often prompted and reinforced by caregivers or peers, through statements like “Little Joe is such a shy boy,” “You asked for it!” “You’re such an idiot for not seeing this,” “You’ll never amount to anything,” and so on. Soon enough, that other-initiated talk can turn inward and become self-sustained disparaging self-talk.

Is it any wonder that deep-set self-hatred is so prevalent? Because of this dynamic, it is clinically crucial to promote a more flexible sense of self that can help clients disentangle themselves from rigid self-concepts and the limitations they impose on behavior.

As mentioned, our self-concepts are largely the products of our learning histories, especially in relation to our caregivers and attachment figures.

Early on, children have no more language for their inner experience than they do for the experience of their senses. And whereas learning to orient to sensory experience is necessary for physical survival, the world of inner experience only acquires significance because it is important to other humans in our lives. It is through social interaction that we learn modes of interacting with our inner experience. This is why it is so common for people to recognize their caregivers’ voices in their self-talk.

When caregivers are stressed, absent, overworked, avoidant or overcome by emotion, chances are they will not respond in ways most conducive to children learning how to recognize and name their inner experience and accept it as normal. Under these conditions, children might be told that they are angry when they are in fact hungry, that they are hungry as the clock strikes noon, that they are not (or should not) be sad when they are feeling sad, that they want ice cream when in fact their caregiver wants ice cream, and so on.

Repeated such experiences during early development may lead to children having difficulties in learning to name what they feel or want with any precision. Their inner experience might have received so little attention that they have no words to describe it. In many cases, they will have learned to fear, deny, or judge their inner experience rather than notice and accept it as one may notice and accept the changing weather. The world of inner experience can thus become an unfamiliar, unstable, treacherous territory, full of darkness, threats, and defects. And that, in turn, will further feed self-hatred, shame, fear, and a sense of unrelenting inner conflict.

In clinical settings, clients who are unable to understand, tolerate, or effectively communicate their inner experience may say that they do not know how they feel or think. They might be unable to describe inner sensations or name their emotions, perhaps only locating feelings in their heads; or they may react aversively to any attempts at helping them contact inner experience, such as through eyes-closed mindfulness exercises.

Because we learn our relationship with our inner experience and concepts of self largely from our attachment figures, the way caregivers respond to our bids for connection as children can have a profound impact on our later behavior in relationships with both our selves and others.  A history of consistent reinforcement for connection bids could result in a secure attachment style, whereas a history in which such bids were consistently ignored may lead to an avoidant attachment style. A history in which those bids were consistently punished could produce an attachment style that’s fearful.

These styles could in turn be reflected in individual styles of relating to inner experience: secure and accepting, avoidant and dismissive, fearful and critical, or disorganized and unaware. Of these, only the first style would naturally incline the individual toward self-compassion. The others would naturally fuel different forms of self-hatred, self-shame, and inner conflict.

It takes a specific learning history and a deliberate context and community to build an accepting and kind relationship to one’s own experience—a relationship that consistently reinforces compassion for one’s own aversive experiences and those of other people. When that history is missing, a healing relationship, such as the therapeutic relationship, might provide a privileged context for building a new learning history that fosters self-compassion skills.

In this way, the therapeutic relationship offers a setting in which a different approach to the self and one’s own experience becomes possible. This can range from helping clients learn to receive their negative self-concepts with strength, wisdom, and kindness to helping them transform a sense of self that is unstable or disorganized. Within this context, clients can also adopt a more flexible sense of self.

Acceptance and Commitment Therapy: A Different Approach to Anxiety Disorders

Most coping techniques that teach people how to handle their abnormal anxieties focus on skills that reduce, replace, and avoid discomfort. These techniques are many that I have tried for my own anxiety including deep breathing, relaxing music, muscle relaxation, and more.

Cognitive behavioral therapy teaches people to control and change their upsetting feelings and thoughts. On the other hand, Acceptance and Commitment therapy teaches people not to change their thoughts or feelings but to change the way they react to them. The three steps of Acceptance and Commitment Therapy are; accept, choose, and take action.

According to Psychology Today,

Acceptance and Commitment Therapy (ACT) is a type of psychotherapy that helps you accept the difficulties that come with life. ACT has been around for a long time, but seems to be gaining media attention lately. Categorically speaking, ACT is a form of mindfulness-based therapy, theorizing that greater well-being can be attained by overcoming negative thoughts and feelings. Essentially, ACT looks at your character traits and behaviors to assist you in reducing avoidant coping styles. ACT also addresses your commitment to making changes, and what to do about it when you can’t stick to your goals. Read More

  1. Acceptance: Acceptance of anxious feelings means learning how to observe and sense them without judgment. Instead, you are able to use compassion and gentleness when confronted with anxiety, fear, worry, panic, and other sensations that may cause discomfort.
  2. Choose: This step is where you decide how you want your life to go. You can ask yourself do I want to remain a prisoner to this anxiety or do I want to live a fulfilling meaningful life?
  3. Take Action: This is by far the hardest step. This involves accepting that in order for things to change you much change your behavior. Taking action means facing your fears and anxieties and making them a small part of your life instead of something that consumes you.

To learn more about Acceptance and Commitment Therapy check out the book:  The Mindfulness & Acceptance Workbook for Anxiety by John P. Forsyth and Georg H. Eifert.

Government Shutdown: Why Can’t the White House and Congress Get Along?

US Capitol

I have found that negotiation and mediation are advocacy tools that successful social workers use to bring about change within individual client systems as well as in policy making. Social workers sometime use creative advocacy techniques that may extend beyond traditional channels in order to protect their clients from harm while balancing organizational policies and procedures that often restrict their ability to do their jobs.  

The government shutdown over funding the Affordable Health Care Act, commonly known as Obamacare, reminds me that strong advocacy is often adversarial and can have negative consequences. What happened to using negotiation and mediation as advocacy tools?  While there are many benefits to Obamacare, few would dispute there is much opposition to the law and full implementation. Mediation is a viable and evidenced-based process for resolving disputes peacefully and collaboratively.  Why take the American people hostage?

Perhaps it’s time for each of us to become mediators. I would like to ask everyone who reads this column to become an armchair mediator with a fair and impartial in examining the government shutdown dispute. Before we can assume the role of armchair mediators, we must first put aside our political affiliations as well as our position on Obamacare to be objective in the matter.  We need to honestly ask each of the parties  “What if you are absolutely right, where do we go from here?”

A mediator would ensure all stakeholders, not just the loudest voices, at the table were heard. The politician, the everyman…Mediators ask difficult questions: for example, where is the opportunity for common ground and how do we respectfully acknowledge opposing points of view?  Read More

In my inaugural column for the Social Worker Helper, my hope is to share my expertise as a mediator  for over 30 years and highlight the use of mediation and negotiation as advocacy tools.  All opinions are valued.

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