(1) It Is My Faith That Every Flower Enjoys the Air It Breathes:

May 1, 2019

Fundamental Assumptions of Psychotherapy

You are perfect. God does not make mistakes. God makes corrections and She has been working on us for 3.5 Billion years. The scripture—the word of God—is written in the Code of Life: in our Genetic code. You were born with a unique physique, intelligence, and disposition perfectly evolved to maximize your survival--and the survival of your ancestors. We can each proudly claim that each of our ancestors survived infancy and childhood. They all reached adulthood, and brought at least one child into the world. We are survivors from a long line of fierce survivors ...The natural state of man is disorder, poverty, and stagnation—this is how we lived throughout our evolutionary past. This is how we “grew up.” Environments on earth drastically change every 10-thousand years or so (the average ice age) and evolution has selected traits over millions of years that were adaptive within environments of both abundance and deprivation. The majority of people adapt well to most environments and it is this capacity has allowed us to survive within and populate the earth. We are a hearty species.

We don’t choose the many circumstances of our lives—whether we live in times of deprivation or abundance—rich or poor, war or peace, protected or neglected. We get plopped into this world—our brains half-baked--as human-beings and we have to figure it out as we go. All of us. We are figuring it out right now (right here, right now…). We don’t have control, but we do have choice—and a responsibility (to ourselves, if not our ancestors)—to live our lives to their fullest potential wherever we do find ourselves.
Most people are happy (70% surveyed). There are lots of reasons to be. The world is getting safer all the time; women and children are increasingly protected by law and the enforcement of law; we are richer, with greater equality, liberty, and justice. This is the land of milk and honey.

However, pain is also woven into nature. Life requires struggle. Life is bittersweet. We live, on average about 80 years, and as we age, we are more likely to experience illness, accidents, disintegration, and death. About 30% of our population has what is diagnosable as a psychiatric disorder (mostly anxiety and mood disorders). These are my clients, and they suffer—in good times and in bad times.

One of the most important lessons in therapy is the difference between pain and suffering. Just like death, pain is inevitable, and is intended by its nature to be instructive—to help us self-correct. By contrast, suffering is the anguish we experience from worrying about the future and regretting what has or hasn’t happened in the past. The objective of therapy is to learn when the pain is not protective or healing, to learn ways of managing the pain, and to heal ourselves. Just as we control what we take into our bodies--if we’re healthy—we can maximize our emotional health, by choosing our thoughts, behaviors, and health practices.

As a clinical psychologist, I’m asked to address an assortment of unanswered--and often unanswerable--questions related to pain, love, loss, meaning, and purpose. The task of the psychologist is to address the questions not with answers (we never actually answer questions), but with a “retelling” of the story—a revision--that allows the healthiest possible understanding, acceptance, and growth. In order to do this effectively, I needed to come up with a way of “connecting-the-dots” myself—of answering --Who Are We? This talk is my attempt to share my fundamental assumptions of psychotherapy with you, and how I am applying this understanding to my clinical practice.

Assumption One: We are Three Animals in One

Ask audience “What do podiatrists study?” “What do proctologists study?” “What do cardiologists treat?”


The Brain is the organ of interest in psychology. Your brain evolved over the course of one-half billion years to become—You—the most highly engineered, intricate, and complex creation of Nature.

The purpose of the brain is to enhance survival through the prediction and control of future outcomes. In milliseconds our brains can do what supercomputers to this day cannot. Our brains protect us and our loved ones instantaneous, without conscious thought.

The first psychotherapist—Sigmund Freud—was a neurologist—a brain scientist. He practiced over 100 years ago, and was interested in understanding the biology of conflicts within the human brain. He established theories—for example, related to conflicts between the Id, Ego, and Super-ego.

Modern neuroscience in applying imaging technologies to the living brain is revealing not just the presence of conflict—but why the conflict exists. It turns out: We are three brains in one! One is behaving, one is emotional, and the other is logical—and this results in a lot of our human conflict. On top of that—we have evolved specialized skills on the left hemisphere that often conflict with the more survival-based and negative right hemisphere. Freud was right.

Behaving Brain.

Reptilian: we are part dinosaur.
We have an ‘old brain’ that is estimated to be over 100 million years old. We share this ‘old brain’ with many other animals walking this earth, and it coordinates ancient drives for basic survival, like food, shelter, sexual relationships, and social status. We are motivated by these drives to engage in behaviors such as approach—avoid, and fight—flight—or freeze.

Emotional Brain

Mammal: we are part dinosaur and part mouse.
Compared with reptiles, mammals provide a significant amount of investment – protection, care and nurturance – in their offspring. Mammals have a rich emotional life—including the super-power of Love from mother to child. We are examples of the survival of the fittest because we are nurtured by the fittest. Compassion and caring for other family members and extended non-kin emerged out of this care-giving to our young.

Logical Brain

Human: we are part dinosaur, part mouse, and part human. Approximately 2 million years ago, humans began to develop a particular type of intelligence which gave us special abilities. The role of the neocortex is to allow the body to resolve conflicts: emotional, social, logical. Through this new brain, consciousness allows a resolution of the conflicts in the brain. Based on a memory of the past, it makes long-term plans and makes long-term plans. The neocortex is the CEO of the brain tasked with resolving conflicts and making difficult decisions when it is the right thing to do.

Left/Right Hemispheres.

Each of us has two other brains: one on the left and one on the right. As brains became larger and more complicated, each hemisphere began to specialize in different skills and abilities. Both hemispheres have languages; the right has a language that is usually fearful and negative in tone and programmed very early in our lives. It is the worrier, the critic, and the one designed to keep you in line. The left hemisphere has the language we use to think through problems and to communicate with others. This was the experiment that created modern humans and it is specialized in abilities such as rational thought, social interaction, and self-awareness. This is the logical hemisphere.

Conflict within the Brain

Decisions are made by various competing parts of the brain–so conflict is inevitable. The prefrontal neocortex serves as the executive decision-maker—the broker—of the multiple needs represented by these brain factions.

Behaving, Emotional, and Logical Brains: Again—3 brains in 1! Inevitable conflicts between drives, emotions, and thought. Imagine the conflict in the brain of a young heterosexual male upon seeing an attractive female in a room. The reptilian brain will urge “Approach! Have sex!” The emotional brain might warn “Avoid! She may hurt you!” The logical brain—if it is called upon at all, might suggest something like: “Approach under these conditions…Avoid under these conditions…”

Right/Left Hemispheres. Of course, conflict will also emerge between the logical and emotional right and left hemispheres. Using the above example, the right hemisphere might experience sudden terror and shame and might say “She won’t like you! You will be humiliated!” The left hemisphere would be more likely to look for the evidence underlying a decision: “She smiled back.” “She’s not wearing a ring.” “She might like me.”


Many human struggles are consequences of brain evolution and not character deficits. Adding a neuroscientific perspective to our clinical thinking allows us to talk to clients about the complexity of our brains. The challenge is to move toward to a mindfulness and compassion for ourselves and others. We can then move toward the conflicts within us—and begin to do something to restore order and balance in our life.

Psychotherapy can be an effective, noninvasive biological intervention. Psychotherapy regulates strong, negative emotion by activating the logical brain and inhibiting the emotional brain. This allows for a “top-down” regulation. We are able to control the more primitive areas of the brain with logic. The power of psychotherapy to change the brain rests in our ability to recognize and alter belief systems that aren’t adaptive. The process for brain change involves deactivation—of old, worn-out understanding and the creation of a new, more adaptive, understanding. Through all this work, more emotional, right-hemisphere networks that store memories of fears are actively integrated with logical thought.

It’s important to remember the body is one connected web–everything goes together. If one system is out of balance (e.g., sleep, stress, nutrition), it throws other systems out of balance too. What’s good for the body is good for the brain. This is an example of a bottom-up intervention. Antidepressants allow a “bottom-up” change. Medication can help the midbrain to achieve a state of emotional inhibition that allows clients to benefit from the logical processing done in psychotherapy.

Assumption Three: We Feel like Mammals

Mammals introduced a new psychology to the world. Our brains developed the capacity to feel emotional pleasure and pain—not just physical pain. Emotions are our “super-powers”: they protect us and our kin in a moment, without conscious thought.

Emotion guides us towards our needs, behaviors, and learning. Low arousal, low performance…Low arousal, low memory…The presence of affect is necessary for decision-making; without emotion, we cannot make the simplest of decisions (e.g., what shoes to wear; what shampoo to buy).

For just a moment, I’d like you to pretend, if possible, being suddenly stripped of all the emotion, and try to imagine this moment without favorable or unfavorable feeling. hopeful or apprehensive comment. Nothing would then have importance beyond anything else. Nothing would have significance, character, expression, perspective—flavor!

Emotion gives us personality. Just as…Relate dispositional/emotional differences to physical/phylogenetic differences (hair/eye color, height, nose size). Our disposition guides the mind’s eye from birth forward. Whether you’re born happy, excited, loving, sad, afraid, angry, disgusted–guides the interpretation of all experience from birth to death.

Tell the story of your client’s earliest memory… Clients who see me are problem-solvers—even in the absence of a problem. Anxious people have the heuristic “better safe than sorry.”…

Negatively-biased emotions such as anger and fear may promote overprotection (avoidance or defensiveness), whereas the positive emotions may facilitate growth (exploratory, or novel-seeking behavior). For the survival of our species, we need people who are very sensitive to all the emotions: anger, disgust, fear, sorrow, excitement, love, and joy: the anxious people plan (e.g., build cities, hospitals), the angry people police the city (attorneys, judges, politicians), the disgusted people protect via hygiene and sanitation.


Emotions are our bodies way of signaling a need. As a therapist, one of my primary goals is to shift my client’s response to unpleasant emotion from one of avoidance to a conscious curiosity and exploration. Emotion is used as a compass to provide a “bottom-up” guide to our needs.

Becoming aware of emotion is then followed up with an exploration and eventual understanding of what we are feeling and why we are feeling it. When we are able to consciously understand the meaning and purpose of an emotion, we can make sense of it and logically decide how we want to respond.

People with negative emotional dispositions—esp. anxiety and sorrow—tend to live theirs live through the avoidance of pain, rather than the pursuit of pleasure or growth. For clients with too much emotional inhibition and avoidance, new learning is stimulated by creating moderate levels of emotion in therapy. Focus is directed on allowing for change and its associated loss, as well as maximizing the pleasures associated with change. In this way, emotion can be woven into a narrative which can be consciously experienced and reinterpreted as necessary. This is the “top-down” approach.

Assumption Four: We Think Like Humans

One of the faculties that make humans special is our capacity to guide our thinking about our experience of ourselves, others, and the world. The brain evolved to help us make optimal predictions and to help us deal with potential danger. Our mind replaces complicated problems with simpler ones that allow quick approximations; not certainties, but best guesses.
We all have a tendency to think more about bad experiences than good ones. It’s an over-learning from the painful situations we encounter through life and helps us avoid them in the future. The brain provides fast, intense, and negatively biased information, and as such, we have evolved to have a readiness for deprivation. The human mind searches constantly for “what is missing/wrong,” rather than “what is present/right.”

There is a survival advantage to doing so. Someone low in anxiety or anger might not live long in a dangerous environment. In that environment, the best mood type for survival would include people who are self-protected by strong negative emotion—like anxiety and anger. But, in a safe environment, like the one we have now, people who are wired with a sensitivity toward strong negative emotional states carry a “lifeboat” of emotion on-land. They just don’t need all the protection, and it is self-limiting.

Many people go through life never having noticed they have a mind. One of the first things we notice when we become consciously aware of our mind—for example, through meditation, is that your brain generates thoughts all on its own and pretty much all the time: a steady stream of words, thoughts, and images emerge.
People often notice voices within them.
1. The planner. A self-reflective internal voice that allows them to plan and guide behavior.
2. The dreamer. A language of self-reflection where thoughts flow. This unfocused voice allows our highest creative thought.
3. The critic. An internal narrator that comments on their behaviors. These voices are often critical and shaming.

How many of you can relate to these voices?


Psychotherapy allows us to gain perspective on our thoughts and feelings by consciously developing self-reflective language regarding what we would like to change and how to change it. Therapy is effective, in part, because it allows us to be mindful of our circumstances and resolve inner conflicts–as a life course correction. By talking about and then editing our own understanding of ourselves and our lives, we can change our perceptions of ourselves and identify obstacles that stand in the way of our highest potential.
Introspection and meditation allow you to get insight into the ‘voices’ in your head: to gain an understanding of their messages; to discern where they’re coming from and where they are directing you.

We have multiple brains—multiple interpretations. The role of the psychologist is to train people to exercise that part of their brain (e.g., hemisphere) that is under-utilized. Think of the “voices” in consciousness as the right-brain speaking to the left-brain. Psychotherapy often involves sorting out these different soundtracks in order to provide a clearer idea of just what is going on in there.

Just as we can effectively—or ineffectively communicate with others–we can communicate with the self. By observing the stream of thoughts and feelings, you are in a position to make some choices that you couldn’t make before. You can evaluate how accurate and useful they are, and whether or not you choose to believe them. The aim of therapy is to get better at predicting. CBT is a mechanism for training the left brain to operate—in addition to, and often in opposition to—the right brain dominance.

Writing about oneself and personal experiences — and then rewriting your story — can lead to a resolution of conflict and a richer understanding of one’s life. Writing in full sentences is therapeutic because it forces the left hemisphere to make sense of the emotional experience of the right brain. Written words allow a scaffolding of neural connections—a representation of the underlying network of ideas.

Another strategy for moderating the automatic tendency towards negativism, is to focus intentionally on what is right via gratitude. Rather than thinking of life’s challenges as problems, try to re-think them as opportunities to make accurate predictions and optimal decisions. Focus on what is right—what good can come from this change.

Assumption Five: We are Social Animals

We are also the product of the relationships and environments that we have experienced in life. We evolved within interdependent hunting and gathering bands and fulfilled such roles as: Mother, Cook, Fire keeper, Protector, Hunter, Healer, Priest, Scout, Musician, Artist, Etc.
We survive by cooperation.

Social Hierarchies are one of our basic “reptilian” drives, necessary for survival. It allows a “rank” differentiating various groups, and in particular — leaders and followers. This instinct increases the probability of survival in hazardous situations. In humans, there are two types of dominant personalities: social dominance and aggressive dominance. The former rely on persuading others by reasoning, and the latter uses threat, deceit and flattery. Relate to Obama and Trump?

The evolution of human language gave us the capacity to be increasingly cooperative, because it gave us the capability to keep track of each other and achieve fairness. Gossip as a form record-keeping. Shame is the result of an internal “gossiper” and nature couldn’t have developed a better mechanism for unconscious social control. When we are angry at ourselves, anger disallows compassion; compassion disallows anger.


How do people change? We change be connecting with others and cultivating deeper relationships with ourselves. The trust generated with a good therapist helps clients gain the broadest awareness of their thoughts and emotions and be open to what we might otherwise automatically reject.

Constructing and editing autobiographical memory can allow a more cohesive sense of the self. Narratives allow us to combine—in conscious memory—our thoughts, emotions, and behaviors in a coherent manner that supports neural integration.

Because we are social creatures, when we feel isolated, our shame feels all the more overwhelming and it remains unchecked. Most people are cooperators. If you are a cooperator, chances are you are not an “alpha” Don’t take it personally. Chronic self-anger associated with shame becomes self-hatred. Self-anger is an enemy to the self, and is targeted in the practice of Self-compassion. Talk about self-compassion.

Assumption Six: We are Self-Aware Animals

We are simultaneously social and isolated creatures: embedded in our groups and our minds. Consciousness leads us to various Existential concerns: death, meaning, responsibility, isolation

Death: Aging is inevitable–as is death. As we age, we experience our opportunity to survive and to grow organically; to “pass the baton” (our genes) to the next generation. We don’t know when it will arrive (decades, moments), only that it will. Talk about time and the missile crisis.

Isolation. We are social animals, yet we are each on a solo journey through life separate from that of others. Paths cross but they don’t converge for long. The destination is the same—i.e. death—but the route, the ease of the road, the rules, and relationships all vary by individual.

Responsibility. You are responsible for You—first—as others are independently tasked with guiding their journey of life. Time as a rapidly depreciating asset. We each depreciate to zero. How to spend one’s increasingly limited time under conditions of ‘use it or lose it’ (e.g., expiring time/death) is the great question of life. Time is our greatest resource and responsibility.

Meaning. To find the purpose of your life, look to that of any other animal.
To exist: to survive and assist in the survival of other forms of life. The rest is up to you! It’s not that life has no meaning, it’s that the meaning is transitory: it exists and passes with every moment…every moment has meaning, and only the present has meaning. After death—the cessatio
n of moments—there is no meaning. There is only meaning now.


Ultimately, the goal of therapy is to help clients recognize and improve their relationship with the self. To realize their greatest potential and live lives of meaning and pleasure.
Life is important. We have limited time to exist…there’s no time to waste. We are living now in a period of great relative abundance. We may not have control, but we have choice. For the first time in human history, we can choose our profession, we can choose whether to have family, we can choose our village. We are free. Especially as women.

Radical acceptance is not about non-suffering–it’s about accepting the necessary & instructive forms of suffering and reducing the unnecessary forms. Change is the defining feature of life; Loss is inevitable. Life is bittersweet. To be angry, fearful, or sad is to suffer. In the long run–especially as we confront our own death–it may be better to radically accept what you can’t possibly change. We free ourselves from the suffering of the judgement of life. Who are we to judge the Universe? Serenity prayer.

Deep freedom derives from a conscious decision to remain free from unnecessary suffering. To live mindfully in the present and to be routinely aware of life’s impermanence and its glory. Every moment free from suffering is a moment of deep freedom to discover the highest pleasure of existence. In recognizing the genius of Nature and accepting it on its terms, we can recognize and accept ourselves–and our genius. We can be in Awe of Life—and live our lives like they are Golden. Because they are…