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1)   Introverts, Extraverts and Psychotherapy   (TRANSFORMATIONS, Issue 8, Jan/Feb/March 2013)


            Do you know where you fall on the introversion-extraversion spectrum?  Or, the better question might be, how would you know, and what exactly is the definition of an introvert versus an extravert, versus the person possessing equal qualities of both—the “ambivert?” 

In this article I hope to highlight these key distinctions, and shed some light on how psychotherapy can, or perhaps should consider our differences in the ways we process information, express ourselves and ultimately need different things from therapy.

            Carl Jung first identified these two “types” of temperaments, and would define them as follows:  Let’s say there is a room full of people and each person is presented with a problem… the introvert, making up between 1/3 to ½ of the room, carefully and quietly takes time to reflect upon and work-out the problem alone, in his or her head before arriving at what they think to be the precise answer.  They then deliver the answer, simply and precisely to the others in the room.  Their energies are spent and directed inward, as this process for them is less emotionally and cognitively taxing. 

The extravert, in contrast, when presented with the same problem, would first be inclined to verbally talk it through, and would prefer to engage others in the room to help their process.  Their energies are best spent directed outside themselves, and it would be more emotionally draining for them to be asked to work in solitude. 

           The introvert recharges his or her energy sources by spending time alone, because this removes the outside stimulation they are more sensitive and emotionally reactive to than their outward counterparts.  

Likewise, the extravert recharges their energy sources by being stimulated—by surrounding themselves with people or simply being out and “absorbing” the stimulating world. 


           Whereas each end of the spectrum is perfectly capable of spending time outside of their comfort zones, Susan Cain, the author of the best-selling novel, Quiet:  The Power of Introverts in a World That Talks Too Much, holds that in order for us to maintain a state of emotional balance (and therefore physical health), the time spent engaging in “non-characteristic” activities should be balanced with our time spent “recharging” in our comfort zones.  

Introverts should find careers in which they can be themselves most of the time, for they will thrive and contribute more intellectually and creatively.  Extroverts should arrange their lives so they too can thrive, whether it resemble a more socially-centric position or leadership role in which his or her voice can be heard and reflected. 


          These essential differences between us should also be considered in the therapy room.  As therapists, we need to consider who we are working with, how our interactional style might be similar or different, and whether we are meeting the needs of the extravert versus the introvert.  For example, some therapists are quick to talk or share while the introverted patient is busy formulating their exact words that need to be expressed. 

           If the introvert isn’t allowed the space to carefully express their words, a disconnect may easily develop between patient and therapist and harm the therapeutic alliance, which we know to be central to a person’s prognosis in therapy.  Likewise, “speaking over” an extrovert, or as some research suggests, maintaining certain postures, can throw them off of their game and potentially harm the alliance.   

One study comparing the two personality types in a mock therapy scenario showed that extraverts were more likely to feel “threatened” by a therapist sitting in a “neutral” stance.  Introverts rated the therapist higher in both posture scenarios, which although the why may only be speculated about, might suggest a slightly more inclined preference for the therapist-patient relationship and the expectations and benefits it traditionally entails.  Or, introverts might have rated their therapists more highly in this study because they actually perceived they needed therapy more.


           Arguments have been made that introverts generally benefit more from therapy than their extraverted counterparts.  (Herein lies a major theory of psychotherapy:  that the proper (verbal) expression of emotion is healing.)  Studies have also shown that not surprisingly, introverts demonstrate higher levels of depression and anxiety than do extraverts.  This might be due to a “holding in” of emotions, a tendency to withdraw from necessary social connections and/or a heightened emotional sensitivity to external stimuli. 

Not surprisingly, extraverts as a population might even be underrepresented in therapy, as their “need” for an outlet to express themselves is not as great as for introverts.


So, what does this all mean for psychotherapy? 


         It is helpful to be aware of where we fall on the introvert-extravert spectrum, whether we’re a patient, therapist or someone who ever has to relate to people. 

Once we have a better awareness of the way we process information, we can become aware of others’ ways of relating to the world and be able to more effectively communicate and tolerate difference. 

Introverts and extraverts need to be able to identify each other and accommodate one another’s needs in the therapy room, workplace and social arena if we want to more efficiently work together and produce better, more creative solutions to problems and maximize each of our talents.  

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2)    ExerTherapy   (June 2013 TRANSFORMATIONS)


In his 2008 book, Spark: The revolutionary new science of exercise and the brain, John J. Ratey, M.D. makes one compelling argument after another for the ways in which exercise can alleviate and even reverse conditions such as anxiety, depression,  ADD,  menopause, and the aging brain.  In this short-hand version of his remarkable text, I hope to convince you of the same in regards to exercise’s effects on learning, anxiety and depression.


How exercise works on the brain:

            Scientists know that exercise improves learning on three levels:  first, it optimizes your mindset (elevates specific neurotransmitters) to improve alertness, attention, and motivation.  Second, it prepares and encourages nerve cells to bind to one another, which is the cellular basis for processing and storing new information.  Third, it spurs the development of new nerve cells from stem cells in the hippocampus, the area responsible for learning and memory, also the first area to degenerate in Alzheimer’s disease. 

            Exercise also diminishes anxiety by working on both the body and the brain.  It provides distraction from worries or invasive thoughts, it reduces muscle tension that feeds into the body-mind anxiety loop much like prescribed beta-blockers do, and it increases serotonin, which works at nearly every junction of the anxiety circuitry, promoting a calmed sensation, improving the performance of the prefrontal cortex to inhibit fear, and calming the amygdala or “anxious fear” center.  By sparking the sympathetic nervous system or the “calming” system, exercise inhibits the amygdala’s functioning and makes new pathways with alternative, “healthy” thoughts.  Thus, it can create an alternative reality, free of anxious thoughts.  Finally, exercise creates a sense of self-mastery, which raises self-esteem, combating both anxiety and depression. 

            If depression is defined as an absence of movement toward anything, then exercise is the way to divert those negative signals and trick the brain into coming “out of hibernation.”  MRI imaging studies have shown that the brain’s gray matter, white matter and hippocampus are significantly more deteriorated in depressed persons than in those who are not depressed.  Those studies have also shown physical regrowth of all three of these areas relative to how much one begins to exercise.  If depression is a state in which the brain’s neuronal connections are shut down and deteriorated, then reforming these connections through exercise is tremendously effective treatment.  Ratey lists three clinical studies supporting this notion.  For example, in 1999, a large study done at Yale University found that a group of depressed participants who exercised by walking or jogging for 30 minutes, three times a week, saw an equal drop in symptoms as the group of participants assigned to take Zoloft, and not exercise.  Blumenthal concluded that exercise was as effective as medication in treating depression (Blumenthal, 1999).   


How much and which type should I do?           


Now one might ask how much exercise is ideal, and what type of exercise is effective for building my brain?  The definitive answer is that more research needs to be done in order for us to know specific amounts.  However, Ratey notes the following:  a 2007 experiment showed that cognitive flexibility improves after just one thirty-five minute treadmill session at either 60 or 70 percent of maximum heart rate.  Aerobic exercise that significantly elevates the heart rate is what has been shown to elevate the “feel-good” and motivating neurotransmitters.  To optimize learnability and brain plasticity, what Ratey suggests is to either choose a sport that simultaneously challenges the cardiovascular system and the brain, such as tennis or volleyball, or do a ten-minute aerobic warm-up before something nonaerobic and skill-based, such as rock climbing or yoga.  The more complex the movements, the more complex the synaptic connections that are made. 

In tackling depression, one study compared a group of participants exercising at a high-intensity level, 3-5 times per week (burning 8 calories per pound of body weight per week), and a group exercising at a low-intensity (burning 3 calories per pound per week).  The high-intensity group lowered their depression scores by half, and the low-intensity group lowered their depression scores by one-third.  So, both amounts of exercise were effective, but the effectiveness directly correlated with the amount of energy expended per week.  Aerobic exercises such as running are most highly recommended, at least 3 times per week for at least 35 minutes per session, to best alleviate symptoms of anxiety and depression.  Finding something that you enjoy and are most likely to stick to is key, so that the effects have the chance to impact your life and keep you feeling and performing well. 


For more on this topic, read Spark: The revolutionary new science of exercise and the brain, by John J. Ratey, M.D., with Eric Hagerman (2008).    







3)   Psychotherapy for the creative artist, and creative blocks



        I’ve treated many creative artists in my practice—thespians, screen actors, writers and behind-the-sceners. Over the years of my own experience as a performing artist turned clinician, I have come to understand the psychological uniqueness of this population. First, I will list some clinical issues specific to the creative artist, and secondly I will address how psychotherapy can be helpful for the all-too-familiar “creative block.”


         Psychological Issues relating to artists:


Low self-esteem due to continued rejection

Low motivation or hope for the future due to lack of work

Body image issues

Disordered eating

Creative blocks

Unresolved emotional issues hindering performance

Performance anxiety



Unresolved emotional issues triggered by work and compromised coping skills

Substance abuse for coping or performance enhancement


Negative self-criticism or self-doubt

Relationship problems

Lack of meaning or purpose in one’s work

Shifts in identity / unstable sense of identity


...The list could probably go on. Needless to say, it’s tough out there for any artist. I have found that fortunately, the artistic mind does incredibly well in therapy as it is naturally intuitive and introspective. One common reason creative artists seek therapy is for “creative block,” or feeling frozen in one’s tracks—the inability to perform or to produce new material. Psychotherapy can help in this area. Recent research has shown that active mood states, particularly the verbal exploration of them, increases creativity. Therefore, having a safe place in which one is motivated to explore aloud their most primitive emotions in the "here and now" might be the perfect catalyst for sparking a creative process.


         Often, that emotional content is accessed and becomes expressed in the form of creativity. Research in drama therapy has shown techniques such as the empty chair, role play and various experiential exercises can be highly effective at increasing creativity in artists.


         Generally, psychoanalytic therapy for creative blocks encourages unbridled unconscious “material” to enter the room through free association, where the person says whatever comes to mind no matter how trivial. Free association through drawing, writing, reporting of dreams or other mediums are used as well, and the key is for both the analyst and patient to analyze the content to discover where the blockage lies. I favor this approach, since I believe nothing leads to understanding, let alone new creative material, like free association does.


         New York psychoanalyst Paul Cooper makes an important point, informed by his award-winning career as a writer, poet and musician. He states that creative blocks for the artist can be mistakenly viewed as a “blockage,” or hault in functioning resulting from the individual’s own inner conflict. This often leads to a “what’s wrong with me?” focus for the artist, and the therapy can become about finding the cause of one’s defectiveness. Cooper’s observation is that the creative process naturally ebbs and flows, requiring times for pause—for “taking in, absorption, gestation and consolidation.” Thus, therapy should work with the circular creative process, with an acceptance and curiosity about where the artist is currently in their process.


         So, it is accurate to say the inherently creative process of therapy, despite the specifics of one’s approach, is helpful in understanding where the artistic “blockage” comes from. As it typically stems from unconscious material, what better way to tackle it or to accept it than welcoming that precious material into the therapy room?



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