A Deeper Understanding of Kleptomania

Reference | November 8, 2011

What is it?

It can be hard to understand why someone would steal something that they do not need, will not use, and will not even sell for personal gain.  But this is exactly the nature of kleptomania, making it so difficult to rationally understand by those affected by it.  Kleptomania is the irresistible impulse to steal objects that are not needed for personal use or for their monetary value.   The kleptomaniac has repetitive, unwanted thoughts, and their thefts are a result of their inability to avoid acting on these impulses.  Kleptomania is different from shoplifting in that shoplifting tends to be well planned out and is done solely for monetary gain or need, whereas a kleptomaniac steals things that are inexpensive or things he or she could have easily bought.  These objects are stolen not for their immediate utility or monetary value; rather, the person tends to discard them, give them away, or collect them.  Normally, the kleptomaniac expresses a tension or arousal before the act, and then afterward there is a sense of excitation, gratification, or release.  After a period of time has passed, feelings of guilt and self-hatred often emerge.

Kleptomania is often thought to be a close cousin to Obsessive Compulsive Disorder (OCD).  Both involve intrusive, obsessional thinking, with repetitive thoughts or images that produce anxiety.  Sufferers of both syndromes often experience compulsions, meaning that they perform actions repeatedly for the purpose of reducing anxiety.  Additionally, many individuals with kleptomania hoard items they steal, resembling an OCD constellation.  Many people struggling with kleptomania find the experience to be ego-dystonic; in other words, they do not want to steal, but find it difficult not to do it, similar to how many struggle with OCD.

Frightening Impulses and the Pleasure Principle

From a psychodynamic perspective, it is theorized that kleptomania may discharge frightening, antisocial feelings while at the same time indulging pleasurable impulses associated with the libido.   Kleptomania has been historically associated with the “ungratified sexual instinct”; in fact, those suffering from kleptomania report an increased internal tension right before or after the act of stealing, and will often refer to it as a “sexual thrill”.   Suffers also refer to it as a “forbidden” or “exciting” thing that is done “secretly”, as if indulging in a sexual taboo.  At some level, these behaviors may demonstrate unresolved conflict regarding prohibited sex drives, sexual arousal, and anger.  These issues are best worked though in therapy with a psychodynamically oriented therapist.

Pharmacological Treatment with Counseling

Because Kleptomania is conceptualized as a form of OCD, evidence shows that SSRIs may have some efficacy in treating kleptomania. In addition to SSRIs, case reports also suggest that lithium, topiramate and other mood stabilizers may benefit this population.  However, because of the heterogeneity of kleptomania, treatment should begin with understanding the particular patient and what motivates their kleptomania, with the medication chosen appropriately to their specific experience.  This population, in general, responds best to a combination of pharmacological treatment and psychotherapy. As in all cases, each individual is different, and should be modified on a case-to-case basis.

If you are suffering from Kleptomania and are in need of treatment, please call me, Jennifer De Francisco, LCSW at (949) 251-8797.

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Understanding the Obsessive Compulsive Personality Disorder

Reference | November 1, 2011

What Does It Mean to be Obsessive Compulsive?

People with Obsessive Compulsive Personality Disorder spend a disproportionate amount of their time thinking and doing rather than enjoying other states of being, such as playing, sensing, daydreaming, intuiting, or creating art.  Many very productive and admirable people would describe themselves this way.

How can we describe the Obsessive Compulsive Character?  Wilhelm Reich described them as “living machines”, and Freud noted that they tend to be stubborn, stingy, and very orderly.  Others have noted their harsh, rigid intellectuality, as well as the tendency to be perfectionistic, punctual, meticulous, overly conscientious, and lacking in adaptability.  Overall, they are dependable, reliable and have high ethical standards.  They have a robotic and mechanical way of being, and simply put, do not, emotionally speaking, “squeeze the juice” out of life.

Thinking, but Unable to Feel

As theorized by Nancy McWilliams in her book “Psychoanalytic Diagnosis”, Obsessive/compulsive people overvalue cognition and thought, and devalue feelings as being childish, or weak.  In fact, they often do not even know what they feel, and often live very sterile lives, missing much of the enjoyment that comes from feeling and processing experiences.   They also are at a significant disadvantage in moments when fantasy, emotions, and play have an important and legitimate role.  For example, if a widow is ruminating obsessively about the details of her husband’s funereal, she denies herself not only the process of grief, but also the comfort of being consoled by friends and loved ones.

Since obsessive people base their self-worth on their ability to think, they usually only feel good about themselves by solving problems or completing tasks.  When circumstances make it difficult for them to achieve or accomplish, shame is felt strongly and consistently for not meeting their unrealistic standards, which over time causes the obsessive person to become depressed.  Losing a job is extremely difficult for almost anyone, but it is catastrophic for the OCD person.

Obsessive and compulsive people tend to worry a lot, trying to meet the demands of internalized parental figures that hold them to a high standard of behavior and thought.  When they have to make a choice, they can become emotionally paralyzed easily, worried that they might make a mistake. This is an effort to keep all their options open and keep control over all possible outcomes. Unfortunately, because they cannot a make decision, they end up having no options at all.

The Basic Conflict: Control and Unfelt Anger

The basic conflict in obsessive/compulsive people is anger at feeling controlled versus the fear of being punished or condemned.   The experience of being controlled, judged or required to perform causes angry feelings and sometimes aggressive fantasies, which is at odds with a compelling need to feel in control, clean, orderly and punctual, and feelings of being out of control, messy, or late are wrapped up in shame.  This “rational” identity is essential for the maintenance of their ego, and as a result, emotions are submerged.  Words are used to conceal feelings, not to express them.

Obsessive/Compulsive people fear their own hostile feelings, and suffer inordinate self-criticism over aggressive thoughts and fantasies. They are nervous about giving in to feelings of lust, vanity, greed, laziness and envy. Rather than accepting that these feelings sometimes arise, and that their self-worth should be based on their behaviors in response to these feelings, they feel guilty for even having the impulse. Shame is also strongly felt; they have high expectations for themselves and feel embarrassed to be seen by others as falling short of proper acts and thoughts.

Early Childhood: Overly Strict or Frighteningly Lax

The parents of obsessive and compulsive people are notorious for setting high standards of behavior and expecting early childhood conformity. In general, they are strict and consistent in punishing bad behaviors and rewarding the good.  When the parenting is adequate and loving, they produce emotionally advantaged children who expect a lot of themselves and tend to achieve their goals.  When the parenting is too exacting, harsh, and condemning, the obsessive/compulsive adaptations can take on a problematic form.

From an object relation point of view, what is notable about obsessive/compulsive people is the central importance of control in their family of origin.  Control tends to be expressed in moralized, guilt-inducing terms in obsessive compulsive-breeding families, and moralization is actively modeled.  As a result, the obsessive/compulsive person is also strongly motivated by guilt.

Another kind of family background that has been noted in the creation of the obsessive/compulsive character is one in which the child feels so bereft of clear family standards and so unsupervised by the adults around them that in order to push themselves to grow up, they hold themselves to idealized criteria.  This idealized set of standards, since it tends to be abstract and not modeled by people known personally to the child, tends to be harsh and untempered.

Therapeutic Implications

Treatment with Obsessive Compulsive patients can be tricky, and it takes a sensitive clinician who is experienced in working with the obsessive/compulsive population, as they tend to exasperate others and can become controlling in the sessions.  Refusing to control the patient while not emotionally disengaging is vital, and an appreciation for their vulnerability to shame is essential.  Refusing to advise, hurry or criticize them for their obsessiveness will foster the most progress in treatment.  It is also important to relate to them warmly and avoid cognitive interpretations, as patients need to learn to feel on an affective level.

If you need treatment for obsessive-compulsive disorder in Orange County, Newport Beach, Irvine, or Costa Mesa, please contact me, Jennifer De Francisco, LCSW, at (949) 251-8797.

 

 

 

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What Is Online Counseling, and Is There a Place for It in the Therapeutic Milieu?

Therapy | October 9, 2011

What is Online Therapy?

Online therapy, through videoconferencing with Skpe and other encrypted digital software makes it possible to access a mental health professional remotely and to have a session over video. This type of online counseling is also known colloquially as “Web Therapy”.

The Benefits

First, let’s cover the benefits. Some individuals use videoconferencing out of necessity-they live in rural areas or in geographic locals that have a shortage of mental health clinicians. These clients now have access to therapy where before consistent therapeutic treatment would not have been possible. Also, bad weather, illness and business trips no longer have to interfere with treatment. In addition, if the client or the patient moves, the therapeutic relationship can be maintained. This is especially crucial since the therapeutic relationship is so much of what heals psychological distress.

An argument can also be made that certain conditions might be well-suited to online treatment, such as agoraphobia, obsessive-compulsive disorder, and severe depression since the symptoms of these conditions sometimes makes it very difficult for these patients to leave the house.

The Concerns

Others disagree. Some therapists report that there is “something lost” when the person is not in the clinical space of the office. Some therapists believe that videotherapy creates emotional distance, and thus therapeutic rapport is more difficult to establish. Patients find it difficult to let down their guard and take emotional risks. Some of these difficulties are simply the result of the limitations of the technology. Online counseling disrupts a basic foundation of the therapeutic connection: eye contact. Patients and therapist typically look at each other’s face on the computer screen, but since the camera is usually perched on top the computer, their gazes are off-kilter. Sessions are also often cut off due to internet disconnections and sometimes the sound moves slower than the video, degrading the therapeutic experience.

My Thoughts

There is a place for Online Therapy. If an individual lives in a remote location, has a travelling job or a debilitating condition that makes it impossible to leave the house, then online therapy is appropriate. I am most comfortable using this modality with current clients that I already have a rapport with who have perhaps moved out of the area, or cannot attend frequent sessions due to travelling. I am not opposed to Online Therapy with a new patient, but I would need to have a telephone assessment first with the potential client to see if it would be appropriate for that individual.

Finding an Online Therapist

If you are interested in online therapy and do not already have a relationship with your therapist, it is important to find someone who is licensed in your state and has experience with teletherapy since there is an art to it, and you want someone who knows how to avoid the therapeutic pitfalls.

If you are struggling to cope with depression, interested in therapy or counseling in Newport Beach, Irvine or Orange County, or want to find out if you are a candidate for online therapy, please contact Jennifer De Francisco at (949) 251-8797.

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Research Shows that Psychotherapy Helps Severe Schizophrenia

Therapy | October 6, 2011

People who suffer from severe schizophrenia have often been considered beyond help when it comes to talk therapy, and it has been a long held belief that schizophrenics must depend solely on medication management for the treatment of their symptoms, with little hope of improvement in their quality of life. Fortunately, new research from the University of Pennsylvania School of Medicine shows that when these patients have access to ongoing psychotherapy, they have far more capacity to improve than was previously

In the study, researcher at the University of Pennsylvania enrolled 31 people from community health clinics in Philadelphia into a program of weekly therapy sessions, about 50 minutes in length. They continued with their medication maintenance as well. After six months, the patients began to show marked improvement in symptomotology and socialization. After eighteen months, the benefits were clear-the patients were scoring much higher on their overall functioning. Their motivation improved significantly, and some were able to alter their lives in significant, meaningful ways. For example, one woman, who had been frequently hospitalized before the study, took a job as a cook at the end of her treatment, and has not been seen at the hospital since.

What is amazing about this study is that these were individuals suffering from severe schizophrenia, the most debilitating and isolating of psychiatric conditions. If anything, this study shows the promise of the therapeutic relationship, and that tremendous change can be done through long-term therapeutic work.

If you are considering therapy or counseling in Orange County, Irvine, or Newport Beach, please call me at (949) 251-8797.

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Want to Improve Your Personality? You Might Want to Quit Smoking.

Therapy | September 29, 2011

A new study from the University of Missouri has discovered that smoking triggers the personality traits of neuroticism (being emotionally negative and anxious) and impulsivity (acting without thinking) among adults. Fortunately, the study indicates that smokers who exhibited these traits can improve their personality through smoking cessation.

In comparing smokers with their peers who had quit smoking, researchers found that smokers had much higher levels of impulsivity and neuroticism.  The smokers were also much more likely to engage in deleterious, self-harming behaviors.  Once they stopped smoking, these traits improved, especially for those aged 18-25.

The researchers explain this improvement, at least in part, as such: people who start smoking tend to be more impulsive, thinking more about immediate gratification without giving a lot of forethought to the negative, long-term consequences of self-harming behaviors. Once the individual has to exhibit self-control, tolerance of frustration, and delayed gratification in stopping smoking, these disturbances in personality improve.

This, however, does not appear to explain things in their entirety.  Why does the neuroticism improve?  It would also appear that later in life especially, smoking has much more to do with habit and cravings than impulsivity and neuroticism.   The good news, however, is that smoking cessation improves not only physical health but the mental health as well.

If you are in Newport Beach or the Orange County, CA area and need help with personality problems, couples counseling, or therapy, please call Jennifer De Francisco at (949) 251-8797.

 

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