Joe is the author and the owner of, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

The Risks of Joy

This past week, one of my clients returned from an exotic vacation and told me he’d felt almost nothing during the trip. He took no pleasure in any of his adventurous activities, and when there…

The Evacuation of Pain

Nearly four years ago, not long after I first launched this site, I wrote about a client who coped with unbearable feelings via her eating disorder: when she could no longer endure a painful emotional…

The Self-Serving Lie

Many years ago when I was just starting out as a therapist, I briefly worked for a large group practice. At the end of my tenure, the managing partner in this group, a respected psychoanalyst,…


    Very good video about a subject that I think is very important to success in therapy. Personally I find it hard to differentiate between the skepticism defense mechanism and true skepticism. For example, if my therapist starts treating my best friend I would probably not mind at first, but I could use it to rationalize my resistance through skepticism later on. However, it’s also valid skepticism as these kind of relationships can get messy and many therapists would not agree with it.

    Ps: I did notice a bit of camera shyness.

    Thanks, Gordon. Yeah, I’m still working on my video presence. I’ve come to the conclusion that what I really need is an actual audience. I’m much more “myself” when I’m talking to a real person than a camera. I think most people are this way.

    You describe our defense mechanisms as lies we tell ourselves to avoid unbearable pain. Do you mean the pain of psychological symtoms like anxiety, panic and depression that we are trying to avoid? Or more emotional pain like sadness or anger or self-hatred? Maybe both?

    This is where I often get confused in therapy. I would much rather feel the pain of an emotion than the pain of chronic anxiety and panic attacks, but it seems that I have little conscious control over that decision. In your book, do you touch upon psychological “symptoms” as defenses as well as behavioral defenses, like lying, using drugs or alcohol?

    Congratulations on the book. I look forward to the Kindle version for download.

    I’ve come to know you in a way through your videos and emails. I can see that you would be a competent therapist. I like your style, and would anticipate your training and methodology in cutting through the superficial, and coming to realizations and real help.

    I often think that the pain of resistance and defenses needs to be greater than the existential problem for therapy to be of a certain efficacy worthy of the activities engagement. You mention that resistance is a defense, and people need their defenses. Defenses work, but of course at a price. What I find interesting is that, the defense; either a thinking patten, emotion or behaviour, eventually becomes more painful, than the pain it is supposed to assuage. A trip to the dentist causes me sheer animal terror. But eventually, when my toothache intensifies and has troubled me for long enough, the pain of confrontation becomes less than the pain of avoidance.

    Yes, but don’t you know people whose defenses work well enough that they NEVER get to that point? On occasion, I feel envious of those people who just get by, whose life works in some minimal way and they don’t have to confront the deeper pain. I do know that it doesn’t really work and that true intimacy is impossible, but there’s a kind of superficial appeal to their lives.

    Had to comment on this Joe. Its so easy to envy people who seem to have it together on the surface especially when your own personal experience is different. Its also hard when you’re surrounded by family who have this personality structure because there is a lost opportunity for a relationship of deep significance. I’m sure they are still walking around with their pain and traumas locked away inside stopping them from knowing themselves and others in a real way. While battling our inner demons can be unbearably painful the outcome is worth it. Your writing experiences show when there’s a will there’s a way.

    Very true. As a writer, and indeed the human being I am, I often envy those who pass through a nine-five week, weekends drinking beer and watching shit t.v, never a thought of introspection or indeed what else there may be out there in the world, or what indeed once was historically, or could be in the future. To be otherwise is both a blessing and a curse. The very fact we call a problem, a problem, is because it evokes in us unwanted intense negative feelings. But only in solving these problems do we grow in consciousness, and the lamp we shine on our next, perhaps bigger problem, grows in luminosity. As a therapist, you are also something of a teacher, and the only way to teach with integrity, is to lead the way where you expect others to follow. I was once bemoaning a similar complaint to a retried miner with no education beyond High School. He said to me, ‘if you know better, then you should do better, it’s not a choice, it’s your duty’. He was right.

    This is an off-topic question but I’m hoping you can answer it (anyone can feel free to chime in if they like). Would you recommend CBT or DBT for someone who has symptoms of depression, anxiety, and self-harming behavior but not BPD? I know DBT was creating for BPD but how much can it benefit people who don’t have that?

    I’m not a big fan of CBT techniques, period. They just seem like bandaids and I’m interested in the deeper meaning. I know there will be other visitors to the site who will feel differently.

    I’m interested in CBT/DBT because it seems to be focused on problem-solving and helping the person function, rather than paying someone to listen to you whine about your mother or just taking pills. I tried a CBT group last year which helped me fix my sleep issues, but I don’t know if it’s helpful with other depression symptoms. In the past I have seen psychoanalysts which I thought was quite useless; basically 45 mins of “how do you feel about that?”. I think psychoanalysis is more beneficial for therapists because it gives them long-term clients to profit off of. That said, I know seeing a psychoanalyst has helped a lot of people, but maybe it’s not for me (I certainly can’t afford long-term therapy right now).

    Maureen from what I know of DBT it can be very helpful in helping to cope with the issues you are struggling with so that (if you choose) you’re then in a better position to benefit from in depth psychotherapy to bring about a more comprehensive understanding of yourself and your struggles. Good luck!

    Interesting, I’m waiting for the speech about dependency.
    It’s a great idea to publish these videos, they make it pretty clear what to expect when starting that kind of therapy, and could help the skeptical ones to give it a chance beyond the first 3-4 sessions.
    Just a technical note: the audio could only be heard on the left channel (a bit annoying for those who have to use headphones).

    Thanks for the technical comment. I have a new wireless mike and I’ll try to figure out what I’m doing wrong.

    I watched the video. I think I can understand the perspective of those who are showing resistance. I can really relate to not wanting to feel the emotional pain again. I do respect the brave clients who keep doing the work.

    Hmm I did not really understand “resistance” until you explained it. I have been accused of being resistant by several therapists; typically by the 3rd session I’m tired of the therapy, feel it’s not worth my time/money, and quit. Then months later I pick up with a new therapist. In the future, maybe you could discuss how you overcome resistance in therapy with your clients?

    First of all, I rarely use the word “resistance” with my clients. In order to deal with it, I usually bring up (gently) the possible reasons behind the resistance. Based on what you say, I would think that a fear of coming to need and depend upon your therapist might be the issue.

    Joe I’d be interested in your thoughts in the next video about dependency on what to do with hard to hold clients such as those with borderline and/or self-harm/suicidal tendencies or overwhelming abandonment fears (if this fits in with the rest of the content).