Therapy for Low Self-Esteem

We live in a society that seems stricken with mirror-image epidemics: narcissism and low self-esteem. In this age of selfie sticks and endless image-crafting, it can seem as if everyone is either hopelessly self-obsessed or desperate for affirmation—or both.

But true self-esteem issues tend to run far deeper than simply wearing masks on social media, and the effects of low self-esteem can be broadly destructive. Low self-esteem can impair personal progress, preventing otherwise resourceful people from pursuing the relationships and goals that they want. Even when those people accomplish great things, the problem remains, devaluing their accomplishments and leaving behind a sadly familiar, empty feeling.

Building a body of self-regard that is deeper and more substantive than any outside metric of success takes time and patience. One must explore how the problem arose, and one must learn first-hand that she is valued—and valuable—even when she stops trying to do or be what she believes other people expect. This is the great gift of psychotherapy: it can help us disempower the lasting injuries of childhood and development.

My Philadelphia psychotherapy practice helps patients explore and resolve the narrative forces that make them feel bad about themselves on a daily basis. Please call or write me today to learn more about good therapy for low self-esteem.

How Depression Therapy Can Help Remove the Mask

One of my jobs as a specialist in depression therapy is to help my patients make sense not only of the depression, but of the constellation of coping behaviors that have developed alongside it.

It’s not unusual for people with depression to hide their despair from friends, loved ones and family, even if the act of hiding makes the depression even worse. Interestingly, high achievers tend to be especially adept at this kind of “masking” behavior.

Why would someone hide such agonizing pain, when the benefits of reaching out and seeking help are so widely known? One case study captures the sentiments of many patients I have met:

It was clear that Jared was acutely ill with depression, but he also despaired for another reason: He blamed himself for his lack of control and for not being able to “figure it out.” He had always had a sense of interdependence, with a concern for the welfare of others. He therefore worried about how revealing his depressive state would affect his parents, concerned that they would feel responsible for his distress and, an even greater fear, that they would then castigate themselves for being ignorant of his condition.

In my experience, high achievers who suffer from clinical depression often evidence this type of social isolation, and self-punishing thoughts like these tend to be a common thread.

Any good therapy for depression must help patients contend with this masking behavior, and with the dynamics of their lives that may have inspired them to hide this pain. Often by understanding what lies behind the masking, patients can also begin to make sense of the depression itself, uncovering its roots in an overdeveloped sense of obligation to others.

Want to learn more? Contact my Philadelphia psychotherapy practice today.

When Parenting Pressure Leads to Depression

I wrote recently about the strong link between parental pressure to achieve, and a sense of emptiness that can develop in pressured children as they grow.

One consequence of a childhood spent living up to the lofty expectations of parents is that high-achieving children often internalize the idea that achievement is the lever they must press to receive a pellet of love. Here’s one account from psychologist Dale Atkins:

“[Your child] also has to want to come to you for nurturing. And, he has to know that he’s going to be good enough and wonderful enough even if he isn’t the best, even if he doesn’t succeed […] Our kids come to us to find out who they are and if we’re not letting them know they’re perfect as they are, they’re going to wonder, what do they have to do to be good enough.”

Psychodynamic therapy is the most effective way to untangle the emotional issues associated with parental pressures–no matter how well-intentioned those pressures may have been–and the scars they can leave. Often, by discussing how we understood those expectations, we can diminish their strength and help restore a more realistic internal sense of self-worth.

To learn more about how you may have been shaped and hindered by undue pressure in your youth, I invite you to contact my Philadelphia psychotherapy offices. I specialize in therapy for depression, therapy for anxiety and therapy for stress.

Perfectionism and the Tyranny of Expectations

A growing number of media outlets have begun highlighting a concerning rise in adolescents’ and young adults’ feelings of emptiness and despair. Some articles have bemoaned the rise of “teacup kids.” Many others have pointed toward a growing suicide rate as evidence of a troubling trajectory.

This recent piece in the New York Times is a knockout, relaying the story of one young woman’s struggles with suicidal ideation, as a touchpoint to explore deeper issues of perfectionism, high expectations and the various pressures of social media. As the author notes:

Nationally, the suicide rate among 15- to 24-year-olds has increased modestly but steadily since 2007: from 9.6 deaths per 100,000 to 11.1, in 2013 (the latest year available from the Centers for Disease Control and Prevention). But a survey of college counseling centers has found that more than half their clients have severe psychological problems, an increase of 13 percent in just two years. Anxiety and depression, in that order, are now the most common mental health diagnoses among college students, according to the Center for Collegiate Mental Health at Penn State.

Many scholars have emphasized the winner-take-all culture of today’s college admissions as a precipitating factor in this trend, but it’s likely that the problem starts earlier, within families and school systems that prize achievement over fulfillment:

These observations echo those made by the psychologist Alice Miller in her seminal book for therapists, “The Drama of the Gifted Child: The Search for the True Self.” In the book, published in 1979 and translated into 30 languages, Ms. Miller documents how some especially intelligent and sensitive children can become so attuned to parents’ expectations that they do whatever it takes to fulfill those expectations — at the expense of their own feelings and needs. This can lead to emotional emptiness and isolation. “In what is described as depression and experienced as emptiness, futility, fear of impoverishment, and loneliness,” she wrote, “can usually be recognized as the tragic loss of the self in childhood.”

One of the bedrock missions of my Philadelphia psychotherapy practice is to help address the issue of pressure and its injuries, and to help performers, artists and professionals resolve the strong feelings that can result. Over the coming months, I’ll be writing more about the psychology of resentment that can bloom within “gifted” individuals, and how psychodynamic therapy can help to resolve many of the burdens that come with high expectations.

Why Therapy for Personal Loss Makes Sense Later in Life

It is becoming more common for people who are well into their fifties, sixties and beyond to seek out psychotherapy, even if conventional wisdom holds that their “busiest” years may be behind them. The struggles of later ages can be somewhat quieter, of course, but they are no less powerful.

One of the most common surrounds the notion of death, both as a real event and as a source of anxiety. As we age, of course, we are more likely to lose friends and loved ones, while racing inexorably toward our own sunsets. All this can take a toll, as one therapist describes:

“Part of it is existential. Most of us have had death anxiety as children, but it resurfaces when we are less distant from death.” . . .

One woman told the group of a particularly fun evening she’d had. But then when she went back to the home she’d shared with her husband and dog, who had both died, she felt the contrast even more sharply.

Getting into a good psychotherapy for grief and personal loss is one of the best ways to make sense of a loss, and to distill the elements within that grief which can be relieved and better directed over time. If you or someone you love is wrestling with the shattering effects of a personal loss at any age, please contact my Philadelphia psychotherapy practice today.

Anxiety Therapy in Philadelphia

One of the primary goals of my job as a Philadelphia psychotherapist is to help patients search for the causes of their distress. Psychodynamic therapy is especially well suited to this task, because it is principally concerned with rooting out the unique personal experiences that may have given rise to the patterns and behaviors which hold us back in the present day.

Recently a controlled study attempted to determine the value of psychodynamic therapy in treating panic attacks, or paralyzing episodes of anxiety whose terrifying power can level otherwise productive and healthy individuals. The results were clear. Psychodynamic therapy proved an effective treatment:

“All treatments showed improvements in patients with panic disorder, but it was noteworthy that psychodynamic psychotherapy showed promise in treating this disorder,” lead investigator Barbara Milrod, MD, professor, Department of Psychiatry, Weill Cornell Medical College, New York City, told Medscape Medical News.

It isn’t hard to imagine why analytic therapy could have shown strong results. Human anxiety doesn’t arise in a vacuum; often it is the consequence of the emotionally resonant experiences that have shaped our lives. Surfacing and exploring these stories head-on can go a long way toward resolving the anxieties they feed. My experience is that while cognitive-behavioral therapy (CBT) can provide essential tools to alleviate the immediate physical symptoms of panic attacks, psychodynamic therapy is necessary to reduce the prevalence and power of these attacks in the long-term. As a result, I am a firm believer in employing both approaches in tandem.

I am proud to offer experienced and compassionate psychotherapy for patients who struggle with the symptoms of anxiety. To begin a course of therapy with an experienced Philadelphia psychotherapist today, please contact me.

Depression Therapy: Is There an App for That?

Depression and anxiety hold us back, diminish our horizons, and in extreme cases, can end our lives. Since these are two of the most common issues in our culture, patients are constantly on the lookout for better ways to manage the overwhelming feelings they precipitate.

Conventional therapy remains the best-known treatment for depression and anxiety, of course, but now technology has begun to make some inroads. Consider MoodGYM, an online cognitive behavioral therapy program that seeks to help people manage some of the destructive thoughts associated with both disorders:

[S]tudies have found that online C.B.T. works as well as conventional face-to-face cognitive behavioral therapy – as long as there is occasional human support.

Of course that part about human support is crucial, not least because there are many dimensions of psychology that computers cannot address. Although the simplest, most standardized parts of CBT may easily be offloaded to software, the conversations that surround this work are essential for true healing.  Therapists typically supplement CBT with deeper inquiry about the emotional components of depression and anxiety – where the symptoms come from, and what underlying factors may be fueling their power.

In addition, the relationship itself between the patient and the therapist can be one of the most transformative elements of therapy, leading to lasting improvement and going beyond workbook therapy to resolve some of the deepest issues we face. Working with a warm, compassionate therapist who is trained to truly hear and understand you, in a nuanced way that an app cannot do, can help you learn to relate more effectively and authentically with the people in your life.

To learn more about how you can find relief through depression therapy and anxiety therapy, please contact a Philadelphia therapist who integrates cognitive-behavior therapy and insight-oriented therapy today.

The Roots of Perfectionism

If you chew your nails, tug at your hair, or otherwise fidget incessantly, there may be something more than idle nerves at play. Many psychology experts believe that such behaviors are tied to a deeper and more complicated impulse: perfectionism.

Although it’s popular these days to call someone a perfectionist in a casual way – not unlike our culture’s widespread adoption of “OCD” as an offhand jab – true perfectionism is often paralyzing and deeply distressing. Patients with perfectionistic impulses often find themselves unable to finish what they start, and scared to compete with others in any meaningful way.

Now a new study has linked perfectionism to anxious habits that may seem mindless at first glance. The study shows a strong correlation between repetitive tics such as nail-biting and their underlying psychology. As this article asks, what can be done?

Currently, there are two possible avenues [of treatment] – a behavioral treatment that involves replacing the habit with a competing action, and a separate approach that focuses on the underlying factors that create tension, such as perfectionism and other negative beliefs, according to O’Connor.

As an analytically trained therapist, I believe that our habits are never random, and that they are often symbolic acts designed to help resolve or relieve an underlying issue. Surfacing that issue and understanding its origins is one of the cornerstones of a successful psychotherapy.

My approach to psychotherapy is integrative in nature, meaning that I consider a patient’s current thoughts and behaviors alongside the past injuries and narratives which may be driving them. Treating the whole patient means incorporating the whole history, and my patients tend to see good results from this deeper look at what drives their habits.

If you’re looking to find a Philadelphia therapist who offers successful therapy for perfectionism, please don’t hesitate to contact my practice today.


Welcome to the Philadelphia Psychotherapist Blog

Welcome to the blog of Philadelphia psychotherapist Josh Dodes!

I created this space as a forum to share some of the most compelling news, ideas and developments in the field of psychotherapy, as well as a few of thoughts of my own about how talk therapy can serve us all more effectively.

Briefly: I am a licensed psychotherapist who has received degrees from Yale University and NYU, and has done post-graduate work at New York’s respected Psychoanalytic Psychotherapy Study Center. My practice is focused on helping patients understand some of the deeper issues that hold them back and influence their daily behavior, including struggles with perfectionism, depression, anxiety, low self-esteem and relationships.

Over time I expect this blog to grow into a sort of comprehensive resource for patients and their families who want to learn more about how psychotherapy works, and where the field is headed.

Feel free to bookmark this page and check back often, as I’ll be posting often in the coming months. Welcome aboard!