CHAPTER 18

Hel ping Avoidants O vercome Their Low Self-Esteem

Beck notes that “in anxiety the dominant theme is danger”1 and that the “person with an avoidant personality simply minimizes . . . social interactions in order to protect [himself or herself from a specific danger, the danger of developing low] self-esteem.”2

Avoidants’ low self-esteem consists of a low self-approval rating originating in an inability to meet self-expectations due in part to self-imposed, excessively high self-standards, along with a hypersensitivity to the criticism of others, leading to a highly critical self-attitude. As a consequence, the avoidant individual concludes, “I think as little of myself as they think of me,” or even “I am worthless.” The resulting negative self-image then leads to withdrawal meant to self-protect— improving one’s self-image through avoiding a test of that self-image by avoiding large aspects of living through isolating social rituals. These involve giving up the seeking of interpersonal gain to avoid experiencing interpersonal losses. That, however, decreases functionality as escalating defensive disengagement creates the very losses that the avoidant is attempting to avert. These losses create a further diminution of self-esteem, for the avoidant now feels, and often is, alone, and predictably tends to think, “I must be a defective person, for why else wouldn’t I have a single friend in the world?”

Elevating an avoidant’s self-esteem therapeutically can diminish his or her need to withdraw defensively. This process starts with distinguishing low self-esteem that is rational and appropriate from low self-esteem that is irrational and inappropriate. Low self-esteem that is rational and appropriate originates in self-criticism and criticism from others that is all too well deserved. When this is the case, enhanced self-pride has to come not from altering one’s thinking, but from

doing things differently. Low self-esteem that is irrational and inappropriate appears when avoidants, for little or no reason, come to dislike themselves or begin to feel that others dislike them. Here enhanced pride has to come not from changing one’s behavior toward others, but from changing one’s mind about oneself and treating oneself better, as a more worthy object of one’s own affections. Following are some ways (adaptable for self-help) therapists can help avoidants do just that.


UNDERSTAND THE ORIGINS OF THEIR INAPPROPRIATELY LOW SELF-ESTEEM

Avoidants can better recognize the distortive nature of their low self-esteem if they comprehend its origins in what is often their nolonger-relevant past. Developmentally speaking, low self-esteem often starts with parental deprivation of love and even physical abuse that the parents tell their children they deserve. Now their children, lacking a standard of comparison, and believing their parents are both fair and omniscient just by virtue of being both adults and parents, buy into that. Then, as adults, these children continue to seek out, or actually beg for, parental approval, but now from people other than their parents. They form present-day relationships with negative-thinking parental substitutes just to try to reverse their negativity. They seek to be made whole again by creating positivity in people who, by their very nature, can only feel negatively toward them. Of course, the devaluation continues anyway. Then they view the continuing disdain as a further reason to self-blame and withdraw because, as they conclude, it’s not that these people don’t love them for reasons of their own, it’s that nobody can love them because they are completely unlovable.


INTERRUPT SELF-PERPETUATING VICIOUS CYCLES

The therapist interrupts low self-esteem-creating/enhancing vicious cycles such as “I can’t do this because I am deficient, and I am deficient because I can’t do that,” for example, “I can’t socialize because I don’t feel worthy enough to attend social events, and I don’t feel worthy enough to attend social events because I can’t socialize.” Effectively interrupting vicious cycles allows the avoidant to experience satisfying small successes that ultimately break the impasse through incremental achievement, leading to less withdrawal and enhanced motivation to go forward. A simple supportive therapeutic statement meant to interrupt low self-esteem-inducing vicious cycles might be “in my eyes you are a worthy person,” and a typical behavioral intervention might be our familiar “habituate yourself to avoidant anxiety by acting more and more nonavoidant each day, and doing so in small increments.”


REDUCE EXCESSIVE AND INAPPROPRIATE GUILT

An excessively guilty conscience, a crucial element of low selfesteem, takes multiple forms: excoriating self-criticism; excessive “don’t make trouble” submissiveness; painful brooding with depressed mood; and pathological, self-destructive acting out.

Speaking cognitively, avoidants develop a guilty conscience because they

• view a few of their negative past actions/present attributes as constituting the entire, inadequate, valueless, or evil self

• think catastrophically, guiltily overreacting to their minor peccadilloes as if these are major sins, then withdrawing, feeling sheepish, ashamed, and shattered by thoughts that they are “stupid” or actual criminals

• see any sign that they are not fully accepted as evidence that they have been completely rejected and feel thoroughly bad, even if one person reacts badly to them

• unfairly judge their behavior in similar = the same thing terms along the lines of assertion = aggression = murderous intent = homicidal action, so that simply thinking bad thoughts becomes the equivalent of doing bad things

• think projectively, changing anxious, self-punitive attitudes into feeling disliked by external malevolent forces and people

Avoidants need to engage and talk back to their guilty, critical, punitive conscience and demand that it be less critical of and more positive toward them. They need to continue to affirm their humanity in spite of their imperfections. They need to accept their reasonable sexuality without suppressing it due to an unreasonable, rigid, all-pervasive, crushing hypermorality. They need to accept their anger, recognizing that everyone, even avoidants, has some justified annoyances toward some people, such as those who are troublesome, scary, and rejecting without even being provoked. They need to permit themselves to be successfully competitive without undue survivor guilt accruing from the belief that the world is a zero-sum place where because there is a finite quantity of X, anything they get by definition they get by taking it away from Y so that instead of experiencing guilt over doing well when others are doing comparatively poorly, they can come to view themselves as separate entities entitled to fulfill their own destiny regardless of whether others fulfill theirs.

Avoidants also need to reduce their guilt over being avoidant. They might do this by making creative excuses for themselves. For example, they can tell themselves not “you shouldn’t be that way,” but “I am that way not because I am bad, but because I am different. That is who I am, and I am being true to myself.” They can soothingly remind themselves that they, like anyone else with an emotional problem, can’t always control their anxiety and so shouldn’t blame themselves unduly for becoming frightened, especially in situations where many people would feel a bit scared such as upon entering a room crowded with strangers. Emphasizing the bright side of what others perceive to be their flaws, they can tell themselves, “Many people like distant, remote people.” They can excuse themselves for being modestly neurotic, “for everyone is.” They can allow themselves to make relational mistakes without necessarily viewing one relationship peccadillo or major failure as a sign of full personal deficit. They can lighten up enough to accept some relationship anxiety as integral to, not an unfortunate or catastrophic complication of, connecting, so that now they no longer masochistically respond to partial relational failure with complete, selfdestructive, apologetic, self-protective, across-the-board withdrawal.

For avoidants, the two magic words of guilt reduction are “so what.” These words can help avoidants recognize that all is not completely lost just because all is not entirely well. Now they can stop thinking “I ruined myself completely” over the slightest, and often entirely imagined, interpersonal “misbehavior.”

Finally, avoidants can profitably allow healthy avoidance to become part of their defensive repertoire. They can and should stay away from people who make them feel guilty, or guiltier, recognizing that these people have problems of their own and that it’s better to withdraw from them than to socialize with them—and stop going back, convincing themselves that they are returning for satisfaction, when they are just going back for more.


REDUCE PARANOIA

Avoidants can become less suspicious of others by countering dis-tortive empathy, a process where they jump to the conclusion that others are judging them negatively because they assume that others are using the very same rigid, unfair, and excessively self-punitive yardsticks avoidants use to judge themselves.


DO AN EVIDENCE-BASED SELF-STUDY

Therapists should encourage avoidants to make a two-column list where they identify their positive features in column A and inscribe these beside the negative features they go on to document in column B—then do the math to see if, overall, they are “OK as is” and, if not, see what they can do to develop a more balanced, more positive self-view, one they newly create and maintain independent of what others seem to, or actually do, think about them. Avoidants who do this remedial exercise often collaterally decrease their need for impression management as they stop grading themselves based on what they believe others are thinking about and how others are responding to them. Instead, they develop internal strong, independent, unvarying self-standards that allow them to view themselves as viable individuals after asking themselves not “do I have what he or she expects of me?” but “do I think well of myself?” Now they refuse to calculate their self-worth entirely by what they assume their reputation to be with others. As a result, they start finding strength and self-approval from where it counts: mostly, or even entirely, from within.

This page intentionally left blank

CHAPTER 19

Treating Sexual Avoidance: A n O verview

Treatment of sexual avoidance consists of an approach that I call “sexual avoidance reduction.” This approach involves a combination of psychodynamic, cognitive-behavioral, interpersonal, educational, and pharmacotherapeutic therapies. The goals are to generate improved performance indirectly through understanding the problem, in particular, relieving sexual inhibitions by reducing inhibitory responses, and to generate improved performance directly through learning the sexual “ropes” (“sexual skills training”), ideally enhancing motivation (the will to act) and increasing emotional expressiveness by reviving desire, improving confidence, and resolving conflict. Here presented in outline form for easy access and maximal utility are the main components of sexual avoidance reduction.


TECHNIQUES

Partner Involving: Prevention

Sexual avoidance between partners can often be prevented by making a good match in the first place. Thus a man with a Madonna complex is well suited to a woman who is Madonna-like. Men and women who are gay need to admit it to themselves as soon as possible to avoid trying to succeed heterosexually, losing valuable time, getting into a failed marriage, and harming their partners by promising them more than they can deliver.

A Case Example

After a few years of marriage, the husband of one of my patients moved out of their shared bedroom permanently. Initially, his wife had pushed for marriage and he had acquiesced, although he really wanted to be a priest. His telling her exactly that when they first met should have given her a hint of what was to come, but she had had a very sheltered upbringing and knew nothing about such matters. She wished she knew that the husband’s disinterest in her sexually was not a fixable thing, but she was too young to realize that, and she just assumed that he wasn’t attracted to her as an individual—because something was wrong not with him sexually, but with her personally. Therefore she concluded that repairs could be easily made if only she somehow took some action.

Stimulation Enhancing

Sexual avoidants need to identify the location of, and learn ways to stimulate, the erogenous zones. Sexual avoidants can learn about the mechanics of better sex through the use of sex manuals. Learning the principles of intimacy is different, and more complex, but it can be done through therapy or by using the many good intimacy guides readily available in bookstores such as books on the topic of “how to get closer.”

Guilt Reducing

Sex education has a collateral effect: reducing guilt by implying approval of the thing being taught. For sex education, among other things, effectively gives the individual permission to feel sexual and actually have sex. Sexual phobias respond especially well to permission giving through sex education. Its healing mantras stick with the learner, countering negative inhibitions by undoing negative parental and societal messages that have been internalized and crop up at the most inconvenient moments to intrude into and disrupt one’s bedroom activities.

Insight Developing

Improved performance can come from understanding the psychodynamics of sexual avoidance, particularly the role played in sexual conflict by the inhibitory factors discussed throughout. Therapists can impart this understanding through psychodynamically oriented therapy, for example, by analyzing masturbatory fantasies and transference distortions and through interpersonal treatment focused on how dyadic relationship problems express themselves sexually. Sexual avoidants can, on their own, use the dynamic formulations found throughout this book to help emerge from those destructive intrapersonal and interpersonal inhibitions that keep them in, or force them back into, their sexual cocoons.

A Case Example

A patient with multiple sexual performance difficulties was often unable to get an erection. If he got one, he would soon lose it. If he kept it for any length of time, he would sometimes experience premature ejaculation and sometimes suffer from ejaculatio tarda.

Through therapy, we discovered that his sexual symptoms were partly his (unconscious) way to tell his fiancée that he wasn’t planning to marry her or anyone else. Speaking of his trip to visit his fiancée in a foreign country, he said, “I never had an orgasm the whole time I was there. That’s because I wanted to let her know that she was getting too attached to me, and so I can’t go back to Europe for she has already planned a life for us when I return. As I always say, ‘If I want sex, I’ll find sex,’ but who needs a relationship for that?”

His sexual inhibitions were also a product of his intense fears of connecting and committing arising out of a conviction that being tender with a woman signified merging the intimate and sexual feelings he longed to keep separate. For being tender meant becoming feminine and sissified as well as inevitably being swallowed up by women to the point of losing his identity. Coming to orgasm meant yielding, and yielding meant becoming vulnerable to a woman’s hurting him— the wages of his sin of letting her up close to him and into his world.

We also learned that his sexual inhibitions were due both to a fear of success and a fear of failure. Erectile and ejaculatory functionality signified success, and success signified vulnerability to loss, and even meant punishment by death. A fear of failure took the form of compulsive self-spectatoring like that due to what the Psychodynamic Diagnostic Manual calls “feeling unsure of [oneself and being] preoccupied and worried about [one’s] general adequacy.”1 So when he was having sex, what went through his mind was, “Boy, she is sexy, and she’s brand-new, and we’re going at it top speed, and I’m almost there, and almost there, and almost there, but, oh boy, I am losing it, and I’ll never get there, and it’s another ruined attempt, and I wanted it to go so well, and what is she going to think of me, and what is going to happen to our relationship, this is awful, she will hate me and never see me again, it’s the end of my world.” As a result, he was unable to just let the sex be and, too focused on whether sex would work, and what was going to happen in the future if it didn’t, he became unable to just enjoy what he was doing in the here and now. For he had made every sexual act into a momentous test of how valuable he was both as a person and as a man, and thus into a commentary on what fate might hold in store for him in the immediate and far distant future.

Personality Changing

Sexual avoidants can enhance their sexual desire and performance indirectly by overcoming inhibiting personality problems. To illustrate, obsessively high expectations associated with excessive resolute perfectionism relating to sexual performance lead to easy disappointment and ready retreat. Often a personality buffered by posttraumatic stress experiences performance inhibition based on anticipation of partner abuse originating in intrusive past accurate and/or retrospectively distorted memories of experienced sexual traumata.

Environmental Enhancing

Improving unfavorable, sexually negative surroundings is a simple, direct way to enhance desire and performance, for example, soundproofing a bedroom that is close to where the children sleep.

Emotional Charging

Strong and persistent stimulation involving nonsexual touching, such as massage, can act as an instrument both of immediate release and of release over time. That, along with regular sexual contacts without forcing things or expecting too much, can cumulatively relieve sexual strictures by ultimately breaking through self-induced, compulsively turned on inhibitory sexual “cold showers.”

Behavior Changing

Behavioral therapy can lead to performance improvement and enhanced enjoyment. For example, a therapist might suggest that a man treat his ejaculatio tarda by increasing his thrusting force and speed and reducing the frequency of his sexual encounters. For some men and women, monogamy without masturbation is a particularly powerful aphrodisiac achieved through focusing on one object, improving quality by reducing quantity. One man’s sexual performance improved markedly when he merely stopped encouraging himself to have intrusive, wild sexual fantasies about third parties and instead forced himself to focus entirely on sex with his wife.

Calm can be enhanced and anticipatory brooding and the anxiety associated with spectatoring reduced through the use of such relaxation techniques as Zen removal and specific breathing exercises, the details of which are beyond the scope of this text.

Cognitive Restructuring

Identifying and correcting cognitive distortions such as “no orgasm = no life” can help individuals stop their panicky viewing of each and every sexual encounter as the sole test of whether they are or are not a full man or woman who will or will not be punished, rejected, and exiled for their sexual thoughts, desires, and performance.

Medical Curing

Symptoms of sexual avoidance can often be relieved directly through the use of medical “magic bullets” such as drugs that treat erectile dysfunction, antidepressants that retard ejaculation, and sexual aids that enhance sexual pleasure (but should not become a substitute for the greater goal of attaining full sexual psychological adequacy without them).

Partner Involving: Remediation

Partners of sexual avoidants can be encouraged to aid the healing process. Instead of leaving it up to chance, partners should tell each other what they really want sexually, and do so without shame. The power of positivity—especially sexual altruism that makes not one’s own, but one’s partner’s comfort/pleasure/orgasm the main thing—can be helpful, especially if the other partner, becoming appreciative, develops new and more loving feelings that feed back to increase the first partner’s desire, ultimately enhancing both partners’ performance.

Partners should stop doing anything they might be doing to thwart each other’s sexual performance/enjoyment. They should avoid allowing themselves to become unattractive. They should not humiliate their partners by making hurtful jokes either about them or about their sexual performance, either directly or indirectly, privately or publicly, and instead, even when feeling negatively, try always to display at least a degree of positivity. They should not express disgust by asking their partners to shower before sex, or come across as disinterested or disdainful the way a patient recently did when he told his straight girlfriend how it was really dykes on bikes that most turned him on. In many of my patients, sex improved when one partner stopped creating the very distancing in the other that he or she complained of. A woman getting paranoid about her boyfriend devalued him by complaining that he was trying to get her pregnant just so that she would stay with him. Another, also becoming paranoid, accused her husband of having an affair when he was actually being faithful, and a third, instead of letting sexual encounters go at their own spontaneous, healthy rate, deaffirmed and invalidated his wife by constantly pushing her for sex even when he knew, but didn’t care, that she wasn’t interested because she was otherwise preoccupied.

Other Involving

It can be helpful to do what one can to stem the influence of parents, in-laws, coworkers, and uncomprehending members of society who make things worse by intruding into a relationship, for example, by making negative passing comments or giving bad advice. In one case, the bad advice consisted of telling a couple to “make the break” when it would have been better to stay, and in another, telling a couple to “stay with the known devil out of a fear of illness and old age” when it would have been better to go.

Options of Last Resort

The following options exist for resolving a situation where one or both partners are resolutely and incurably sexually avoidant:

• both agreeing to separate or file for divorce now

• both agreeing on an open marriage, staying together, and relating as friends without becoming enemies, enjoying the partner without being sexually demanding and threatening divorce, accepting the partner as is and living with things the way they are rather than responding negatively to diminished or nonperformance

• one agreeing to lovingly help the other find someone else more suitable

• saving oneself by bettering one’s life, say, by taking trips to no-where/anywhere just to get away

• staying faithful and becoming sexually avoidant/inactive oneself

• helping a partner by compromising and agreeing to have a certain amount of sex anyway, yielding even when one doesn’t really feel like it, even modifying one’s sexual preferences to give the partner what he or she wants to avoid being rejected

Sometimes partners who married sexual avoidants who performed in the beginning then never again have children and feel stuck in, and are actually trapped together for, a lifetime of child rearing. Partners have to decide how to raise children in this environment. That often involves making important decisions about therapy, including about whether, as individuals, they should make the rounds of personal therapists and work out their problems one on one, or go together visiting marriage therapists to work out their problems in couple therapy. Since there are few to no fixed rules on how to proceed, the answers so often depend on personal preference as well as on therapist availability and cost.


FOR THOSE WHO ARE PARENTS

Parents have a job to do to prevent sexual avoidance in their children by staying out of their children’s bedrooms. Figuratively or literally “looking through the peephole” can only cause the child’s sexuality to become not an exercise in having fun oneself and giving pleasure to others, but in spending one’s life avoiding displeasing and shocking mother and father.

Parents whose children have become so sexually avoidant that they are hanging around the house with little or no motivation to go forth and find someone for themselves have to learn how to handle a child reluctant to move on because he or she has few or no outside relational needs.


PROGNOSIS

The effectiveness of treatment of sexual avoidance often depends on the patient’s motivation to change. That, in turn, may or may not be enhanced by increasing isolation from the partner. The prognosis often improves when organic causes, such as alcoholism; prescription medicine overusage or drug usage; testosterone deficiency; liver disease; diabetes; an endocrine, circulatory, or neurological disorder; or genital-area pathology such as penile phimosis or genital warts can be ruled in and effectively treated.


THERAPEUTIC ERRORS

As one of my patients related, illustrating how therapists often mistreat sexual avoidance, “The first marriage counselor we saw, back in the 1990s, told us to read performance manuals when what we needed was intimacy guides, then to read intimacy guides when what we needed was performance manuals.” As the husband of the couple reported, much of the time, the therapist just sat there and laughed, while his wife sobbed away with a box of Kleenex because he wasn’t having sex with her. The therapist said to him, “Are you kidding? You mean you really don’t have sex?” The final therapist this couple saw (after that, they both gave up and gave in to someone else—as the wife said, “You could see how effective the therapists all were!”) told the husband, “You’re gay, right?” to which the husband honestly replied no, only to have the therapist respond with a most unhelpful, pedestrian, “Then get off the pot.”

PART THREE

SELF-HELP

This page intentionally left blank

CHAPTER 20

Overcoming Shyness an d ^Withd rawal

As an avoidant individual, that is, as someone who suffers from avoidant personality disorder (AvPD), you are shy, scared, and lonely. Fortunately, you can generally help remedy this state of affairs through your own efforts consulting with guides such as my action-oriented, step-by-step reparative guide on self-interventions you, as an avoidant, can use to overcome your relational (social) anxiety over attachment, intimacy, closeness, and commitment and get closer to your family, make more friends, and possibly even form an intimate reciprocal liaison with a significant other in a long-term, lasting, loving, fulfilling, committed relationship.

The following protocol, much of which is based on earlier material here repeated and recast for self-help purposes, offers specific delimited activities useful for preventing and overcoming AvPD—focused tasks that, in my experience, have helped avoidants go from retreat to connectivity. I break this protocol down into small, one-day-at-a-time steps to offer a laddered approach involving going a little forward each day, allowing the avoidant to make continual progress without feeling overwhelmed due to taking relational plunges that are excessive, only to panic, give up, and avoid the cure the same way he or she gives up and avoids so much else.

Of course, not all avoidants need to make changes that are mini-mal/incremental. Some can boldly truncate the process by facing what makes them anxious all at once, perhaps by combining some of the steps and skipping others where mastery is not necessary or has already been achieved. And obviously, not all of my daily exercises will be applicable to or needed by a given individual. Each avoidant person is different, for avoidants are encumbered to lesser or greater degrees by their avoidances; diverse in their fears; living under different external, variously more accommodating or less supportive circumstances; and individually more or less prone to backsliding. Also, completing each day’s exercises is only a start. Selected exercises often have to be repeated more than once until practice makes perfect. What is important is developing a comprehensive, ongoing, personalized game plan adapted specifically to the individual’s preferences and needs, taking into account one’s personal, often unique, situation.


PREVENTION: SELECT YOUR PROFESSION WISELY

Those who recognize in a timely way that they are potentially or actually avoidant should consider selecting a profession that allows them to earn a living should their avoidance persist or worsen. These professions include post office mail sorter, writer/indexer, mountain climber, grave digger, philosopher/poet, psychotherapist who substitutes living vicariously through patients for real-life encounters, animal trainer/ pet shop worker, or circus performer. Some avoidants-to-be might even consider selecting a profession that can help them become less avoidant. These professions include working in a charitable organization such as a homeless shelter or being a greeter in a funeral home, real estate broker, host on a cruise ship, sports instructor in a gym, politician, medical healer, salesman, and cab driver. An example of a profession that should be avoided would be a professional critic, for professional critics cannot help but acquire personal enemies because of their inevitable need to professionally eventually say something bad about someone’s work.


PREVENTION: AVOID INTENSIFYING PREEXISTING AVOIDANCES AND KEEP NEW AVOIDANCES FROM APPEARING

Avoidants should try not to worsen their avoidance by doing the following:

• pushing themselves too far, too fast to become nonavoidant

• associating with avoidant companions, especially those who newly traumatize them in ways that revive old, unintegrated traumata

• self-traumatizing by compulsively and self-punitively reviving and trying to integrate early traumata, repeating them or their

equivalent in the here and now, over and over again, in an attempt, typically futile, to master the past

• settling in to endless punitive therapy with a therapist who revives old and creates new emotional traumata by being confining or making hurtful technical blunders

• going off medication they should stay on

Particularly onerous are actions that actively court rejection like those of my patient who was just too scared to meet a man she liked in person, so on New Year’s Eve, she stood at his window, called him on her cell phone, told him she was down there (in the dark—he couldn’t even see her), asked him to wave back, then disappeared before he could even make that simple gesture to, and unthreatening connection with, her.


ACCEPT AND LIVE BY YOUR GOOD PROGNOSIS

As Oldham and Morris suggest, “People with Avoidant Personality Disorder are luckier than they may think,”1 for unlike schizoid individuals, who suffer from a fundamental inability to relate, avoidants have the ability to relate, but have difficulty realizing it until it is released through formal therapy or self-help (strength of will, singularity of purpose, and persistence toward achieving one’s goal required!). Also, many avoidants get better spontaneously or should external circumstances improve—even when their AvPD is so chronic and severe that they have isolated themselves from most or all human relationships. Another fortunate aspect of AvPD is that unlike many other disorders, AvPD doesn’t leave crippling residue or permanent scars, especially when avoidants have retained a few crucial relationships that they can use as the basis for revival and repair.


DETERMINE TO WHAT EXTENT YOUR AVOIDANCE IS HEALTHY AND PREFERENTIAL AND SO CAN,


AND EVEN SHOULD, BE RETAINED

Avoidance can be healthy when it is not a sign of an emotional disorder, but of a preferential, reasonable, rational desire to be alone or to be left alone. Avoidance is preferential when avoidants, solitary by choice, have built their aloneness comfortably into their lives. They are not rationalizing when they say that they like being self-sufficient and self-contained, independent of others, and their own master, and speak eloquently of how they enjoy the peace that comes with removal and detachment. These are the avoidants we see in public comfortably eating dinner in a restaurant by themselves reading the Sunday newspaper on Saturday night, or fishing by day, day in and day out, alone by the seashore—welcoming the escape from inner turmoil that comes from pulling back from a world they feel is too much to bear. (Often they want to remain aloof but are too embarrassed to admit it, so they say not “I want to disconnect,” but “I am too fearful even to attempt to make connections,” that is, out of guilt, they say that “I am not an independent individual, but a pathologically avoidant person.”)

Avoidance can also be healthy when it is limited and small scale, creative, appropriate to the circumstances, and for the ultimately greater nonavoidant good of allowing the individual to retreat from uncomfortable, unimportant relationships in order to prevent discomfort in these relationships from spreading to contaminate and destroy potentially important social and personal contacts or one’s entire life.


RETAIN HEALTHY/NORMAL AVOIDANCES

Avoidants should not change simply because others expect them to. They should only make those changes that are right and necessary for them. A husband shouldn’t enter therapy for being an avoidant when the real and only problem is that his wife, the one pushing for him to get help, is a passive-aggressive.


DETERMINE AND ENHANCE YOUR MOTIVATION TO CHANGE

Change, even though possible, is time consuming, difficult, and painful. Therefore avoidants should not attempt to relinquish entrenched avoidant patterns before determining for themselves if the comforts of limits are greater than the discomforts of their limitations.

Motivation is enhanced by focusing on the advantages of nonavoidance (see table 20.1).

Do at Least One Nonavoidant Thing Today

Each day, avoidants should try to think and act in at least one nonavoidant fashion. That might involve just picking up the phone instead

Table 20.1

The Advantages of Nonavoidance

Potential freedom from relational fear

leading to the ability to form durable relationships of intimacy with others so that one comes to

savor pleasurable and rewarding interpersonal relatedness, which also involves

having pleasurable sexual relationships while

firming up a newly developing capacity for the self-realization that comes from forming durable relationships

leading to developing self-pride about one’s new and improved personal and professional achievements, ultimately being able to

leave a meaningful personal, interpersonal, and professional legacy behind.

of letting the answering machine take the call. It might involve keeping one eye always open for who might be looking at and trying to make contact with them so that they can react appropriately to the positive overture. It might involve starting saying hello to strangers, even or especially the ones who probably won’t say hello back. It might mean meeting relational challenges head-on, that is, not with their usual fight/flight responses, but by staying put and resolving relationship problems in place.

Set Specific Goals

An important aspect of setting specific nonavoidant goals involves contemplating what it will be like when they are achieved. Avoidants can ask themselves, what will being nonavoidant feel like? Will things be better when I am connected than they are now with all my disconnects? What will my nonavoidant future be like, one where I am better able to relate, get close, and commit to relationships with friends, and even one significant other? What exactly will it be like to move out of my parents’ home and face the world? Will it be worth all the trouble and anxiety predictably involved? Will I lose my nerve when my parents, as I can expect, respond negatively to my leaving? There are downsides of translating my new nonavoidant philosophy into meaningful action. But what reassurances can I give myself that I can tolerate any or all of them, and what reminders can I give myself about the many upsides that do exist?

Different transactional goals and their underlying causal anxieties require different specific remedies. For example, exposure anxiety has to be resolved if the main goal is to comfortably attend parties and other social events, while anxiety over criticism has to be resolved if the main goal is to become less remote at work by not allowing oneself to be cowed by unsupportive, openly critical superiors, peers, and underlings.

Set Priorities

In setting goals for themselves, avoidants need to determine which avoidant behaviors cause them the most trouble and create the most havoc. Then they have to decide if they want to try to relieve their greatest fears first (even though those are the most difficult to master) or work first with their more moderate fears because though these are not necessarily the ones whose resolution will provide the most comfort, they are at least the ones that are easiest to resolve.

Be Patient

Avoidants must set themselves a realistic accomplishment/achieve-ment timeline based on rational, not irrational (emotional), desire and practical need. That means recognizing that avoidance reduction takes time. Because avoidants didn’t get to be avoidant overnight, they will not become nonavoidant tomorrow. Also, avoidance reduction requires persistence, which is time consuming, and vigilance, which is emotionally draining—with both needed to avoid backsliding should, as often happens, the same fears recur and need to be mastered all over again.


IDENTIFY RESISTANCES TO IMPROVEMENT

These include the questionable assumptions and shaky rationalizations listed in table 20.2.


JOURNAL/SCRIPT YOURSELF AS SUCCESSFUL

Journaling involves recording why one wants to change, including enumerating in writing the virtues of relating over being isolated and the rewards of relating over the acknowledged discomforts of getting close and undergoing commitment. It also involves recording one’s emotional responses, and distinguishing these from one’s realistic

Table 20.2

Resistances to Improvement

I don’t have the time to meet people.

The world is a fearsome place, full of frightening, rejecting people, so why even bother trying to get better?

I have nothing but bad luck, so there is no sense in even attempting to meet anyone good, or good for me.

There aren’t any people worth meeting where I live.

I can’t help my shyness, and no one else can help me become less shy either.

My anxieties and fears are absolute, not relative, based on reality, not on fantasy, therefore I am incurable, for my problem is irremediable.

It’s not my fault that I am an avoidant, it’s my upbringing.

It’s not my fault that I am an avoidant, it’s my chemical imbalance.

My loneliness is preferential. I like to be alone; I value my privacy and independence above all else.

Marriage isn’t right for everyone, and it’s not right for me.

The grapes are sour, for relationships are not all they are cracked up to be.

Some of the best things in life are only available to the isolate, like being able to sleep without being awakened by a partner’s snoring, being able to stay in bed as long as I like, being able to drop my clothes on the floor without anyone complaining about the mess, not having to pay for my partner’s financial excesses, and being able to travel without compromising my itinerary just to give in to someone else’s demands.

anxiety responses, that is, distinguishing what I do fear from what I should fear, then responding accordingly.

Journaling also provides avoidants with an opportunity to review their progress as they ask themselves and write down the answers to such questions as “what have I done to avoid whom today?” After they answer such questions, they should write down possible areas of improvement and change accordingly. For almost certainly they have done something that they should not repeat. They have looked right by someone good then retreated to remain invisible. They have overlooked someone who would like and even love them if only they would have let them. They have shied away from someone who is right for them using a flimsy excuse—because “he is a longtime friend and so we can’t get romantic; because you shouldn’t mix business (getting close to people at work) with pleasure (having friends and even meeting partners through the job); because she is someone I met on one of those ‘stupid blind dates’; or because he has some (all too human) frailties and misfires from time to time.” They have not listened hard enough to others’ positive feelings mixed in with their negative feelings toward them. Having heard their words without listening between the lines, they have taken the expressed negative arm of another’s ambivalence too seriously and, having also overlooked the good in the other person, failed to rescue a relationship they could have formed and sustained if only they had been a little more charitable, and a lot more understanding.

Avoidants should consider using the methods of Kelly, a psychologist, who, in the 1950s, used a technique called “fixed role therapy” to change people’s perceptions of themselves and help them break through their self-imposed limitations. In a clinical setting, using a technique applicable to avoidants, he had clients write a self-characterization describing their strengths, values, weak areas, and the like. Then Kelly would “rewrite” the script, using much of the original, changing what the clients wished to alter. Then he would ask the clients to become this new character, in other words, to act “as if” they were the star of a play featuring the new, improved version of themselves.2 (Of course, avoidants can rewrite their relational scripts on their own and give them the happier, more satisfying endings of which they dream.)


MAKE HELPFUL REAL-LIFE CHANGES

Avoidants who feel exposed/trapped in the small town they live in might try traveling to a big, anonymous city to meet old friends and make new ones. Avoidants who feel isolated in an unfriendly, large city might try visiting friends in a small town and ask them to introduce them around in the new surroundings.


MASTER YOUR ANGER

Avoidants should try to avoid getting angry in the first place. They need to spot exactly when they get angry; understand why they get angry; question if their anger is appropriate to the circumstances or is coming more from within than from without; and stop using anger as a defense against relational anxiety—getting angry to thwart loving and being loved. For example, they should not do what one of my patients did when she first sought blind dates, only to then look for something about the individual that would allow her to express her preconceived negative notion about how most blind dates are “bad news.”

Many of those avoidants who were unable to avoid getting angry in the first place had some success changing their anger style from aggressive to passive-aggressive, with the goal of minimizing the even greater harm to their relationships that can come from hurting others’ feelings less in subtle and more in open and direct ways.


FACE AND OVERCOME SHYNESS

Overcoming shyness starts with recognizing that shyness, and the withdrawal that accompanies it, is an active, dynamic, not a passive, static, condition. Avoidants shyly withdraw not passively, but actively, because they withdraw defensively—taking motivated steps to pull back from and even give up on looking for new relationships. Individuals should determine for themselves if they shyly withdraw for one or more of the following reasons, with, in each case, remedies implied.

Low Self-Esteem

Avoidants with low self-esteem are shy because they feel that they don’t deserve to meet anyone because they feel too unworthy to form/ enjoy relationships, and even wish to spare others the pain and perils of having to relate to someone as unworthy as they believe themselves to be. They are also shy because their low self-esteem leads them to lack confidence to the point that they do not feel sufficiently comfortable relating unless their relationships meet a number of reassuring conditions in advance, particularly those involving the certainty of constant and unconditional approval and the promise that the relationship will not sour in any way in the foreseeable future, or ever.

A Pathological Need to Meet Others’

Expectations and Impress Them

Avoidants are overly attuned to and sensitive about what others think of them. The opinions of peers, teachers, entertainers, religious leaders, and the media count for too much. They overworry about their image, convince themselves that others think poorly of them, think poorly of themselves, then shyly withdraw as their way to pass negative judgments on themselves—judgments that are even more negative than the ones others pass on them.

An Inability to Master Inner Fears by Harnessing Soothing, Reassuring Defenses

Shyness is due in part to the absence of reassuring defenses, which include denial defenses that say, “That is just the way some people are, it’s their problem not mine, and I will simply refuse to let them bother me or get me down,” and healthy projection, where avoidants blame others for scaring them, instead of acknowledging their own responsibility for being anxiety-prone.

A Surfeit of Unhealthy Projection

Here, after viewing the world as their personal inkblot and attributing their inner anxiety to external fear, they come to see the universe as a place full of frightening potential or actual adversaries, whom they shyly retreat from as their only possible response to what they imagine to be their personal difficult or impossible environmental circumstances.


ENHANCE SELF-ESTEEM

Self-esteem enhancement in great measure involves becoming more permissive toward oneself. This involves allowing oneself to be simply human—permitting oneself to make some mistakes, without constantly self-spectatoring and criticizing oneself for being imperfect, and instead, in a balanced way, congratulating oneself for doing some things right—although not necessarily for doing all things perfectly.


RELEASE THE HOLD OF PAST TRAUMAS

Avoidants can prevent past old traumas from becoming present posttraumatic stress disorder by discriminating between bad past and good present relationships so that they do not generalize from old bad past experiences to sully new, unrelated, potentially satisfying involvements. This tendency to generalize is exemplified by the cat that, burned by jumping on a hot stove, fears and avoids not only hot stoves, but cold ones as well. Avoidants need to regularly remind themselves that just because, as children, they experienced ill treatment at home does not mean that everyone outside the home will treat them equally badly so that as a consequence, they must avoid all men and women in the here and now as “hot stoves,” when in fact, as “stoves,” they are safely “cold.” Not all new acquaintances are old, fearsome, problematic parents, siblings, or friends who once demanded that they impress others favorably as the only important thing, then rejected and deprecated them if they didn’t; parents who double-binded them by criticizing them no matter which way they felt and whatever they did; peers who bullied them; people who stifled their humanity, especially their rational anger and perfectly acceptable sexuality; or people who told them, in their controlling fashion, “Either be exactly like me, or be gone.”

It helps if avoidants keep in mind that contiguity between past and present is so often illusory and simply coincidental. For since humans can behave in only a few really different ways, everyone in the present is unavoidably, and in some respects likely, to remind all of us of someone from the past.


DEVELOP TRANSACTIONAL INSIGHT

Avoidants need to document why exactly they fear opening up and getting close to others. Table 20.3 summarizes some of the possible reasons for easy self-help access.

Table 20.3

Problems with Getting Close

They fear they will reveal something they don’t want to feel, know about themselves, or display to others.

They fear being overwhelmed and tied down emotionally.

They fear being controlled and dominated.

They fear merger and need to maintain their identity fully intact.

They are too self-absorbed to be “just” one part of a couple—this though successful relationships, by definition, lead to a positive, often matura-tional, change from “me” to “us.”

They are reluctant to make the personal sacrifices that relationships require.

They fear being hurt again in the present and future in the same way they were hurt in the past.

They are jealous individuals convinced that anyone they love will only betray them and leave them for someone else.

They are competitive individuals who feel guilty due to the zero-sum belief that what they win, others must therefore lose.

They fear success in all areas, and especially in the area of relationships.

(continued)

They have a masochistic need for failure, especially when it comes to relationships.

They have bought into social messages about the wonders of splendid isolation.

They actually like being loners, meeting nature by themselves in a test of strength and mettle, one that, if they win, they believe will make them strong and powerful enough to be able to endure and survive, no matter what.


ROLE-PLAY

Through role-playing, avoidants can put themselves in the place of others so that they can see exactly how they come across to people, then make necessary repairs to harmful interpersonal trends and fix potentially off-putting character traits such as obsessive rigidity and paranoid suspiciousness. Videotaping themselves and showing the results not only to themselves, but also to their significant others, can provide them with feedback as to how they can improve their appearance and behavior in a way that will lead others to become more accepting of and welcoming to them.


MAKE TRIAL FORAYS INTO NONAVOIDANCE

Becoming less avoidant requires actually giving nonavoidance a try. Too often avoidants decide implicitly (by only thinking about it) whether they do or do not wish to remain avoidant. Instead, they should embrace the simplistic but true principle “Try it, you might like it.” Then they should say to themselves, “I will focus on, and single-mindedly make, relationships my ongoing concern. I will not allow myself to be sidetracked in my quest for nonavoidance. I will fix on my nonavoidant goals and head for my nonavoidant objectives in a straight line, with as few side trips or time-outs as possible, while not letting anyone or anything get in my way.” They should then take themselves in hand and force themselves to act less shy and be more related, telling themselves, “You can do it, and you can do it now,” even though they find themselves at the start behaving in an inadequate or embarrassing fashion.


TAKE CONSULTATIVE ACTION

Avoidants can profitably share their fears with others. Instead of retreating in silence to save face they should own up to their interpersonal anxieties, bringing them out into the open not only in order to expose them to the cleansing light of day, but also to get others to understand and sympathize with, instead of reflexively reacting negatively to, them. Asking others not to mistake their shyness for hostility makes it clear that they are not bad, but fearful, people, not individuals who dislike, but men and women who are afraid of, others. This effectively throws avoidants on the mercy of a, it is hoped, understanding “court” that will give them credit for their honesty and appreciate, understand, and respond positively to their frankness.


SEEK OUT HELPFUL FRIENDS AND FAMILY

At some point, avoidants should try to become sufficiently nonavoidant to be able to approach friends and family they can enlist to help them cope with and master their avoidance. These third parties can

• exhort avoidants to at least try to relate.

• act as good companions who provide avoidants with practice relationships and therapeutic corrective emotional experiences that can generalize, for relational successes with familiar, accepting people spread to facilitate or actually become relational successes with strangers, who, in their turn, likely will become more accepting and less difficult to approach

• promote healthy identification, leading by example—the example of model people who are less fearful, less guilty, more selftolerant, and more self-assertive

• provide the avoidant with a warm, reassuring, healing holding environment in which there is less or no reason for anxiety; evidence that patient perseverance will lead to relief; positive feedback that says “you are too good to fail,” “that’s great that you have succeeded,” and “your low self-esteem is lower than by rights it should be”; and good nourishing fatherly/motherly advice such as “there are other places where you will be happier/more welcome/ more popular than in the suburbs.”

• introduce avoidants to others, hoping that potential or actual rewarding relationships with them might result

• offer avoidants constructive, not destructive, criticism, as tolerant friends giving avoidants a fair and balanced ongoing assessment of the effect they are having on others, and as amateur life coaches offering avoidants specific suggestions about what needs to be done to make future improvements, without repeating past mistakes

• Offer younger avoidants-to-be (children and adolescents) an avenue of escape from parents, countering extant unhealthy parental attitudes by offering the young people a positive view of their true worth and a place of escape, saving them, it is hoped, from becoming more seriously troubled than they otherwise might turn out to be

Avoidants can profitably consult with ex-avoidants to discover how these others got over their avoidance. They can do this one-on-one or through joining therapy groups (if they can find the right one) composed of group members who are also having problems with avoidance.

Of course, avoidants, already too highly impressionable and sensitive for their own good, need to be very careful in picking third-party assistants. They should not ask for help from people who infantilize them with their own avoidant philosophy of life or who keep them in tow because they do not want to let them roam free. They should challenge gurus who advise or recommend avoidance in subtle ways—such as through advocating Zen-like removal philosophies, which, though useful for nonavoidants, are ultimately bad for avoidants, who are already too removed for their present and future good.


LEARN ACCEPTANCE: TO FORGIVE ONESELF AND OTHERS

Avoidants need to learn to be kinder and more forgiving both to themselves and others. In the vernacular, they need to cut themselves and others some slack, using a “so what?” approach that involves relinquishing that uncompromising, perfectionistic, all-or-none attitude about relationships that causes them to pull back if they or others make even one little mistake, and without giving all concerned a second chance. Avoidants should remind themselves that most relationships are neither all good nor all bad, but somewhere in between those two extremes, and strive to get relationship grades that, though not perfect, are at least passing.


INTERRUPT VICIOUS CYCLES

Avoidants need to interrupt vicious cycles characterized by the following:

• A given relationship doesn’t work out, intensifying their self-critical tendencies, lowering their self-esteem, leaving them even more hypersensitive to criticism, predictably increasing their self-critical tendencies, and thus lowering their self-esteem even further.

• Their fear of rejection leads them to distance themselves protectively, resulting in their actually being rejected, leading to more fear of rejection and further distancing, as displays of unreasonable fearful timidity and shyness create negative feedback in others, who think not “he is afraid of me,” but “he doesn’t like me,” or even “she hates me,” prompting further withdrawal and further retaliative rejection from others.

• They avoid because they are depressed, and they are depressed because they have avoided.

• They do not seek interpersonal gains for fear of experiencing interpersonal losses, leading to defensive disengagement that creates the very losses they are attempting to avert.

• They feel shame that leads to avoidance, which leads to more shame about having been avoidant.


INURE YOURSELF TO CRITICISM

How to do this is discussed at length in chapter 17. I find a helpful mantra consists of reminding oneself that behind every criticism of another is a self-criticism, which is not surprising considering how people, especially these days, are mostly, if not only, talking about themselves, which they are doing even when they seem to be referring to/addressing others.


IDENTIFY AND CORRECT SPECIFIC COGNITIVE ERRORS ABOUT RELATIONSHIPS

This process is discussed in detail in chapters 7 and 11. Perhaps the most common cognitive errors avoidants make is to confound some with all, for example, ambivalence (he has mixed feelings about me) with rejection (she rejects me totally and completely).


ANALYZE YOUR DREAMS

Avoidants should analyze their dreams to see if they shed light on their dysphoric feelings and irrational negativistic beliefs. An example of dream analysis is offered in chapter 7.


CHANGE YOUR RELATIONAL PHILOSOPHY

Lonely individuals who consciously complain about relationship difficulties but unconsciously remain aloof from close relationships offered, or rupture actual close relationships that promise, really threaten, to work, often do so because philosophically they believe that isolation is splendid. Instead, they should make enemies with their avoidant value system before “I like being alone” becomes “and besides, I have no other choice.” They must convince themselves once and for all that isolation, rarely splendid, is rather mostly an unpleasant and even dangerous condition. They should refuse to allow themselves to be carried away by siren songs about the pleasures of being alone. They should put intellect before passion, putting the recognitions that “it’s not better to be alone than to be in a relationship” and “relationships are worth whatever trouble it takes to sustain them” in place like a helpful alarm, warning them that such beliefs as “the single life is for me,” “I can get along better without you from now on,” “life will be better after you’ve gone,” and “I will be in great shape when you die and leave me your armoire” are not satisfying personal mantras, but self-destructive personal constructs. In other words, avoidants should follow Freud’s advice—“where Id was, there Ego shall be”3—and distinguish preference from compulsion: their true ideal, and what they really want out of life, from their automatic thoughts and behaviors that effectively order them to be anxious.

Keeping all this in mind, avoidants should try to answer the following questions truthfully, and, depending on whether the answer is nonavoidant or avoidant, remind themselves of the answers daily:

• Do I want to be alone or do I fear commitment and intimacy?

• Do I really believe that isolation is splendid, or does something inside warn me of the terrors of connecting and strongly suggest that I stay out of a relationship because my dreams of intimacy will never come true, or actually be nightmares?

• Do I really want to “do my own thing,” or am I afraid of “doing my thing with you”?

• Do I truly like my fantasies of walking alone into the distance through swirling mists, or am I conjuring up those mists in order to hide from myself and others, to keep myself from getting into a close, warm, loving relationship?

• Do I truly identify with songs that speak of being a rock and an island, tell me I should be glad that I am single, and proclaim that never, never, will I marry, so that I really want to be insular, or am I really afraid of “singing another tune,” ’ by analogy, leaving my avoidant island, taking the nonavoidant plunge, and swimming to shore?

Avoidants can help distinguish preference from compulsion by looking back over their lives to see if they can spot the exact (historic) moment when approach became avoidance, as desire to relate turned into a fear of closeness and intimacy due to beginning, and still active, conflicts between approach (desire) and avoidance (fear). Avoidants should identify present-day wish-fear/desire-guilt/ rebellion-submission conflicts within themselves in order to determine if it is these, not freewill, that are prompting their so-called philosophy of splendid isolation, one that is in fact the product not of a search for desirable splendor, but of the taking up of heroic, defensive measures to meet the, for them, avoidant irrational threat of welcoming others into their lives, homes, and families.

Avoidants can better relinquish their avoidant value systems and resultant avoidant positions if they

• identify with others whose beliefs and ways are less avoidant— emulating people they admire for their social abilities and successes, whose nonavoidant philosophy has led to real-life social connectivity

• take a more sanguine view of human nature, one that emphasizes the positive and welcoming aspects of people they presently view in a mostly negative and forbidding light

• disentangle themselves from overly repressive family relationships that are the product of and lead to/enhance/fix their avoidant beliefs such as the belief that family always comes first, and newly break as free as they can from families who won’t let go, but instead resolutely infantilize and smother them

• become more willing to give up something to get something and so make the necessary sacrifices for relationships, as they accept some anxiety in exchange for a degree of accomplishment; willingly sacrifice a degree of self-pride, autonomy, independence, and the need to express oneself completely and honestly to a newly developing closeness; relinquish the pleasures of getting revenge

on those who have presumably been rejecting of them; and give up at least some of their treasured identity, and instead of being “me,” become “us,” along the lines of Joni Mitchell’s reminder that when it comes to love, “some loss of self is inevitable.”4


MASTER DISSOCIATION

Avoidants need to stem dissociative flights from the possibility or actuality of acceptance where they fail to respond to positive gestures and laugh off a serious approach—as they become defensively aloof in order to reflexively squelch feelings they perceive to be dangerous and forbidden, doing so by the pathological expedient of distancing themselves from the people who elicit those very feelings.


OVERCOME BOREDOM AND RESULTING NEOPHILIA

Avoidants need to relinquish protective boredom that, in effect, says not “I am afraid you find me uninteresting and reject me,” but “I find you uninteresting and reject you”—one of those negative responses that disrupt intimacy along the lines of “don’t say hello once and it will be overlooked; don’t say hello twice and you will be overlooked.”


HELP OTHERS BECOME LESS AVOIDANT

Helping others become less avoidant is a royal road to helping oneself along similar lines. Avoidants might try each day to convince one previously avoidant person to stop rejecting and to accept people instead. Avoidants might also consider working to create a less avoidant society—for example, supporting or joining groups dedicated to overcoming such (always avoidant) bigotry as gay bashing, and spousal abuse.


MAINTAIN YOUR PHYSICAL HEALTH AND IMPROVE YOUR PERSONAL APPEARANCE

I often recommend a complete cessation of smoking, limiting one’s use of alcohol, and using only prescribed medications in as low a dose as one’s physician will agree to. When necessary, I refer my avoidant patients for an appearance makeover, perhaps to an exercise guru or cosmetic expert, and suggest that patients watch makeover TV shows such as those on what to wear.


EVALUATE AND REEVALUATE YOUR NEED FOR THERAPY OR ANY THERAPY YOU MAY ALREADY BE RECEIVING

Since avoidance is an interpersonal problem, the solution may require not only self-help, but also supplemental professional help from a flesh-and-blood therapist.

Avoidants need to be certain that their therapists have made the right diagnosis. There are relatively few therapists familiar with AvPD, and I have gotten many letters from patients complaining that their therapists called them depressed or paranoid, when they were in fact avoidant. Because avoidants need to face their fears gradually, but inexorably through graded exposure, before they can obtain full, useful self-understanding, the most effective therapists are action oriented, rather than purely intellectual healers; that is, they do not rely exclusively on imparting insight then expect avoidants to attempt, and be able to take, nonavoidant action simply because they understand themselves. Effective therapists also do not rely solely on cognitive-behavioral therapy alone, without simultaneously employing insight-oriented, interpersonal, and supportive methods. The latter methods are often criticized in the cognitive-behavioral literature as inadequate—for example, Anthony and Swinson say, “As for other psychological therapies, although they certainly have a place for treating certain types of problems, they are not proven when it comes to treating social phobia and other anxiety-related conditions.”5 But this so-called inadequacy is often not the product of the methods themselves, but due to the therapist relying on them exclusively.

Avoidants often need to do their own research and ask their therapists specific questions about indications and contraindications, adverse effects, and the risks and rewards of being medicated for anxiety and depression. Many individuals with AvPD benefit from pharmacotherapy to reduce anxiety and depression. On the positive side, prescribed benzodiazepines and antidepressants can help avoidants become less anxious and fearful, while antidepressants can help relieve an avoidant’s depression. But on the negative side, both can interfere with relationship formation and maintenance. Both can create a chemical nirvana that removes motivating anxiety and depression, which warn avoidants to do something with their lives before it’s too late; take a needed edge off the socially useful protective paranoia that allows avoidants to determine if there is anything wrong with, or even dangerous about, certain others; soften the “craggy neurotic profile” an avoidant needs to be interesting, not bland/pedestrian/ordinary; and lyse the pro-social interpersonal (hyper-) sensitivity and capacity for empathy that so often originates with, and depends for its continuance on, being anxious, depressed, and paranoid.


SUMMING IT ALL UP AND PUTTING IT ALL TOGETHER

Avoidants should apply the lessons learned as often as they can, and preferably on a daily basis, ultimately bringing all helpful therapeutic methods to bear on each and every troublesome interpersonal encounter, effectively using multiple approaches to chip away at the avoidant problem and reduce relational anxiety to the point that it becomes sufficiently tolerable to allow them to feel comfortable and fearless enough to be transactionally active and interpersonally venturesome.

Throughout, avoidants should continue to expose themselves to one feared situation after another, until they prove to themselves that relationships are in fact, if not entirely safe, then at least less dangerous than they fear. To keep moving forward and keep their avoidance from coming back, taking hold, and escalating once again, they should constantly review, rethink, and rework what they learned and practice the remedies over and over again, until practice makes perfect. As their fear and anxiety subside, they can begin to think more clearly and take on more and more challenges, until they have attained the level of nonavoidance that is both possible and right for them.

Getting over avoidance is a lifetime job. Avoidance can be more easily reduced than entirely eliminated. Therefore, every day of their lives, avoidants have to be on the alert for distancing, and every time they detect that the distance between themselves and others is resurfacing and increasing, they should repeat the step-by-step remedies outlined in this chapter and in the rest of this book, until they can cope with and master their anxiety and avoidance and so change themselves and their lives in the direction that they, not their psychopathologies, want things to go.

Загрузка...