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Indo-Pacific Journal of Phenomenology
versión On-line ISSN 1445-7377
versión impresa ISSN 2079-7222
Indo-Pac. j. phenomenol. (Online) vol.13 no.2 Grahamstown abr. 2013
From panic disorder to complex traumatic stress disorder: Retrospective reflections on the case of Tariq
David Edwards
This is a phenomenological-hermeneutic case study of Tariq who initially presented with panic disorder. It documents how, as therapy proceeded, the underlying meaning of his initial panic deepened as its roots in traumatic memories of childhood emerged. There were four spaced phases of treatment over four years. The first focused on anxiety management; the second was conceptualized within schema-focused therapy, and evoked and worked with childhood memories using inner child guided imagery; in the third and fourth phases insights gained led to an authentic re-engagement with family members in relationships that had been problematic. The panic attacks resolved and there were two dreams representing a reconfiguring of his relationship with his deceased father. The first two phases were the focus of an unpublished case study presented at a conference in 1995. This article incorporates material from that study and looks back at the case both in light of developments in phases two and three and also in light of theoretical developments in our understanding of complex trauma since the initial presentation.
Tariq approached me for treatment of panic attacks in the early 1990s. This was about the time that Judith Herman's (1992) Trauma and Recovery was published, although I did not read it myself until ten years later. In this book, she proposed the concept of complex posttraumatic stress disorder and provided some provisional criteria. She also pointed out that many clients presenting with emotional instability in various forms have a history of trauma that has not been recognized. "All too often," she observed, "neither patient nor therapist recognize the connection between the presenting problem and the history of chronic trauma" (Herman, 1992, p. 123). This turned out to be the case with Tariq.
When anxiety management interventions had limited impact, the focus of Tariq's treatment shifted to a series of traumatic childhood incidents. The case was conceptualized in terms of Young's (1990) schema-focused therapy and the case was written up for a conference presentation (Edwards, 1995). This article describes Tariq's clinical presentation and treatment, based on the original case study, as well as further information, obtained when Tariq returned to therapy over a year later. It also offers an interpretative reflection. Since Herman's (1992) book was written, a wealth of accessible literature has appeared (for example, Courtois & Ford, 2009) on the way in which repeated trauma can give rise to a range of clinical presentations. Young's (1990) schema-focused therapy has also evolved considerably. The single publication (Young, 1990), which was into its third edition a few years later (Young, 1999), was precursor to dozens of books and articles on what is now called schema therapy (van Vreeswijk, Broersen, & Nadort, 2012; Young, Klosko, & Weishaar, 2002). This has become a significant treatment for complex trauma presentations including borderline personality disorder (Farrell, Shaw, & Reiss, 2012; Farrell, Shaw, & Webber, 2009; Giesen-Bloo et al., 2007).
Schema-focused case formulation and intervention
Early maladaptive schemas (EMSs) are structures of emotionally charged memories and associated cognitions that developed in childhood in situations where basic needs were not met. These are the source of everyday cognitive distortions and irrational or intense emotional responses. EMSs are early, in that they are often laid down in early childhood, and maladaptive since they give rise to problematic symptoms either directly or because of dysfunctional coping that develops to keep them out of awareness. In schema-focused cognitive therapy, EMSs are assessed and then activated and restructured using imagery and dialogue techniques such as those developed in Gestalt therapy. Their incorporation into cognitive therapy had already been described in the 1990s by Young (1990) and the present author (Edwards, 1989, 1990).
Professional interest in the disjunction between intense emotions or irrational behaviours evoked by seemingly neutral everyday situations goes back to the origins of psychotherapy in the 19th century. The English surgeon Dendy had used the term 'psychotherapeia' in 1853 and in the decades following there were detailed accounts of dissociative phenomena and recognition of the role of trauma in their genesis (Ellenberger, 1970). In the cognitive literature, Kelly's (1955, p. 83) theory of personal constructs included a "fragmentation corollary" according to which "a person may successively employ a variety of construction subsystems which are inferentially incompatible with each other." Foa and Kozak (1986) proposed that traumatic events which evoke intense fear and give rise to 'fear structures', primitive non-verbal cognitive systems that give rise to automatic appraisals of threat when triggered by stimuli related to the original trauma memory. These structures are separated from the rest of the cognitive organization and information, and cognitions they contain are not integrated with information derived from other experiences and are therefore not reality tested. Treatment therefore needs to bring the information in the fear structure into contact with corrective information, a task that calls for more than rational argument since the fear structure is a non-verbal system. On the same lines, Stiles' assimilation model is based on the supposition that "problematic experiences ... are experiences that are not adequately contained by the available schemata" (Stiles et al., 1990, p. 412) so that it is the task of psychotherapy to promote their assimilation.
The metaphor of healing the inner child
One approach to addressing the dissociated residue of past unresolved situations or unintegrated painful events is through the metaphor of healing the inner child (Missildine, 1963).Phenomenologically, this is more than a metaphor because when early schemas are activated, clients may experience themselves as childlike or behave in a childlike fashion and it is easy to engage them in dialogue work in which the child expresses its experiences and in which the therapist can counsel the child in a caring and empathic way. Long before Alexander and French (1946) wrote about the importance of a corrective emotional experience, Ferenczi (1929, p. 124) had written of how:
(possibly as a result of unusually profound traumas in infancy) the greater part of the personality becomes, as it were, a teratoma [tumour], the task of adaptation to reality being shouldered by the fragment of the personality that has been spared. Such persons have remained almost entirely at the child-level, and ... [what they] need is really to be adopted and to partake for the first time in their lives of the advantages of a normal nursery.
Although largely ignored by his psychoanalytic colleagues, Ferenczi's (1929) insights are at the heart of inner child work which emerged as a synthesis of theories from psychoanalysis, analytical psychology, transactional analysis, gestalt therapy and the humanistic experiential therapies (Abrams, 1990; Bradshaw, 1990; Capacchione, 1991; James, 1977; Rowan, 1990; Stone & Winkelman, 1988). This corrective emotional experience calls for a process of symbolic reparenting. While this can be promoted through the relationship with the therapist, inner child work uses imagery psychodrama to cultivate positive inner figures.
Although inner child work can be adapted to the wide variety of clinical presentations and childhood experiences that need to be addressed, there are five basic steps. First, the childhood schema is activated by means of experiential techniques such as emotional focusing, guided imagery, 'chairwork' (Young, 1990), or drawing and other art forms (Capacchione, 1991). Second, the child describes her/his experience, pain, and unmet needs to an empathic listener who might be the therapist or the client as he or she is at present or one or both parents, provided they have an empathic side to them. Third, the child's experience is normalized as the kind of response a child would be expected to have in the situation. Fourth, the therapist challenges and contradicts explicit or implicit messages from the parents that were psychologically harmful, points out the negative consequences for the child, and authoritatively expresses alternative ideas that are conducive to healthy psychological development. Finally, empathic parent figures are brought in who can appropriately acknowledge the needs and feelings of the child and support their natural development. The actual parents may mature and rehabilitate themselves, but where this is not feasible, they can be replaced with images based on real people with nurturing and empathic qualities (which includes the therapist). Sometimes, images of new parents emerge spontaneously.
These steps create conditions in which the emotional damage done by the original parents or other role-players is uncovered and understood and the process of healthy development that was arrested is restarted and cultivated.
Aims and method
This is a phenomenological-hermeneutic case study. The process of psychotherapy offers a rich source of data that is of particular interest phenomenologically. In the presence of an attentive and compassionate listener and guide, clients enter a process of exploring their experience (which of course includes their behaviour) which can continue and deepen over months. In the process, many of the conditions and stages of phenomenological research as described, for example, by von Eckartsberg (1998) or Smith and Osborn (2003) are followed. The therapist/researcher works with the client to investigate his/her experience and explicate this experience. There are also dynamic elements not usually present in interview research. First, the therapist uses active interventions which an interviewer would not use. However, these typically engage with the client's lifeworld and catalyze a deeper understanding of this lifeworld. Second, there is a longitudinal process as the client's experience changes and the transformation process itself can form part of what is being investigated. This longitudinal trajectory has the advantage of addressing one of the central concerns of phenomenology. Giorgi and Giorgi (2003, p. 27) noted that "the capacity to live through events ... greatly exceeds our capacity to know exactly what we do or why we do what we do". Similarly, Smith and Osborn (2003, p. 64) observed how researchers attempt to "capture and do justice to the meanings of the respondents," but these meanings may not be "transparently available." In the process of therapy, new questions arise and are answered and new horizons open up which repeatedly shed fresh light on the client's lifeworld and disclose new depths to his/her experience of this lifeworld. Over time, the therapist's and client's understandings change as each sees how the initial experiences were located in hidden meaning structures which make increasing sense of what was at first presented.
At the same time, there is a process of ongoing interpretation on the part of therapist and client as they try to make sense of the unfolding experience. This hermeneutic dimension is made explicit in the writing of a case study and is evident here in three ways: 1) The initial case formulation used a current theory to make sense of the raw material of the client's behaviour and experience; 2) interpretation became a focus of scrutiny as the case unfolded and the formulation was tested and refined or revised in light of the unfolding phenomenology of the client's experience; 3) in the present case study there is a further hermeneutic step: a case that began some twenty years ago and was written up shortly afterwards is reviewed from a distance in light of more recent clinical perspectives.
The final step for von Eckartsberg (1998) is the communication of results to the researcher's community "in shared expert language or their professional idioms" in a way that presents "the structure of a phenomenon, articulating what 'it really is' as a human meaning" (p. 23). A psychotherapy case usually brings forth more than one phenomenon. By means of a narrative together with interpretive commentary, the case study researcher can articulate complex structural relationships between interrelated phenomena that emerge during the course of therapy. Readers who persevere to the end can judge for themselves whether this has been credibly achieved in this presentation of the case of Tariq.
Formally stated, this case study has four aims. The first aim is to show how a developmental perspective on Tariq's symptoms of panic disorder emerged and was used as a basis for conceptualizing the case in schema focused terms. The second aim is to show how this was used as a basis for integrating guided imagery psychodrama into the treatment and how this set in motion a process of change. The third aim is to examine whether therapy contributed to meaningful change and, if so, how it did so. Finally, the fourth aim is to look back at a case treated two decades ago through the framework of current theories about complex trauma.
The client
Tariq, an Asian professional man in his early thirties, who was divorced but in a steady relationship, sought treatment for panic attacks. He was seen for a total of 30 sessions, in four phases spaced over nearly four years. He was assessed and treated for panic disorder, but when this had limited impact, experiential work led to the emergence of important childhood memories that led to a schema focused re-conceptualisation. He subsequently gave written permission for the use of the case material for research and publication. Names and some identifying information have been changed to ensure his privacy. Some sessions were tape-recorded and a narrative of the treatment reconstructed from session notes made during and after sessions with the help of the tape-recordings.
Case narrative
Context and presenting problem: "Am I going insane?"
It was during a national squash tournament that Tariq received a phone call with news that his sister, Janita, had been hospitalized with a "breakdown." He usually dealt with the anxiety of competition well. He felt the usual "butterflies" beforehand, but once the game started, he had a single-minded concentration that enabled him to focus so well that he did not allow anything to disrupt his performance. A few weeks earlier, he had visited Janita who lived in another city with his mother. He deeply disapproved of her on account of a series of defiant and irresponsible behaviours: an affair with a married man at the age of 14 which she shamelessly pursued in front of their parents; as a young teenager speaking to their father on equal terms and humiliating him by ignoring his authority; a short lived marriage and a divorce; and abandoning responsibility for the daughter of this marriage, whom she left entirely in the care of their mother. He had felt so angry that he had refused to talk to her during his visit.
As he listened to the phone call, he felt overwhelmed. However, as he walked away he knew that even this would not interfere with his playing, or this is what he thought he knew. In the next game, he began making mistakes. Still he thought: "Nothing is going to shake me!" Things got worse. "What's happening? I am a guy that can handle pressure." Despite this, his performance just fell apart. Afterwards he berated himself: "Don't look for excuses. You should have punched through."
After this, his confidence was shaken and he had frequent attacks of mounting panic. Sometimes he felt afraid to play squash in case an anxiety attack ruined his game. He would think: "I don't have the mental reserves any more to really concentrate like I used to". He became anxious merely from thinking that an attack of mounting anxiety could strike at any time out of the blue. "I can't afford to let it come creeping in," he thought, "I have to eliminate it entirely to feel safe". He worried about his sister, that he was responsible for her breakdown because of his not speaking to her over the holiday, that he still felt angry with her and it did not seem appropriate to be angry with someone who was so ill. He also worried that he would become responsible for looking after her if his mother were to become sick or die, and that this could become a lifelong burden. Finally, he believed that these anxiety attacks were the beginning of a progressive mental illness that would almost certainly lead to his going insane just like his sister.
Phase 1: Sessions 1-6 - Assessment and anxiety management
These sessions included a detailed assessment and standard cognitive therapy procedures. We identified antecedents to the anxiety attacks: times when his mind was not busy such as driving the car or lying in bed waiting to fall asleep; having an argument at work; and thinking or hearing about Janita. He collected the key cognitions already referred to and we worked on getting distance from them and reevaluating them. I encouraged him to accept the anxiety and learn to modulate it instead of insisting on eliminating it entirely. There was good collaboration and he made progress with everyday anxiety management. However, Tariq was not satisfied. He wanted the anxiety out of his life. Although he felt more in control, the therapy was not fast enough for him. He dropped out and went to a psychiatrist for medication.
Phase 2: Sessions 8-10 - Drop out and return
Eleven months later, having experimented with different doses of four medications and wrestled with a range of unpleasant side effects, he was back, wanting to deal with the anxiety "once and for all". This was ambitious since he was moving to another city in less than three months. He wondered if I could use hypnosis to speed up the process. We contracted for four further sessions of cognitive therapy to be followed by four sessions of 'hypnotherapy' if I felt it would be appropriate.
More of the phenomenology of his fear of going insane emerged. A TV movie about a person who had a breakdown sent his anxiety soaring and he stopped watching the movie. He had been told that his mother had had some sort of breakdown soon after his birth, but had been unable to find out more. Two members of his family had Downs Syndrome, and one had frequent seizures as well. While he was growing up he had often spent time with them and wondered if what they had was contagious and could have been passed on to him. Although a graduate and a professional, he had never corrected this misinformation and had no differentiated understanding of psychopathology. He felt relieved when I explained that Downs Syndrome was a genetic disorder that was not contagious and that at his age any genetic disorder he himself might have had would have manifested long ago.
Although these experiences seemed to account, at least in part, for his fear of going insane, the fear seemed unshakeable. A few nights later, while trying to fall asleep (a vulnerable time for him as he would start rehearsing anxious thoughts), he again began to think: "Am I losing it ... going out of control ... going insane?" He had images of himself breaking a window and trying to jump out, something Janita had done when she had her breakdown. In session 10 I used a chair dialogue to contrast the part of him that knew rationally that he was not about to go insane and the part that was convinced he was. The rational part was desperately weak, even with considerable coaching from me. It was no wonder that it could not compete at vulnerable times such as when his mind was not occupied, or when he was preparing for a tournament. The scared part won the argument hands down. I asked if he could imagine what this powerful scared part looked like and he saw a demon with horns and tail.
Phase 2 continued: Sessions 11-12 - Imagery work and the meaning of the demon
Now we proceeded to the 'hypnotherapy'. He already believed that his irrational thoughts were "imprinted on his subconscious" and that through hypnotic suggestion they could be weakened or erased. After a relaxation induction, I gave suggestions that using the skills he had learned he would easily be able to manage his anxiety and that when he had the thought that he was going insane he would easily be able to remind himself that this was not the case, that anxiety attacks are not a precursor to a breakdown and that what had happened to his sister was completely different from what he was going through. I asked him to imagine the demonic figure sitting in its dark corner and to see himself shining a torch on it which caused it to slowly dissolve. I gave him the tape to practice with at home.
However, at the next session (session 12), he told me that he had used the tape once but refused to use it again. The suggestion that he was not going insane triggered intense anxiety. He thought: "What if thinking like this only makes the belief that I am going insane even stronger and etches it ever more deeply on to my unconscious mind?" It was as if in response to being told, "There's nothing to be afraid of" there was another voice that answered firmly, "Yes there is, my fear is real!"
After a relaxation induction, I suggested he see an image of this part of him that was insistent on maintaining the fear. He saw the little demon, mischievously enjoying worrying him. I asked the demon to reveal what it was that it needed us to take seriously. At once, a series of memories of childhood unfolded, mostly of around age 6-7: waking in the night and going to his parents' room, telling them his stomach was sore, it was not sore at all but they would not listen if he were to tell the truth that he was feeling scared; left alone in a car while his father went into his office to fetch something and feeling terrified that he would be attacked and kidnapped; and being left in the house with his two sisters and feeling responsible for protecting them if any catastrophe happened, and feeling inadequate to do this.
These memories revealed the basis for his vulnerability to anxiety attacks. His parents were extremely punitive and deliberately induced fear in order to maintain discipline. He recalled the humiliation he felt when his sisters noticed bruises on his legs from being beaten with his mother's slipper. The family had a live-in servant whose boyfriend was a policeman and regularly visited in uniform. One day Tariq lost some parts from his tricycle. His parents asked the policeman to warn Tariq that if he did not find them all he would arrest him and put him in jail. Tariq, who had no idea that his parents had put the policeman up to it, was terrified. He recalled how Janita was similarly threatened: her father told her that if she misbehaved an alcoholic hobo who hung about on the street would come and get her.
In addition to this routine fear induction at home, his parents emphasized how dangerous the world was and were overprotective. After school, his father fetched him; he was not allowed to take the bus like other children. When he had a cold, he was confined to bed and medicated at once. At the beach, his parents, who could not swim, warned the children, "Don't go near the water, or you will drown." On top of this, his experience of fear was systematically invalidated by his parents. If he cried, he was branded a "cry baby" and mocked in front of the family. Whenever he expressed fear, he was explicitly told, "There's no reason to be scared" and his father often called him "sissy." His father (who had died about ten years ago) had been a respected public figure, active in political work and social upliftment. Tariq had eventually decided, "I can't be a weakling in the shadow of this powerful man." In due course, he had successfully walled off these negative experiences and found a way of also being strong and unshakeable.
Phase 2 continued: Sessions 13-14 - Guided imagery and rescripting
Tariq reported that the guided imagery of the previous session had "stirred up a pot." The idea that we had awakened a split off child part of him seemed to him both positive and negative. On the one hand, it offered a hope of cure in a way that the previous therapy had not. On the other, it introduced three new fears, each of which required to be addressed. First, he thought, "If I stir up all these old childhood fears, will I reinstate them?" This could be translated into, "If I give up the schema compensation, will I be left with nothing but the frightened child I used to be?" I pointed out that the only way to eliminate the anxiety is to tackle the schema and not to take refuge in the compensation, the capable adult persona that perched on such shaky foundations. Second, he asked, "Am I normal to have this fixated frightened child sitting inside me like this?" I told him that I regularly worked with people whose social persona seemed to others to be strong and intact but who harboured much that was unresolved from childhood. Finally, he asked, "If I let myself look at this, will this damage my relationship with my mother? Will I hold her responsible for my anxiety and become angry with her?" I pointed out that even if he did go through a period of feeling angry with his mother this need not hurt her in any way because, since he did not live near her and was about to leave the country, he could choose whether to express it to her or not.
Encouraged that the guided imagery work of the previous session was getting to the underlying causes of his anxiety attacks, and feeling at peace with these responses, he was keen to continue. After a relaxation induction, I suggested he would return to an early scene related to his present day anxiety. At once he saw himself aged 4 or 5 playing with his tricycle. He could see the policeman, and knew that pieces of the tricycle were missing. He imagined what it would be like to be taken and locked away in jail. How lonely and isolated he would be with no contact with his family. He tried to push the fear away. In the background were other memories too, from later on, when police on pass raids came at night, intimidating the family and demanding to be let in. Now he felt terrified, seeing the policeman in his uniform warning him that he would be taken away if he lost the tricycle parts.
I suggested he introduce his mother into the scene and tell her how terrified he felt. In response he spoke as his mother, telling the young Tariq how these were just threats to get him to behave himself and were not based on any real possibility that he would be taken away. She explained that little boys cannot be arrested anyway, and that even adults are not sent to jail for losing parts of their bicycles. In response, he told his mother how he had really believed what the policeman had told him. I then asked him to enter the scene as his present adult self and to tell the young Tariq that it was not appropriate for his parents to induce fear in this way as a means of changing his behaviour. Their job was to create a safe world in which he could grow up feeling secure and cared for. By telling him stories like this they were doing something that did harm that would last for a very long time. Next, I invited him to tell his mother the same thing. Tariq explained to her that these methods of discipline were counterproductive and that the fear she was laying down would trouble Tariq for years to come. Finally, he told the young Tariq that he did not have to be afraid any more because he (the adult Tariq) would look after him.
Session 14 began with his reporting that the imagery work of the previous session had "created a major insight" and a great deal had "clicked into place." He saw with a new clarity how much fear induction there had been from his parents and recalled many situations in which "fear was pressed in" while he was growing up and even as a late adolescent. It had been so strong that he had felt that the responsibility of having children was too onerous and he had not wanted to have children himself. He saw too how his parents' over-protectiveness had compounded the problem. This was a major shift. The demon had been disarmed, the resistance gone. There was also a much greater self-acceptance. He could look at himself compassionately in those early memories, without having to dismiss himself as weak and unworthy of his powerful father. He was also beginning to re-evaluate his parents' behaviour. He could see how they had reinforced the boy's normal fearfulness and caused him to feel demoralized and alone.
Finally, he recalled that telling his parents in the imagery that they should not have induced fear in the way they did had felt like defiance. He was scared to be defiant. He had been "hotheaded" and had a terrible temper, which he had learned to control. Janita had been the defiant one, and her behaviour had become outrageous and eventually she had wound up in a psychiatric hospital. Up until now, it had seemed safer to avoid behaving like her, in case he eventually went insane too. However, because I had allied myself with the healthy child and acknowledged his feelings, he realized there was no further need for defiance, which had been rooted in the desperation of not being heard.
Tariq was keen to finish with further imagery work. Session 12 had focused on the first step of inner child work, activating the child and letting it be seen. Session 13 had focused on the steps two to four, allowing the child to express his real feelings, acknowledging them empathically and explicitly naming the parental attitudes and behaviours that were harmful. A small beginning had been made towards step five, building an appropriate inner parent, in that the adult Tariq had told the boy that he would take care of him. After the relaxation, he connected with a scene at about age 7 in which his father had left him alone in the car while he went into the office. He felt alone, sad his father had not taken him along, frightened he might be kidnapped and never see his parents again, and disappointed his father had no insight into his true feelings. When his father returned, I had Tariq tell him of all these feelings in detail. Tariq replied, "I'm only 7 years old and many things frighten me. I need you to acknowledge these different feelings that I have and let me tell you about them". His father was able to recognize the boy's legitimate fear and need for parental support and undertook to be empathic and supportive instead of mocking and indifferent. He also acknowledged that ignoring and mocking Tariq's feelings and deliberately inducing fear were harmful and caused him much suffering. We closed by returning to the tricycle scene and worked to create an image of his mother as a "good parent" too. I thought that was the end of the therapy, and wondered if I had helped him enough to make a difference to his panic attacks.
Phase 3: Sessions 15-22
18 months later Tariq returned for a further 8 sessions. Overseas he had had further panic attacks, some anxiety management counselling and taken a benzodiazepine. He had been back for a few months and had recently had another panic attack. Discouraged, he concluded he was "back to square one." However, the situation was moving. He had visited the family and Janita ran to him at the airport, crying. Now he learned from a relative that she had been sexually molested at school. Here was a family plagued by trauma but it was too early for him to take in what this meant. He was ruminating again about whether he was also heading for a breakdown, and whether he might end up being responsible for her in the long term. This was an intolerable thought. He was angry about her teenage affair which she had flaunted in a way that humiliated their parents, and her repeated angry outbursts and demands that took all his parents' attention to the extent that to this day his mother could not come to visit him. He wanted to be as far from her as possible.
At last, however, he was receiving validation for his anger. First, I asked him to express it in a letter to Janita and bring the letter. He also expressed his anger at his mother for tolerating Janita's behaviour. Then on a family visit, he was surprised to find that Janita was well. He met with her psychiatrist who gave him insights into the impact of the sexual trauma and the enmeshed relationship between Janita and her mother. She encouraged him to express his anger to Janita, which he did. Previously he had believed this was not appropriate because of the hardship she had been through. Then he dreamed his father was dying, and, looking closer, saw he was already dead. In a later session, he would indicate that he now recognized that he did not have to behave towards Janita as their parents had done. He could confront her from his own feelings and did not have to take responsibility for her.
Other important changes were also taking place. He acknowledged his intolerance of being alone and began to work with the intolerance. He had also recognized how he had fought for control, being intolerant of others who saw things differently, and demanding certainty. This of course had been apparent at the beginning when he insisted on eliminating the anxiety rather learning to tolerate it. Previously accepting unwanted feelings or accepting others who thought and behaved differently was experienced as being submissive, defeated. He had now reframed it.
Phase 4: Sessions 23-30
Seven months later, he came for a final 8 sessions. He had had no more panic attacks. He worked on incidents where his father has been dismissive or angry. Tariq had once made a White friend and his father had threatened to throw him out of the house, saying "Pack your bags and go and live with them!" He realized that he had believed, "Your parents are right - what they decide is law. You don't have a right to question that." He wrote a letter to his father expressing how he felt. A few weeks later, he dreamed he said to his father, "Let's level with one another," and told his father he had been wrong about the way he did things. This was not in anger, instead he was accepting that this was how it was and feeling the sadness of his own chronic loneliness and deprivation, "a loss I've never acknowledged before", and something exacerbated by his own emotional withdrawal from others. He also realized he had been behaving in a dictatorial manner himself as a way of keeping a connection with his father and was letting go of that now. At the end, he described how he was learning new ways of being in everyday situations and had a strong sense of moving forward.
Interpretive discussion
There is considerable evidence that Tariq was helped by the therapy. He had no further panic attacks after the middle of phase 3. He became accepting of and congruent with his own emotional responses and important relationships in the family had been significantly reconfigured. How this happened is discussed in four steps as described above under method.
Step 1: Initial case formulation in terms of panic disorder
At the outset, Tariq clearly met criteria for panic disorder in terms of the DSM-IV (American Psychiatric Association, 1994). His persistent concern about having future attacks, his worry that the attacks were a sign of impending mental illness, his anticipatory anxiety at the thought of visiting his sister or playing a game of squash, as well as sometimes avoiding playing altogether in case he had an attack and it ruined his game, are all consistent with a diagnosis of panic disorder. A fear of going insane, like the fear of having a heart attack, has long been recognized as common in panic disorder and helps to escalate the panic attack (Beck & Emery, 1985). There was also evidence that panic could be relieved quite rapidly by helping clients enter situations that triggered panic and training them to rationally evaluate irrational fears and concerns (Clark, 1986), particularly with reference to misattribution of anxiety symptoms to having a progressive mental disorder or impending heart attack.
Step 2: Revised schema-focused case formulation
When the panic did not respond to a cognitive therapy approach in phase 1 and neither the first part of phase 2, the imagery work led to a developmental reconceptualisation of Tariq's anxiety. In terms of Young's (1990) theory of schema development, Tariq had developed fear-driven early maladaptive schemas (EMSs) about the world ("it is a dangerous place in which terrible things can easily happen") and about himself ("I am not safe"). As Young (1990, p. 53) pointed out, maladaptive schemas in the area of autonomy "often arise when parents overprotect their children, for example by continually warning them of exaggerated dangers and risks" and when parental behaviours "make it difficult for children to have the secure sense that they can express their own needs and feelings without fear of reprisal".
In addition, in response to his parents' punitiveness and invalidation of his fears, there was defectiveness /shame ("my feelings are not acceptable ... I'm not good enough"), social undesirability ("I am undesirable because I am weak and timid") and subjugation ("What I feel and need is not important. What my parents need is important"). Tariq had coped by schema compensation, the development of a self-identity that is the opposite of the core maladaptive schemas. Tariq's adult persona, with its strength and resourcefulness, was a compensatory structure that enabled him to cope effectively with challenging situations, including the demands of national level sporting competition.
The news of Janita's breakdown had bypassed this compensation and triggered the underlying maladaptive schemas. His request to the therapist was, in effect, for help in restoring the compensation and preventing further triggering of these schemas. It was clear that this was no longer viable. His insistence on the complete elimination of the anxiety so that he could feel completely in control and the force of the schema-driven distortion that his anxiety was a prelude to insanity could only be addressed by addressing the EMSs themselves. The inner child conceptualization undercut the resistance. Until session 13, attempts to restructure the thought "I am going insane" had evoked powerful and persuasive counter-arguments. These started to shift in response to contacting and accepting the frightened child.
Although I did not articulate my formulation consciously, my implicit understanding at the beginning of session 13 was that the taped instruction "there is nothing to be afraid of" was a direct attack on the reality represented by the childhood schemas, and these schemas were fighting back. It was as if the demon were saying: "Don't tell me that I don't feel afraid. My father and mother were always telling me that. But I am afraid. And no one will acknowledge that and listen to me." The anti-anxiety self-instructions, rather than helping the frightened inner child, were experienced as further invalidation and awakened a defiant response from a deeper part of him that wanted meaningful healing.
The work of session 13 resulted in a great deal of spontaneous insight and cognitive restructuring after the session. The recognition of the full impact of his parents' over-protectiveness and fear induction while he was growing up enabled him to distance from and disidentify with the part of him that felt frightened in a way that had never happened before. The fact that this took place is evidence for the validity of the conceptualization and the efficacy of the intervention to engage the client's early maladaptive schemas. The response to the guided imagery work provided ongoing assessment of the balance between the client's difficulties and resources. The fact that he was able to spontaneously put into his mother's mouth words telling the young Tariq that the threats used to intimidate him were never real, or into his father's mouth an empathic appreciation of the young Tariq's fear at being left alone in the car, demonstrated that the internal images of his parents contained many strong and positive characteristics and that they could be rehabilitated as caring figures for the inner reparenting process. Tariq's feedback about the last few sessions of phase 2 provides evidence for the schema based formulation. Without solicitation, he described the imagery sessions as the most useful. The anxiety management and rational restructuring work of the previous sessions had been of value, but had left him feeling he was not getting to the root of the problem.
Tariq's experience and the unfolding process in phases 3 and 4 built more detail into this formulation. In schema therapy there are two legs on which promoting change is based. The first is the work of reparenting through inner child imagery and the therapy relationship. The second is supporting the client in reconfiguring current relationships in ways which replace old dysfunctional patterns with new authentic ones. In phase 3, it became clear how his early schemas were being activated by his interactions with the family. His anger with Janita and his mother and his belief that it was not appropriate to feel anger or use it to confront them maintained his invalidation and left him disempowered and helpless. This was first challenged by the therapist's validation of his experience and taken a step further by the insights given him by the psychiatrist and her encouraging him to confront his sister. The therapy given to Janita and family members following her hospitalization had made it possible for this reconfiguration to begin. The fact that Janita was recovering and rebuilding her life and his realization that he did not have to be subjugated to her tyrannical behaviour relieved him of the fear of being permanently responsible for her.
The two dreams about his father were evidence of the transformation of his internalized parental images. In the first, he dreamed his father was dead. His father had been dead for ten years, but this dream was about the grip on his experience of his internalized father whose word was law. He no longer needed to be subjugated to him. The dream in phase 4 in which he leveled with his father and told him he had been wrong in the way he had parented showed that the shift had been thoroughly integrated. His recognition that his own controlling and dictatorial behaviour had been modelled on his father and had been a way of keeping a connection with him allowed him to give it up and become more flexible and in doing this he allowed himself to feel the loss of the loving father he had never had.
Step 3: Retrospective
Looking back to when Tariq was treated, I clearly understood the basics, but now, my clinical understanding is enhanced by the evolving literature on complex trauma. Tariq did not meet criteria for post-traumatic stress disorder (PTSD) as his anxiety was not obviously associated with flashbacks to particular traumatic events. However, he does have a "complex traumatic stress disorder" as defined by Ford and Courtois (2009, p. 442) in terms of having been exposed to "repetitive, chronic or prolonged" events that "involve harm such as physical, sexual and emotional abuse and/or neglect or abandonment by parents or caregivers" that occur at "developmentally vulnerable times ... especially over the course of childhood, and become embedded in and intertwined with the individual's development and maturation." The results of such "a history of complex psychological trauma and complex reactions" can manifest in a range of clinical or subclinical presentations that may or may not meet criteria for a DSM diagnosis. As Ford and Courtois (2009, p. 441) observed, this perspective "makes a substantial difference in clinical assessment and treatment".
The evolution of schema therapy, which fully shares this perspective, has been part of this broader appreciation. Tariq's story is like that of many clients who do not respond to brief CBT interventions and for whom Young's (1990) schema therapy was developed. I had the good fortune of attending seminars by Young during a post-doctoral fellowship in 1985 and had used similar imagery methods prior to these seminars. A schema based formulation therefore evolved naturally once we began the imagery work. Given Tariq's demand that the problem be sorted out rapidly, and because brief treatments of panic disorder had been developed, I did not look deeper in the first few sessions. Looking back that does not seem inappropriate. A great deal of relevant information was gained and Tariq's self-awareness increased during that phase.
Tariq's panic attacks were not obviously secondary to another disorder such as generalized anxiety, social phobia or PTSD. Yet they were the tip of a big iceberg. I see more clearly now how formulation in schema therapy has much in common with our current understanding of PTSD in that it supposes that intense symptoms are evoked by the activation of a dissociated memory system. In PTSD, a dissociated memory of a traumatic event is experienced as a flashback. In schema therapy, the schema is usually associated with a series of painful childhood memories, although most of them may not qualify as life threatening traumas. When the schema is triggered, emotions associated with the schema memories are experienced, but, as Young et al. (2002, p. 29) observed, "the individual may or may not connect this experience with the original memory ... the memories are at the heart of the schema but they are usually not clearly in awareness, even in the form of images". This may happen with PTSD too so that the traumatic basis of panic attacks or other intense symptoms may not be correctly recognized by clinicians (Raby & Edwards, 2011).
Tariq's experience was embedded in schemas incorporating a range of intensely distressing childhood experiences that included physical punishment that left him covered with bruises, threats of being arrested and imprisoned (at the age of 4), the fear of being kidnapped, and experiences of the house being raided by security police because of his father's political activism. They also included the confusing mixture of punitiveness, overprotectiveness and invalidation of his experiences. There is much we do not know, such as the impact of his mother's breakdown when Tariq was born and the general climate of growing up with a political activist father amid the escalating violence of the later apartheid years. Other childhood memories contributed to his fear of insanity. We do not know whether his mother's breakdown played a role here, but there was a contribution from the fears evoked by his relatives with Downs Syndrome. Some of this was addressed directly in the imagery work which anticipated future developments in the field as this kind work would soon be called "imagery rescripting" and become a standard CBT intervention for a range of clinical problems (Arntz, 2011; Holmes, Arntz, & Smucker, 2007).
Increasingly theories of psychotherapy engage with the multiplicity of voices or parts of self and see psychotherapy as a process in which clients learn to help conflicting parts work together in new ways (Rowan & Cooper, 1999; Stiles, 2011). Although at the time I was aware of how dysfunctional coping had locked Tariq into his anxiety, today I would explicitly formulate them in terms of schema modes, which have become a central feature in contemporary formulation (Lobbestael, van Vreeswijk, & Arntz, 2007; van Genderen, Rijkeboer, & Arntz, 2012; Young et al., 2002). Here I italicize the terms for these modes, some from the literature, others adapted by me. Access to Tariq's vulnerable child was blocked by a range of modes: 1) parent modes, internalized from his childhood, the punitive parent that criticized and invalidated, and the demanding parent that required him to perform; 2) avoidant modes, the detached protector that cut off his emotions, and the avoidant protector where he avoided threatening situations; and 3) compensatory modes included an adult mode that enabled him to function effectively, but was not a fully healthy adult since it was cut off from the child and engaged in rationalization and denial (rationalizing over controller), there was also a scolding overcontroller that imposed control on others, while one mode in which he felt anxiety was not the vulnerable child but a worrying overcontroller that ruminated ineffectively in the hope of eliminating uncertainty.
The question is whether these insights would have made a difference to the course of therapy back then. In a similar case today I would probably spell all this out, but even without my having been that explicit, we can see from the narrative that Tariq increasingly allowed the coping modes to weaken. He experimented with more authentic behaviour as the healing in his vulnerable child allowed a connection between the emotions in the child and the rationality and strength of the adult which allowed for the building of a flexible and sensitive healthy adult. If I were treating him now I would have given him Young and Klosko's (1994) Reinventing your life and/or Helen Kennerley's (2000) Overcoming childhood trauma to read during phase 2. They were not available to me then. These might have expedited the pace at which he got to grips with the schema based sources of his problems, but given his frequent relocations these might not have made much difference. Looking back we can see that Tariq's therapy unfolded organically, with the work of each phase providing a foundation for the work of the next as his own innate capacity for healing (Bohart & Tallman, 2010) was supported and strengthened.
Concluding reflection
Phenomenological psychology must do justice to the range of human experiences. This includes the experiences of people that unfold in psychotherapy. The process of psychotherapy is of particular relevance to the phenomenological project because it is a prolonged process of evoking and explicating meanings - which is at the heart of phenomenological psychology. The concept of the lifeworld focuses on the way in which an individual's life and experiences are embedded in life and action in the world. It is a way of stating that experience cannot be separated from the process of living and acting in the world, both physical and social. However, there is a trap here. In practice, much of human experience in the lifeworld is inauthentic, circumscribed by roles, self-protective coping, and meeting other's expectations. It does not have an openness at all. As Kruger (1988, p. 37) observed, individuals can "keep certain aspects of [their] experience in the dark and can in fact hide [themselves] behind a mask".
A focus on the lifeworld deals with consensual reality as widely shared, but leaves mysterious individual experiences which diverge from those of others. Although, Kruger (1988, p. 87) argued that each individual's "life structure remains in principle open", this openness calls for a capacity for reflection which is best done in dialogue with someone who can create "optimal conditions" for them to explicate their experience. This involves empathy and attunement on the part of the therapist that can set in motion what is essentially a creative process that allows the deeper meanings to emerge. For Kruger (1988) these primarily emerge in words, but they can, as powerfully, emerge as images. Kruger (1988) also sees this as a process that is not just of interest to armchair philosophers. It is a process that can give rise to transformation and healing, and the finding of a new way of being-in-the-world.
As Kruger (1988, p. 79) pointed out, anxiety arises in response to threat and that "what looks like something harmless to others can reveal itself to the perceiving person as something quite threatening". The phenomenological stance can therefore not dismiss anxiety that appears irrational or ill founded. However, acknowledging the experienced sense of threat is only the beginning. The kind of psychotherapy described here helped Tariq explicate the initial distressing experience and layers of deeper meanings that were colouring and exacerbating his experience with threat. The recognition of individual differences in how the same situation is experienced is central to phenomenology and is understood in terms of historicity: each individual's experience in the present is shaped by his or her unique course through life. How this happens, how the past shapes the experience of the present, is of central importance to psychotherapy because problematic experiences are so often rooted in meaning systems that were shaped by adverse situations in the past.
This study provides a detailed investigation of how this developed in Tariq's life. Returning to the quote from Herman (1992, p. 123), in the first paragraph of this article, "the connection between the presenting problem and the history of chronic trauma" is something that therapists need to help their clients uncover as an important step in bringing about a change in their experience. Case studies like this one are particularly significant for the science and practice of psychotherapy as they show how such problematic meanings can indeed be uncovered and changed.
The author thanks 'Tariq' for giving permission for this material to be used for research and publication.
This research was supported by grants from the National Research Foundation and the Research Committee of Rhodes University.
Referencing Format
Edwards, D. (2013). From panic disorder to complex traumatic stress disorder: Retrospective reflections on the case of Tariq. Indo-Pacific Journal of Phenomenology, 13(2), 14 pp. doi: 10.2989/IPJP.2013.13.2.6.1180
Abrams, J. (1990). Reclaiming the inner child. Los Angeles, CA: Jeremy Tarcher. [ Links ]
Alexander, F. G., & French, T. M. (1946). Psychoanalytic therapy: Principles and applications. New York, NY: Ronald. [ Links ]
American Psychiatric Association. (1994). DSM-IV: Diagnostic and statistical manual of mental disorders (4th ed.). Washington D.C.: American Psychiatric Association. [ Links ]
Arntz, A. (2011). Imagery rescripting as a therapeutic technique: Review of clinical trials, basic studies, and research agenda for personality disorders. Journal of Experimental Psychopathology, 3, 189-208. doi: http://dx.doi.org/10.5127/jep.024211 [ Links ]
Beck, A. T., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive approach. New York, NY: Basic Books. [ Links ]
Bohart, A., & Tallman, K. (2010). Clients as active self-healers: Implications for the person-centred approach. In M. Cooper, J. C. Watson, & D. Holldampf (Eds.), Person-centred and experiential therapies work: A review of the research on counseling, psychotherapy and related processes (pp. 91-131). Ross-on-Wye, United Kingdom: PCCS Books. [ Links ]
Bradshaw, J. (1990). Home coming: Reclaiming and championing your inner child. New York, NY: Bantam. [ Links ]
Capacchione, L. (1991). Recovery of your inner child. New York, NY: Fireside books. [ Links ]
Clark, D. M. (1986). A cognitive approach to panic disorder. Behaviour Research and Therapy, 24, 461-470. [ Links ]]
Courtois, C. A., & Ford, J. D. (2009). Treating complex traumatic stress disorders: An evidence-based guide. New York, NY: Guilford. [ Links ]
Dendy, W. C. (1853). Psychotherapeia, or, the remedial influence of mind. The Journal of Psychological Medicine and Mental Pathology, 6, 268-274. [ Links ]
Edwards, D. J. A. (1989). Cognitive restructuring through guided imagery. In H. Arkowitz (Ed.), Comprehensive handbook of cognitive therapy (pp. 283-297). New York, NY: Plenum. [ Links ]
Edwards, D. J. A. (1990). Cognitive therapy and the restructuring of early memories through guided imagery. Journal of Cognitive Psychotherapy, 4, 33-51. [ Links ]
Edwards, D. J. A. (1995, March). Integrating inner child work into cognitive therapy for panic: A case study. Paper presented at a conference of the Psychological Association of South Africa, University of Pietermaritzburg, Pietermaritzburg, South Africa. [ Links ]
Ellenberger, H. F. (1970). The discovery of the unconscious: The history and evolution of dynamic psychiatry. New York, NY: Basic Books. [ Links ]
Farrell, J. M., & Shaw, I. A. R. N. (2012). Group Schema Therapy: Catalyzing schema and mode change. In M. van Vreeswijk, J. Broerson, & M. Nadort (Eds.), The Wiley-Blackwell handbook of schema therapy: Theory, research and practice (pp. 341-358). Chichester, United Kingdom: Wiley-Blackwell. [ Links ]
Farrell, J. M., Shaw, I. A., & Webber, M. A. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40(2), 317-328. doi: http://dx.doi.org/10.1016/jjbtep.2009.01.002 [ Links ]
Ferenczi, S. (1929). The principle of relaxation and neocatharsis. In M. Balint (Ed.), Final contributions to the problems and methods of psycho-analysis (E. Mosbacher and others, Trans.) (pp. 108-125). New York, NY: Brunner/Mazel. [ Links ]
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20-35. [ Links ]
Ford, J. D., & Courtois, C. A. (2009). Conclusion: The clinical utility of a complex traumatic stress disorders framework. In C. A. Courtois, & J. D. Ford (Eds.), Treating complex traumatic stress disorders: An evidence-based guide (pp. 441-453). New York, NY: Guilford. [ Links ]
Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., ... Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized controlled trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63, 649-658. doi: 10.1001/archpsyc.63.6.649 [ Links ]
Giorgi, A., & Giorgi, B. (2003). Phenomenology. In J. A. Smith (Ed.), Qualitative psychology: A practical guide to research methods (pp. 25-50). London, United Kingdom: Sage. [ Links ]
Herman, J. L. (1992). Trauma and recovery: From domestic abuse to political terror. New York, NY: Basic Books. [ Links ]
Holmes, E. A., Arntz, A., & Smucker, M. R. (2007). Imagery rescripting in cognitive behaviour therapy: Images, treatment techniques and outcomes. Journal of Behavior Therapy and Experimental Psychiatry, 38, 297-305. [ Links ]
James, M. (Ed.). (1977). Techniques in transactional analysis for psychotherapists and counsellors. Reading, MA: Addison-Wesley. [ Links ]
Kelly, G. A. (1955). The psychology of personal constructs. Volume 1: A theory of personality. New York, NY: W. W. Norton. [ Links ]
Kennerley, H. (2000). Overcoming childhood trauma: A self-help guide using cognitive behavioral techniques. New York, NY: New York University Press. [ Links ]
Kruger, D. (1988). An introduction to phenomenological psychology (2nd, rev ed.). Cape Town, South Africa: Juta. [ Links ]
Lobbestael, J., van Vreeswijk, M., & Arntz, A. (2007). Shedding light on schema modes: A clarification of the mode concept and its current research status. Netherlands Journal of Psychology, 63, 76-85. doi: 10.1007/BF03061068 [ Links ]
Missildine, W. H. (1963). Your inner child of the past. New York, NY: Simon & Schuster. [ Links ]
Raby, C., & Edwards, D. (2011). Unrecognized hospital trauma as a source of complex psychiatric symptoms: A systematic case study with implications for children's rights and evidence-based practice. Psychotherapy Research, 21, 541-553. doi: http://dx.doi.org/10.1080/10503307.2011.587470 [ Links ]
Rowan, J. (1990). Subpersonalities. London, United Kingdom: Routledge. [ Links ]
Rowan, J., & Cooper, M. (Eds.). (1999). The plural self: Multiplicity in everyday life. London, United Kingdom: Sage. [ Links ]
Smith, J. A., & Osborn, M. (2003). Interpretative phenomenological analysis. In J. A. Smith (Ed.), Qualitative psychology: A practical guide to research methods (pp. 51-80). London, United Kingdom: Sage. [ Links ]
Stiles, W. B. (2011). Coming to terms. Psychotherapy Research, 21, 367-384. [ Links ]
Stiles, W. B., Elliot, R., LLewelyn, S. P., Firth-Cozens, J. A., Margison, F. R., Shapiro, D. A., & Hardy, G. (1990). Assimilation of problematic experiences by clients in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 27(3), 411-420. doi: http://dx.doi.org/10.1080/10503307.2011.582186 [ Links ]
Stone, H., & Winkelman, S. (1988). Embracing our selves: The voice dialogue manual. Tiburon, CA: Nataraj. [ Links ]
van Genderen, H., Rijkeboer, M., & Arntz, A. (2012). Theoretical model: Schemas, coping styles and modes. In M. van Vreeswijk, J. Broerson, & M. Nadort (Eds.), The Wiley-Blackwell handbook of schema therapy: Theory, research and practice (pp. 27-40). Chichester, United Kingdom: Wiley-Blackwell. [ Links ]
van Vreeswijk, M., Broerson, J., & Nadort, M. (Eds.). (2012). The Wiley-Blackwell handbook of schema therapy: Theory, research and practice. Chichester, United Kingdom: Wiley-Blackwell. [ Links ]
von Eckartsberg, R. (1998). Existential-phenomenological research. In R. Valle (Ed.), Phenomenological inquiry in psychology: Existential and transpersonal dimensions (pp. 21-62). New York, NY: Plenum. [ Links ]
Young, J. E. (1990). Cognitive therapy for personality disorders: A schema-focused approach. Sarasota, FL: Professional Resource Press. [ Links ]
Young, J. E. (1999). Cognitive therapy for personality disorders: A schema-focused approach (3rd ed.). Sarasota, FL: Professional Resource Press. [ Links ]
Young, J. E., & Klosko, J. (1994). Reinventing your life. New York, NY: Plume. [ Links ]
Young, J. E., Klosko, J., & Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. New York, NY: Guilford. [ Links ]
About the Author
David Edwards has been a Clinical Psychologist and practising therapist for over thirty years. He is a founding fellow of the Academy of Cognitive Therapy, having trained at Beck's Centre for Cognitive Therapy in Philadelphia in 1984/5 where he attended seminars with Jeffrey Young, the developer of schema therapy. Professor Edwards has a longstanding interest in psychotherapy integration and has done experiential training in a variety of humanistic and transpersonal approaches. He is certified as a schema therapist and schema therapy trainer with the International Society of Schema Therapy (ISST). He is a Professor at Rhodes University, where, until his recent retirement, he provided professional training and supervision in cognitive therapy for two decades.
Over a long career, he has published some 70 academic articles and book chapters, overing areas as diverse as the use of imagery methods in psychotherapy, the history of imagery methods, case studies of the treatment of simple and complex PTSD, guidelines on the treatment of trauma related disorders, case studies of the treatment of other disorders including conduct disorder, ADHD and social phobia, and case study as a research methodology. Additionally, Professor Edwards has co-edited a first year text book, and is the author of 'Conscious and Unconscious', in the series Core concepts in Psychotherapy (McGraw Hill). His research for this book led to the publication of two articles in the IPJP in 2003 and 2005.
For more information about him and the training he offers, visit www.schematherapysouthafrica.co.za E-mail address: email@example.com


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About LivingInNavarre
With how many storied TD has run about the NSA lately I'm suprised they haven't started a whole new site devoted just to the NSA.
I'd bookmark NSA-Dirt!
Are you kidding!? Just ask for a government grant for creating liberal art displays.
When things finally get bad enough our choices will be Red, Blue or Lead :/
Maybe I'm way off the mark but if it's so obvious they will mostly ignore all that streaming media wouldn't it be easy to start embedding messages into said media? Hell, for that matter you could just run subtitles to give the orders for Jihad.
Ooops, think I gave them something to think about. Now they'll have to collect all data!
The part I found most interesting was a story that stated the judge ONLY looked at the Constitutionality of the policy...even though she does go on to mention that 88% of the stops resulted in releasing the individual with no further action.
To add to the popcorn debate Schumer was furious that they didn't get a fair hearing in front of the judge.
I know I should insert some witty remark about pots, kettles and black but it's not worth the effort.
It was my thought that there's a 90% chance that more info will be leaked. Nothing like having a soon to be terminated sysop looking for revenge. My guess is every one of them are loading up thumb drives as we speak.
Out of curiosity did you not listen to his words carefully before voting for him? Once you stopped listening to the 'promises' you realized this is one scary dude and has some really twisted ideas for the future of America.
Remember playing that old game with the big soft mallet caleed "Whack A Mole"?!?!
Due to the oversight of releasing conflicting redacted documents. [REDACTED] will be terminated.
http://www.theatlanticwire.com/national/2013/08/government-knocking-doors-because-google-searches/67 864/#.UfqCSAXy7zQ.facebook
Makes you wonder if they are not looking then how did they know?
At least that takes the heat off the Tea Party Terrori...erm, I mean Patriots.
I loved the article that correlated the amount of campaign donations to their yes or no vote. I'm proud to say my elected official Bill Miller received $109,000 in campaign donations from the snooping industry and he proudly voted to defeat the Amash Amendment. Bless his heart for not listening to his constituents.
Techdirt meet Drudge. Pretty cool.
Yes, I agree with that but lets first take care of the vets that are fighting, being wounded or dieing so we can be free.
We ask young men and women to risk their lives to fight wars with no cause. Then we take their school benefits away, deny them proper health care, punish them if they have christian or conservative views.
It's sickening to see money wasted on overbroad spying programs or welfare for people who do not benefit this country.
The House has voted 36 times to repeal Obamacare. It's still here so when you are a minority (and 2 good legislators are very much a minority) then they have a snowballs chance in hell of getting any bill even considered.
If the public is properly outraged, and a class action suit will give it the media attention it desperately needs, then those same people can start calling their own elected officials and ask for something to be done.
But I really doubt even that will be enough. I'm against this half-baked amnesty bill and have called, emailed and faxed my boy Rubio to express my concerns. The best I've gotten back is a very generic form letter telling me the benefits of letting millions of illegals to suddenly be able to collect welfare.
Not sarcastic. Part of me wanted to see the reaction from that statement.
I wish we still had a government that functioned for the betterment of the people but I fear those days are gone forever. When there are no proper channels to effect change it really limits what we can do and the alternatives are scary.
I realize I no longer have rights and my elected representatives don't listen to me. What options are left for us to create change?
I'm on the fence about his situation. There are valid whistleblower channels he could have worked through before going public. On the other hand I can see how it looks like no one will be punished for the IRS scandal.
This weekend a lot of talking heads from congress and various administrations have said he took an oath. The same kind of oath they took themselves yet seem to violate when it's convenient.
I guess I disagree with how he went public yet I fully understand. This was the dark secret we all knew about but once it became open knowledge we will look at our government differently. Hopefully the dialog will be about how our government is running amok and not about the leak.
And for Snowden, I hope he was smart enough to keep some secrets in a safe place to be exposed only if something happens to him.
Seems all cable news has turned into tabloid stories. I admit if I watch tv news it will be FOX but they are a day or more behind what's already on the internet.
Since I am a conservative I tend to Drudge. But I have noticed many of the breaking stories are links to local papers or small local tv stations.
I guess I find it funny that when I hear FOX or CNN say 'breaking news' it's a story I already read 3 days ago put out by some small affiliate.
There already is a stupid version of this going on. How about installing cameras to watch cameras?
I think I will take out a patent on 'insertion of over cook semi beef patty into round bi-symmetrically separated bread container'


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Monday, July 1, 2013
July 1 - Moses the Black, Martyr, Peacemaker, Convert
Moses was a slave to an Egyptian slaveholder and did his job only because he was forced to do so. He was known as a man of excess who ate too much and drank too much as well as being sexually immoral and physically and verbally abusive. Eventually, he was cast out of the home of his master because he was finally caught stealing from the coffers and then he had murdered another slave to cover over his offense. He was cast into the wilderness but his hard life and dark desires had formed him into the kind of man who could survive for quite a while with very little. For those years he was fueled only by a dark rage and vengeful passion. He assembled around himself a band of thieves and bandits who obeyed his commands and executed his sinful desires. Having placed himself in a position of dominance and control he was able further to drift into the grasp of corruption--indeed Moses could be said to "live by the sword." One night he swam across a stream, with a knife clenched in his teeth, to murder a man in his sleep. He had targeted this man because the man's dog had foiled a previous robbery attempt by Moses and his fellow bandits. In that attempt, many of the band that followed Moses were arrested. Luckily for his victim--and for Moses--the dog alerted the owner and the authorities yet again. Moses knew he would be executed for his many crimes if he was caught and so he fled so that he might keep his freedom.
He fled from the authorities who were now searching for him and found refuge in a monastery in the desert of Scetes near Alexandria. At first, it was a convenient place to hide where the authorities would not come and take him and nothing more but through the slow and steady ministry of the monks, he began to be converted to the faith of his hosts. After many long day, he finally professed faith in the one who had said that all who live by the sword will die by the sword. He renounced his past life and sins and devoted himself to the monastic life even as he failed to fit into it well. He was a novice in the faith and often asked questions of his brothers so that he might learn how to live like a Christian. He now believe that his previous way of living was bankrupt and led to death but he knew no other way and so he had to be taught slowly. One night, thieves broke into the monastery to take some of their meager possessions. Being a big man and given to adventure, he disarmed each of the men and dragged them by the collar of their clothing into the chapel where the monks were praying. He interrupted their worship to ask their advice: "I don't think it's Christian to hurt them," Moses said, "so what do I do with them?" The thieves looked at the peaceful man who had skillfully disarmed them without a weapon and were impressed by his words. If Moses the Black could find peace through Jesus, they reasoned, then they could do the same. Soon, they were converted.
Moses spent the rest of his life trying to become the best follower of Jesus that he could be. It was hard and though he was not especially gifted for the monastic life--his background game him no assistance--he grew slowly and steadily. Once, he was asked to attend a meeting of monks to discuss an appropriate penance for a brother who had sinned against the others.Moses didn't show up on time and so they sent a man to fetch him but Moses was unwilling to come. Finally, the brother in charge of the meeting went to bring Moses to the meeting and Moses agreed to do so because of his love and respect for the man. Before he left, though, he grabbed a jug of water that had a small hole in it. They walked all the way back to the meeting with the water leaking out behind him. When he finally arrived they asked him why he had brought a leaky jug with him and he responded,"My sins run out behind me and I do not see them, but today I am coming to judge the errors of another." The group dismissed themselves to reflect upon the message that Moses had brought to them and later decided that grace, mercy, and forgiveness were the appropriate responses to a brother who has sinned when each of us--all of us--has the same problem and same need.
Years later, Moses had become the leader of a group of desert monastics. As a group of Berber raiders bore down upon the monastery the monks argued that they must prepare to resist their attackers. Moses--who had once lived by the sword--forbade any resistance and, instead, instructed his monks to pack their things and flee the monastery immediately. He insisted it was better to run or to die than it was to take up the sword in resistance and when he said it he spoke from dark and painful experience. Most of the monks took him up on the offer but Moses and seven others stayed behind and waited for the raiders with open arms and plates of food. Moses knew that his own martyrdom was fast approaching and insisted that this was a good thing for he had lived by the sword and, now, he would gladly die by the sword. When the raiders arrived, they had no time for the hospitality of the monks and cut them down where they stood. Moses the Black who had misspent his youth found redemption not on the day he was martyred but on the day he met a group of monks who taught him another way--a way of peace, love, mercy, and grace.
Posted by Joshua Hearne at 7:00 AM
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Each Night Features a Favorite Episode of One of the Sharks
We're going to need a bigger week. ABC'S hit series "Shark Tank," fresh from a TCA Award win for Outstanding Achievement in Reality Programming and 2013 Emmy nomination for Outstanding Reality Program, is eating up ABC's primetime schedule with a special "Shark Tank Week," beginning Sunday, September 8 at 8:00 p.m. "Shark Tank Week" will conclude on Friday, September 13 at 9:00 p.m., gearing up for the Season 5 premiere the following week, on Friday, September 20 (9:00-10:00 p.m., ET) on the ABC Television Network.
The Sharks thoughtfully fished out six episodes from the past four seasons. Following are highlights from each episode, along with quotes from the Sharks themselves about why these episodes are among their personal favorites:
Sunday, 9/8 (8:00-9:00 p.m., ET) - (Mark Cuban's pick) --"Episode 401" - Two business partners from Bedford, NH demonstrate to the Sharks how to use SurfSet, their surf-inspired exercise equipment. Mark Cuban says, "SurfSet fitness is one of my all-time favorite episodes because, not only did I have to work hard to get a deal, but because they are great people that I really enjoy working with." (OAD: 9/21/12)
Monday, 9/9 (8:00-9:00 p.m., ET) - (Lori Greiner's pick) -- "Episode 407" - "This was the most compelling episode EVER!," explained Lori Greiner. "Even though I knew what was going to happen,
I was on the edge of my seat watching! The Scrub Daddy pitch is riveting as Daymond and I are in a fast-paced 'auction style' bidding war with a huge surprise twist at the end! Also," she adds, "the Shemie (a modern day slip) pitch in this episode is an emotional roller coaster that revealed secrets and surprises none of us ever expected!" (OAD: 10/26/12)
Tuesday, 9/10 (8:00-9:00 p.m., ET) - (Robert Herjavec's pick) - "Episode 301" - Music lover Robert Herjavec enjoys the pitch-perfect presentation from a Dothan, AL man who is overcome with emotion when he explains why the Sharks should take ChordBuddy, his unique guitar learning system, on the road. "A great investment is not just about the money - it's the product, pitch and, most importantly, the entrepreneur and his ability to execute," says Robert. "When you get all that - plus the benefit of a really fun guy and the chance to be a rock star - you get a home run!" (OAD: 2/3/12)
Wednesday, 9/11 (8:00-9:00 p.m., ET) - (Barbara Corcoran's pick) - "Episode 406" - "This episode is chock-full of everything that makes us all love 'Shark Tank!,'" says Barbara Corcoran. "I meet my favorite entrepreneurs of all time -- Young Sabin and Jim of Cousins Maine Lobster, a single but very profitable food truck in LA. The cousins answer a battery of tough questions without blinking an eye. But not one Shark thinks to ask the obvious... 'How long have you been in business?' I later learned that they had only been in business six months but had watched every single episode of 'Shark Tank's' four seasons and prepared multiple answers for every question they heard! Walking, talking examples of over-preparation, a key trait found in every great entrepreneur. Sabin, Jim and I are reelin' in the dough, no surprise." (OAD: 10/19/12)
Thursday, 9/12 (8:00-9:00 p.m., ET) - (Daymond John's pick) - "Episode 315" -- Emotions run high on both sides of the Tank when Billy Blanks, Jr., the once-homeless son of Tae Bo legend Billy Blanks, asks the Sharks to invest in Dance With Me, his and his wife's dance fitness program designed for all ages, shapes and sizes. "Episode 315 was an emotional episode for me. After I realized Billy Blanks Jr. did not fully understand the deal Mark Cuban and I offered him, I got out of my seat and chased after him. I did not want this amazing person to walk away from a deal because of a misunderstanding. The episode shows that the person behind the company is always more important than the numbers." (OAD: 5/11/12)
Friday, 9/13 (9:00-10:00 p.m., ET) -- (Kevin O'Leary's pick) - "Episode 422" - A mother and daughter team from Cohasset, MA offer the Sharks a sweet opportunity to invest in Wicked Good Cupcakes, their homemade cupcakes-in-a-jar business. Kevin O'Leary, aka Mr. Wonderful, says, "I love a strong woman who can run a business. I'd invest in a woman first before a man any day, and I did." (OAD: 4/26/13)
"Shark Tank" became a ratings force this past season, regularly finishing as Friday night's No. 1 program on the major networks among Adults 18-49. In addition, the series grew 17% year over year to deliver its highest-rated season ever.
Last season, the Sharks offered $12.8 million of their own money in investment deals. In Season 3 the Sharks offered over $6.2 million; in Season 2 they offered close to $4 million, and in the show's first season they offered $5.4 million to entrepreneurs.
Mark Burnett, Clay Newbill and Phil Gurin are the executive producers of "Shark Tank," which is based on the Japanese "Dragons' Den" format created by Nippon Television Network Corporation. The series is produced by Sony Pictures Television.


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Rescue Mission, IWU to Announce PartnershipPosted: Updated:
Want A Guaranteed Negative Return?
Here we go again! On Wednesday, August 14th, we watched the Dow Jones Industrial Average (DJIA) drop over 800 points. The previous Monday the Dow ended down over 700 points. But what you may have missed is the sharp downward move in interest rates that has intensified with the recent stock market volatility. What does this mean for your portfolio?
Most Popular Stories
Historic Military Convoy to Cross Indiana
A sentinel moment of U.S. history is playing out Sunday in South Bend when the recreation of the U.S. Army Transcontinental Military Convoy rolls into town. Approximately 70 historic military vehicles are retracing the original 1919 cross country trip which traveled along the famed Lincoln Highway.
West Lafayette Center Breaks Ground
West Lafayette city officials this week broke ground on the $31.5 million West Lafayette Wellness and Aquatic Center at Cumberland Park. Plans for the 72,000-square-foot project feature a natatorium, three gymnasiums, exercise machines, free weights and community rooms.
Forbes Ranks Top Colleges; 3 Indiana Schools Make the Cut
Forbes released its 12th annual ranking of America's Top Colleges based on direct benefits a university or college provides its students. Several Indiana universities made the list in some "sub-categories", like Grateful Graduates Index, but the University of Notre Dame was the only school in the state to break the top 20 overall rankings.
Caito Foods to Cut Jobs
Michigan-based SpartanNash (Nasdaq: SPTN) has decided to discontinue the Indianapolis-based Caito Fresh Kitchen operations. The grocery retailer-distributor acquired Caito Foods Service in January 2017 for $217 million. The company broke ground on its $32 million fresh kitchen process facility in 2015.
Foundation Investment Partners Acquires W.A. Jones
Cleveland-based private equity firm Foundation Investment Partners has acquired Whitley County-based truck parts distributor W.A. Jones. Terms of the transaction were not disclosed.


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September 13, 2010
Panna Cotta
200ml cream
100ml milk
45g sugar
3g gelatine powder
1 tsp water
Mix the gelatine powder with a tsp of cold water and let it bloom.
Bring the milk, cream and sugar to boil in saucepan. Turn off the heat once it starts to boil.
Add the gelatine and mix well, making sure it is all dissolved.
Cool down to room temperature, and then pour into pots/containers and leave in fridge to set.
Strawberry Mousse
150g strawberry puree
2g gelatine powder
200ml cream
30g sugar
1 tsp water
Mix the gelatine with the water and let it bloom.
Heat sugar with strawberry puree until sugar has melted. Add the gelatine to it and mix well until dissolved. Cool down to room temperature.
Whisk cream until stiff peaks. Fold in strawberry mixture until well mixed.
Spoon or pipe the strawberry mousse over the panna cotta and leave it in the fridge to set.
Strawberry Glaze
3 tbsp strawberry jam
50g strawberry puree
Heat up the strawberry jam with the puree until well mixed. Cool to room temperature and pour a thin layer over the top of each pot. Return to fridge to set.
6 comments:
- Divas and dreams photography blog said...
Oh wow, this looks so yummi....I gotta try to make this, I´m sure my kids would love them too :-)
Thanks for your sweet comment. I think your blog is lovely too and your design is so pretty, your color combo and your taste is amazing.
Take care
Hugs Christina
- September 13, 2010 at 6:35 AM
this looks sooooo pretty and delish, you're one talented miss!! you're inspiring me to get my baking act together again!
- September 14, 2010 at 1:27 PM
- Ingrid said...
These look amazing and I love the way you have laid the images out - makes it very easy to follow the recipe.
Ingrid x BYW
- September 23, 2010 at 8:41 AM
- Jamie said...
These are fabulous! I've been itching to make panna cotta again but your double dessert of panna cotta and mousse puts my little simple dessert to shame! This is simply gorgeous!
- October 22, 2010 at 8:00 AM
- thepassionatecook said...
loving your pictures... and craving that panna cotta! the strawberries here in s'pore leave much to desire... waiting for ozzie season to officially open!
- October 23, 2010 at 5:55 PM
- heavenwildfleur said...
passionatecook: thanks! i totally agree that strawberries in sg are pretty blah... most of the time sour and anaemic looking :( can't beat the fresh produce in europe...
- October 24, 2010 at 11:20 PM


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Steam now offers early access to DayZ, the standalone game based on the Arma II zombie modification of the same name. Here's the warning about what this does and does not include: "DayZ Early Access is your chance to experience DayZ as it evolves throughout its development process. Be aware that our Early Access offer is a representation of our core pillars, and the framework we have created around them. It is a work in progress and therefore contains a variety of bugs. We strongly advise you not to buy and play the game at this stage unless you clearly understand what Early Access means and are interested in participating in the ongoing development cycle." Here's the overview of the project:
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Strength in Numbers
Update: Don't bother reading what I wrote below. Go read what Gulliver wrote almost a year ago instead.
All of the DoD budget talk and the vociferous debate over whether or not to preemptively strike Iran's nuclear infrastructure has highlighted what I think is a troubling trend in military analysis.
Too often, analysts point to total military expenditures as a means to compare relative military strength. For instance, proponents of forthcoming DoD budget cuts like to cite the fact that the U.S. spends more on national defense than every other country in the world combined as evidence that DoD can afford to tighten the purse strings. This evidence also appears when analysts and pundits are making the argument that Iran does not pose a military threat to the United States.
This argument is not limited to appearances in pithy op-eds and blogs either. It's prevalent in scholarly journals and other academic texts as well. The following is from a 1997 article in International Security:
Each of the Eurasian great powers (with the exception of Russia) spends about the same amount on its military as the others, which suggests that none could easily overpower the rest.
Now, the authors moderate their claim by using the word 'suggests', but the point is clear – they believe similar levels of military spending equate to similar levels of military power.
Is this really the best way to measure the relative military strength of two or more countries? I submit that the answer is no. Military power is far too complex to measure with a simple fact like military expenditures. Concepts like doctrine and readiness are hard to quantify, but play a huge role in military power.
Let's take the following hypothetical.
Let's assume that the U.S. and Russia spend the same amount of money on their respective militaries. Let's further assume that the U.S. allocates a sizeable portion of its resources to training – we'll say the average fighter pilot gets roughly 150 hours per year in the cockpit. Russia, meanwhile, elects to spend its resources on slightly more capable jets, but its pilots only get 20 hours per year flight time, and they ran out of money before they could build a simulator. If we assume that similar circumstances exist throughout the Russian armed forces, who has the more capable military? The well-trained one or the one with the expensive equipment that the troops don't know how to use effectively?
Military spending is an easy way to measure military strength, insofar as it can provide an initial estimate for assessing the comparative military strength of two or more countries and/or be included in an introduction to set the stage for the main argument. But it's hardly appropriate to cite such data as your sole evidence while making an argument in favor of budget cuts or whether a hostile power represents a military threat.
And if that's not convincing, just look at the Pentagon. Not exactly the model for spending money efficiently or wisely, huh?
Jomini permalinkFebruary 7, 2012 6:35 am
I don't know how deliberate this is, but you are sort of implying that the huge budget for the U.S. military doesn't necessarily translate into an advantage in combat because much of the money disappears into corruption, OK into the part of the Department of Defense that makes it impossible to produce audited accounts.
February 7, 2012 10:58 am
The approach you've described, particularly the quote about spending parity among Eurasian great powers, is common in the international relations/political science literature. Military analysts – both academic and popular – should do better.
Here's what I wrote about this almost a year ago, after the 2011 IISS Military Balance was published:
Which brings us back to relative military power: from a strategic planning perspective, comparative measures aren't particularly useful. We should more appropriately be asking "what is X country's capability to perform this particular mission?" Frankly, it doesn't matter one damn bit whether China achieves parity in global military power with the U.S. next year, ten years from now, in a century, or never. What does matter is when Chinese capabilities begin to meaningfully impinge upon the USG's ability to accomplish its desired ends in a particular theater, the most important of which, of course, is probably Northeast Asia/the Western Pacific. You could argue that this is already happening, and that the pace at which this is happening is accelerating. That's a much more important piece of analysis than simply projecting that Chinese defense spending will match the U.S. budget in real terms within a certain number of years.
All of which is a long way of saying: I agree with you.
February 7, 2012 11:28 am
Jomini—you are sort of implying that the huge budget for the U.S. military doesn't necessarily translate into an advantage in combat because much of the money disappears into corruption
Jon can defend himself on this, I'm sure, but I think this is a serious misreading. In fact, I can't find anything in the original post to support this interpretation.
What the post does imply is that "the huge budget … doesn't necessarily translate into an advantage in combat" for a variety of reasons, which is so true as to scarely merit comment. (One of my big whines about the defense bureaucracy is the tendency to use the word "capability" as a synonym for a weapon system. A piece of gear only translates into a capability when it's manned by trained personnel, employed in a manner consistent with sensible doctrine, maintained by people who know what they're doing using a sustainment infrastructure that's been developed through effective forward planning, and so on.)
The failure to effectively translate cash into capability isn't just a matter of corruption; in fact, corruption plays a comparatively small (though significant) role when considered alongside the many, many other structural, bureaucratic, strategic, and tactical constraints that bear on how well we use the money allocated for defense.
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While getting a buzz cut and keeping it in that fashion might not be your thing, it is the number one reason to get this haircut. It matches certain people's image very well and it is always tweaked to different degrees with fades and whatnot to give it a better appeal. However, not everyone wants to sport a buzz cut for the long term. Still, there are many benefits and reasons for doing so. For example, people do this when it's going to be summer in one of those extra hot climates, and they also do it at times to grow new and healthy hair after having damaged their hair. There are many more reasons as well, and again many benefits to doing so. So if you're wondering why get a buzz cut, then check out the following reasons with explanations.
Save Money
While you may not want to give yourself a buzz cut, this would save money. Even if you have the professionals give you a haircut, however, you're still going to save money opting for buzz cuts on a consistent basis. Think about it, how often do you get you hair cut? You're going to get a haircut much more often if you just get a trim or a certain style. This really takes your hair all the way back to its roots. Additionally, this gives you plenty of opportunities to style your hair differently as it grows back out.
Getting a buzz cut is consistency, always allowing your hair months of a changing hair style vs keeping it the same old boring hairstyle every day without really changing lengths. And, it makes it easy when it comes to your request at the stylist. If you want, you can easily enjoy this haircut at your local barber shop, without really having to to go a stylist. Many men go to stylists these days because they are requesting all kinds of things be done to their hair.
Clean and smooth
Keeping things short and sleek is always trending as a look, and you really want to notice the next benefit. One thing that many men in enjoy is ease of maintenance when opting for a buzz haircut. Have you ever gotten one of these types of haircuts before and suddenly realized in the shower your hair was gone when you went to use the shampoo? The time spent washing and styling your hair is now a thing of the past. In fact, many men don't want very long before they go and get the buzz cut once again, maintaining that type of clean-cut appearance. That is another reason why men get this type of cut is because it does give off that kind of image for sure.
Camouflage Baldness
Another benefit is that it can look much better in connection with those bald spots. Men lose hair as they age, and if you have bald spots, you can make them much more camouflage when you have a buzz cut. Think about it for a minute and remember people's hair you've seen where they're losing hair in one spot and the shorter hair is much more accommodating than long hair in stark contrast.
What group of well-known individuals are known for having crew cuts? Soldiers are known for having these, and this has been a long-standing tradition. Men in uniform look good with this type of hairstyle, and the same goes for men wearing suits and other clothes meant for dressing up in style. In essence, this goes with that clean-cut image, and it is a very professional hairstyle.
Look Younger Some people actually look older with shorter hair, but many people look younger, too. Some people like getting these cuts because it makes them appear younger, accentuating their facial features in different ways. It definitely does accent facial features, whether for good or bad.
One thing about getting a shortner hair style, too is that you and those you know are getting a little taste of what you're going to look like if you start losing your hair. In all seriousness, this is not a bad thing. It's desensitizing you and others to that image of you missing hair. This can work in your favor if you fall into that statistic concerning many people losing their hair early in life.
Confidence in image is also a big thing when it comes to getting a buzz cut. When you have hair, you can hide behind that hair in ways. This benefit goes hand in hand with the fact mentioned earlier about you accentuating your facial features. You and your confident expression and appearance aren't going to be hiding behind any hair.
Many reasons to get a short hair cut have been given. It's up to you whether or not you want to give it a shot, but you certainly see why many are doing so, and why it's trending.