Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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2440 M Street, NW
Suite 710
Washington, DC 20037

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Willpower Failures: When Good Intentions and Outside Forces Collide

By Lynne Gots, posted on July 7th, 2013.

I just cleaned out the fridge. No more unidentifiable slimy greens in the vegetable crisper, shriveled limes in the fruit bin, and molding jars of pickled okra and salsa on the shelves. I’m planning a roasted eggplant dip and cucumber salad for dinner tonight to use up the last of this week’s CSA produce.

I was feeling pretty virtuous until I opened the freezer. Sharing space with the plastic containers of precooked beans, quinoa, and brown rice, alongside the loaves of artisian whole-grain bread, were three half-gallons of ice cream, three pints of premium gelato (there had been four until I polished one off last night—“to free up shelf space”) and three pints of frozen yogurt. I’d purchased one of the gelatos and one of the frozen yogurts. My husband had stockpiled the rest.

He’s pretty health-conscious most of the time, avoiding excess salt, eating massive salads every night, and eschewing red meat. Formerly a cooked vegetable hater, he’s even become a devotee of roasted Brussels sprouts and kale. So how to explain his frozen dessert hoarding habit?

I found the answer in a New York Times article, “Why Healthy Eaters Fall for Fries.” Several studies of consumer choices in fast-food restaurants found that posting calorie information did little to reduce calorie consumption overall. In fact, at Subway, people actually ate higher calorie meals despite reading the nutritional information, possibly because the chain offerred a $5 special on footlong subs.

Behaviorial economists conclude that good intentions take a back seat to economic incentives when we’re choosing what to order in a restaurant. That also seems to be what’s going on when my husband shops at the Giant. When I’ve asked him to cut back on buying ice cream because I end up eating more of it than he does, he says, “But it was on sale. Two for the price of one!”

I can’t get upset with him. It’s not his fault. Behavioral economics made him do it.

So I guess I don’t have to beat myself up either for lacking the willpower to eat fruit for dessert instead of gelato. And for not choosing the frozen yogurt—which, as I said, is in ample supply in my freezer and would be a lower calorie option. Because another study of consumer behavior found that people presented with a range of healthy, neutral, and unhealthy menu items most often went for the unhealthy foods.

As psychologists do, the researcher coined a term to explain the tendency to make a nutritionally unsound decision when more nutritious choices are available:  “vicarious goal fulfillment.” Just seeing the healthy menu options apparently makes us feel healthier and thus gives us the license to overindulge.

So the next time I’m tucking into a bowl of Talenti caramel cookie crunch, I won’t blame myself for my lack of willpower. And I might even top it with a dollop of whipped cream and a drizzle of chocolate syrup.

Because I’ll know it’s just a case of vicarious goal fulfillment.

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Posted in General, Mental Health and the Media, Motivation |

Colorado Movie Theatre Massacre: Trying to Make Sense of a Senseless Act

By Lynne Gots, posted on July 21st, 2012.

Whenever a deadly shooting rampage occurs, the experts are asked to explain the mental makeup of the perpetrator. Everybody struggles to understand what could drive an ordinary-seeming, though perhaps reserved, young man (it’s almost always a shy young man) to commit such a horrific act. But although the personality profiles of these mass-murderers share a few common features—paranoia and social isolation, most typically—we can’t really know what has driven a particular individual to violence.

A few hours after the 2007 Virginia Tech shootings, I received a call from a local TV news station where I’d made regular appearances. They wanted to interview me about the tragedy. What could have motivated the twenty-three-year-old student, Seung Hui Cho, to kill two students in a dorm, then barricade a building and kill 30 more people before turning a gun on himself?

I declined to appear on-air because I couldn’t, in good conscience, render my professional opinion. I’m not an expert on violence. And even if I were, speculating about the psyche of a person I hadn’t met and knew nothing about would be unethical.

However, other professionals—including some forensic specialists—don’t seem to share my reservations. They freely offer up theories, often presenting their viewpoints as fact.

In a Washington Post article about the Colorado shootings, one forensic psychiatrist said, “Mass-shooting cases have the common motive of an attacker seeking immortality. Each of the attackers have [sic] different degrees of paranoia and resentment of the broader community. Some are so paranoid that they’re psychotic. Others are paranoid in a generally resentful way but have no significant psychiatric illness.” That makes sense (though I’d suggest that being a mass shooter is, ipso facto, indicative of significant psychiatric illness).

He goes on to add, “They’re people who are unfailingly unable to form satisfying sexual attachments.” Maybe that’s true. Still, I’d like to see more evidence.

But then he elaborates. “ . . . and their masculinity essentially gets replaced with their fascination for destruction. The overwhelming majority of folks who do this are male because of how, in our culture, masculine identity is so closely tied to the capacity to destroy.”

Really? Do most men derive their sense of identity from violence and destruction?

Fortunately, the Post article counters this histrionic gobbledygook with the more measured viewpoint of a psychiatric expert from Duke, who says, “They [mass killers] tend to be young and male and  . . . sort of isolated. The problem with that is that there are tens of thousands of people who meet the same description and never do anything like this.”

In the wake of this latest Colorado tragedy, we’re sure to see many more speculative statements about the mind of James Holmes. And they will be beside the point. Because no matter how much we’d like to comprehend the inner workings of a madman, we’ll never be able to make sense of a senseless act.

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Posted in Mental Health and the Media |

How Long Should Therapy Take?

By Lynne Gots, posted on April 23rd, 2012.

Picture a day bed draped with an exotic, patterned blanket on a faded Oriental carpet in a room decorated with African sculptures and shelves overflowing with books. This image accompanied an opinion piece in yesterday’s Sunday New York Times about the ineffectiveness of long-term, unstructured, open-ended psychotherapy.

Although the author Jonathan Alpert doesn’t say it, the picture does. The kind of therapy he’s describing, in which the therapist listens passively with just an occasional nod or a “How do you feel about that?” is the psychodynamic approach practiced by Freud and his disciples. Even in the absence of compelling scientific evidence to support its effectiveness for a host of psychological problems, this type of treatment still has a tenacious hold on many practitioners today. But that’s a topic for another discussion.

The article has inspired a barrage of outraged Tweets and blog posts by therapists who’ve perceived it as a disloyal attack on our profession. Many of them practice long-term psychotherapy and, understandably, feel the need to defend their approach. While I’m not as offended by Alpert’s allegations as those colleagues, I still take issue with much of his argument.

When people seek me out for treatment, they’ve usually done their research and know I practice Cognitive-Behavioral Therapy. CBT is much more focused, problem-oriented, and time-limited than the traditional therapeutic approach that keeps patients on the couch for years on end, perhaps with no resolution of their neuroses (think Woody Allen). So if you’ve decided to work with me, you’re not expecting the process to drag on indefinitely.

Even so, problems aren’t always neatly resolved in the twelve to sixteen sessions described in the treatment manuals. That’s why, when I’m asked how long therapy will take, I always say, “That depends.”

Depends on what, exactly? A variety of factors enter into the algorithm—your willingness to push through discomfort, the presence of complicating conditions (depression, substance abuse, marital problems) secondary to the problem that brought you in, scheduling and financial constraints, the level of your current distress, among others.

I’m not trying to be vague or evasive. To the contrary, from the first session I try very hard to help my patients define clear, specific goals and understand what it will take to reach them. But it’s not nearly as simple as Alpert (“Manhattan’s most media friendly psychotherapist,” according to his website) makes it seem when he writes, “Many patients need an aggressive therapist who prods them to face what they find uncomfortable: change.” (I don’t think it’s by accident that Alpert, as media savvy as he appears, is touting an all-out assault on the fear of change. His new book, Be Fearless: Change Your Life in 28 Days, is due for release any day now.)

More important than having a particular therapeutic style, I believe, is understanding how change happens and being willing to confront the obstacles as they come up, even if it means putting the therapeutic work on hold for awhile or discontinuing treatment altogether until the interfering conditions can be resolved. Better yet, predicting and addressing potential difficulties at the outset can help speed the progress of therapy and minimize both the patient’s and the therapist’s frustration.

To that end, I spend a lot of time up front laying a solid foundation for the treatment phase of the work, sometimes taking a month or more to build the base. (So much for 28 days, and the treatment hasn’t even begun!) As tempting as it may be to offer a quick therapeutic fix, I’ve learned from experience and some unsatisfactory outcomes not to jump in too fast. And while I agree “it doesn’t take years of therapy to get to the bottom of . . . problems,” I’m also highly skeptical of Alpert’s claim that “for some of my patients, it doesn’t even take a whole session.”

Most critical to me—and, I hope, to my patients—is for us to have the same agenda. So if someone has learned to cope with her panic attacks but wants help in sorting out career issues, say, I’m fine with continuing treatment for as long as we both agree it’s helpful.

Many of my patients are ready to wrap up therapy in two months, or six. But I’ve been seeing others for four or more years, though not ever week, certainly, and not because they’re not making progress. If that were the case, I’d have referred them on long ago, possibly to a psychodynamic therapist with a different set of skills from mine. Still, I know some more orthodox cognitive-behavioral therapists wouldn’t openly admit to extending the length of treatment past the standard guidelines despite the prevalence of this practice.

Sometimes people like to come back every so often, or even on a semi-regular schedule, to stay in shape. It’s like continuing to see a trainer after you’ve achieved your peak level of fitness. Reevaluating your routine and shaking it up from time to time can help keep you on top of your game.

So I wouldn’t necessarily conclude, as Alpert does, that an extended course of therapy means the treatment is bad or ineffective. I wouldn’t even agree that someone who’s in therapy to feel better (a situation he likens to relaxing “spa appointments”) without working on specific goals for change is wasting his time, although I personally wouldn’t be treating that individual. What’s most important, in my view, is to assess what you’re hoping to get from your treatment. And if you don’t feel you’re making the progress you’d like, by all means bring it up with your therapist for review.

You might need to tweak the approach, or you might need to move on. It depends.


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Posted in Behavior Change, Mental Health and the Media, Psychotherapy |

This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.

Contact Dr. Gots


2440 M Street, NW
Suite 710
Washington, DC 20037

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If you don't receive a response to an email from Dr. Gots in 48 hours, please call the office and leave a voicemail message.

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© 2008-2019 Lynne S. Gots, PhD. Photographs by Steven Marks Photography.