On the Couch with Dr. Michael Edelstein

Dr. Grohol: Yep, I agree.

Can you talk a little bit about what you mean by something you talked in your book called “low frustration tolerance,” and how that comes into play with the way we often think about things in our lives?

Dr. Edelstein: Yes. And as I just mentioned, John, along with unconditional self-acceptance, high frustration tolerance is a prescription for a happy life. And low frustration tolerance means you have goals in your life: long-term goals, middle-term goals, short-term goals, and then you try to figure out ways to achieve those goals.

Something as small, you would think, to many people, as getting out of bed in the morning. You have a goal to get out of bed at 6:00 AM and get to work on time. But then you get up in the morning, and it’s dark out, or it’s cold in the room, or your tired. So that’s frustrating to push yourself to get out of bed.

And low frustration tolerance comes from a demand: “It must not be so frustrating or so difficult to get out of bed. It should be easy. So I’ll press the snooze alarm and try again in five minutes when it’ll be easier.” And then, in five minutes, you have the same philosophy, normally, and you do it again, and ultimately you’re late out of bed and late to work, because you had difficulty, you created difficulty yourself in tolerating the frustration.

And this leads to procrastination. You put off doing things that are going to be frustrating because you convince yourself, “It should not be so hard. I can’t stand this frustration. I’ll do something fun now, like have a drink or have a smoke or surf the web, or anything but pay the bills or wash the dishes or do my homework, or ask the boss for a raise, because it’ll be uncomfortable.” And then that’s an easy way to a difficult life.

So the solution is to accept the fact that life consists of one frustration after another, one hassle after another, one dissatisfaction after another–of course, with satisfaction and joys in between, so it’s not all grim–and that’s the way it is.

And the more you accept that, again, unconditional self-acceptance, the more you accept the fact that there are going to be frustrations. And if you face them and get over them and not have them hanging over your head–if you do the homework right now, or just wash the dishes, or make the bed, or have the unpleasant discussion with someone that you’re better off having, and get it over with — and then you’ll have less frustration in the long run.

So people who have low frustration tolerance or low discomfort tolerance tend to go for a quick fix, immediate pleasure, short-range hedonism. But paradoxically that creates more frustration, discomfort, and hassles in the long term.

Dr. Grohol: A lot of the things you talked about in the book — and certainly, you give a lot of concrete examples and walk people through those examples to really show how this can be put into daily practice or what-not.

It kind of led me to wonder, though: how can a person move from hearing this, what you’re saying today, and thinking, “Wow, these are great ideas, and this is a great way of looking at my problems. I hadn’t thought of it this way,” into actually putting some of the techniques of Three-Minute Therapy into practice? How does a person do that?

Dr. Edelstein: Well, that’s the key question. And I answer that in my book, “Three-Minute Therapy.” And the answer is, first, is you’re saying we have a superficial recognition, once we understand some of these theories, that it’s our thinking that causes our problems, it’s our demanding, musty thinking, and that there are no musts, there are no shoulds, just preferences. So the first step, or the first stage, is the superficial recognition of that.

But then the question you’re asking is, how do you go from stage one, a superficial recognition, to stage two, a deep conviction, deeply feeling it and believing it, having an entirely new, demand-free philosophy? And the answer is that bridge from stage one to stage two comes from the same learning principle that we use to learn most things, and that says, “Reinforcement is the royal road to learning.” The more we reinforce, review, repeat, go over, practice something, again and again and again, whether it’s an idea or an action, the better we get at it.

So it’s the same with kicking at your demands and thinking in terms of preferences. The more you practice it, the more you etch new pathways in your brain and start to think a different way. So you’re more likely to go into a bar thinking like a non-addicted person, so you’ll be able not to take a drink, or have a hot discussion or a difficult discussion with your friend or colleague or partner without an angry philosophy, or perform without an anxiety-creating philosophy.

You have a new way of looking at things. You’ve developed stage-two learning and, through the practice, repetition, and reinforcement. And writing out the three-minute exercises is a key to that practice.

So I recommend to my clients that they religiously write out those three-minute exercises, daily–once a day, twice a day, three times a day. I once had a client who, after a week, brought in 41 three-minute exercises she had written out that week and was dramatically better as a result of that.

And in each chapter in my book, “Three-Minute Therapy, ” I discuss a different type of problem, like procrastination, panic attacks, social anxiety, anger, depression, relationship problems, addictions, and money worries, and show you how you can use these principles, apply it to that problem, with a three-minute exercise. So that’s very useful for the reinforcement process. That’s the key.

Dr. Grohol: It makes sense when you say it like that. And I guess it comes down to just a lot of practice, over and over again.

Dr. Edelstein: Exactly right. Practice, practice, practice.

Dr. Grohol: [laughs] Understood.

You mentioned the example of going into a bar. And certainly, in the book, you have a chapter devoted to the interesting background, an alternative look at Alcoholics Anonymous, one of the most famous and oldest self-help approaches around. What are some of your primary criticisms of the AA approach?

Dr. Edelstein: Well, the main problem, as I see it, with the 12 steps is that they encourage the idea of powerlessness. The first step of the 12 steps is something like, “We acknowledge that we’re powerless over alcohol.” And I think that’s a failed notion. I think it’s obvious that you have power over alcohol, because you’re the one who picks up the beer, pours it in your glass, and decides to swallow it. You exercised your power over the alcohol.

The alcohol didn’t knock you down and pour itself down your throat. If it did, I would admit that the first step is correct: you are powerless over the alcohol. But you did it. And unless you take responsibility for doing it, for your drinking, and stop saying you’re powerless or you have no control, then, to that extent, it’s going to be harder for you to get over your problem.

And I work with people who have gone or are in the 12 steps, and they say sometimes they use the first step as an excuse to drink: “Well, I’m powerless, so I’ll have another drink. I can’t help it. Don’t blame me; it’s not my fault.” So that really is a very harmful notion.

Also, another thing that I think that the 12 steps encourages is a kind of dependency–dependency on the meetings — as opposed to REBT, where we teach people to be their own therapist by giving them tools and strategies they can use.

And also, paradoxically enough, dependence on drugs at 12-step meetings. Often there’s a lot of coffee-drinking going on, and people might have substituted one addiction for another.

Also, dependence on other people. You’re encouraged to have a sponsor, and you speak to your sponsor, call your sponsor, whenever you have the urge to drink–which can be used constructively in some cases, but then there’s a tendency to get dependent on that and not depend on yourself.

Also, there’s the notion in the 12 steps: once an alcoholic, always an alcoholic, and if you’ve gone 99 years without drinking, you’re still an alcoholic. And I have a few problems with that. One is I don’t like the idea of an alcoholic. It sounds like self-rating to me. You’re evaluating the total person based on a pattern of behavior. And that’s not the total person; a person is a process, always changing. And so they could drink a lot for the first 10 years of their life and drink moderately for the next 10 years of their life.

So, to say that they’re an alcoholic is a gross over-generalization, and can, in some cases, lead to a self-fulfilling prophecy: “I’m an alcoholic, so I’m helpless. What can I do? An alcoholic has to drink.” But if I’m an imperfect human who over-drinks at times, then it’s clear that I can change, since it’s just my behavior, and I can change my behavior.

Also, another idea of alcoholics, or a related idea, is that you have this problem for life. And obviously you don’t because there are many people who have had drinking problems or other addiction problems for some of their life or much of their life and then they get over it, they give it up, they leave it behind, and they never over-drink or overuse drugs again. So it’s not a problem that someone has their entire life, just because they have it for part of their life.

And then, finally, in terms of critiques of Alcoholics Anonymous, is the abstinence idea, that only abstinence works; moderation is impossible. But we know from statistics, and from anecdotal evidence, that some people some of the time learn to drink moderately, or learn to use cocaine moderately or smoke moderately or eat moderately or gamble moderately, those kinds of things, and abstinence is not necessary for all people all the time.

Now, when I have clients who have an addiction problem, they say, “I don’t know whether to try moderation or try abstinence. What do you suggest?” And I normally say, “Well, whatever makes sense to you.”

But if neither makes more sense to you, usually abstinence is safer, because, for most people most of the time, it’s harder to slip back when you’re abstinent than when you’re moderate, because when you’re moderate, the line is somewhat less clear. Although you can make clear lines. You could say, “Only two drinks this week, and that’s it.” That’s a pretty clear line. But for humans, who tend to over generalize and blur things, it seems to be easier to go from two drinks to three drinks than go from zero drinks to one drink.

So I’d normally recommend abstinence. And it seems that more people, as a group, succeed when they use abstinence rather than moderation.

Dr. Grohol: Good point. A lot of what you just said there seems to make so much sense and yet you don’t hear it spoken very often out loud that a lot of the things that Alcoholics Anonymous seems to stand for, a lot of the 12 steps, is sort of a greater dependence on others and this belief that you have no responsibility or control over drinking.

Dr. Edelstein: That’s right. And one of the reasons that gets blurred is because they go from “You have no power over your drinking” to “Therefore you need a higher power to help you.” [laughs] So they sort of squirm out of it. Rather than saying, “Well, just go drink, because you have no power over your drinking…” They say, “This higher power will help you.” And so, again, that’s dependence of another sort on this idea of a higher power rather than on yourself as being squarely and firmly responsible for your drinking and someone who can change that on your own.

Dr. Grohol: If you could offer one piece of advice to people who have tried psychotherapy in the past and felt frustrated by their lack of progress or gains made in it, what might that be?

Dr. Edelstein: Well, that would be to consider that all therapy is not therapy, in the sense that there are different types of therapy. So, just as there are different types of cars and different types of food–if you try olives and you don’t like olives, you wouldn’t say, “Well, I’m not going to eat food because I don’t like food.” You’d say, “I don’t like olives. I’ll try broccoli,” or chicken, or something like that.

And it’s the same thing with therapy. There are dramatically different types of therapy–as I mentioned earlier, the Freudian brand where you talk about your childhood and your dysfunctional family, and then the cognitive behavior therapies where you talk about what’s going on now in your head and how you can change that.

So I would suggest to people that they look for a cognitive behavior therapist or a Rational Emotive Behavior therapist. And you can look on a website called rebtnetwork.com and there’s a referrals page there which lists REBT therapists around the country.

Also, I suggest that you look for a therapist who’s going to give you actual homework–things to do, cognitive and behavioral homework–at the end of each session, and then checks on that homework at the next session to see how it went and to help you modify it, because that’s the key.

As I tell my clients, it’s not my brains in the session that’s really going to help them that much; it’s what they practice and work on between sessions that’s going to make all the difference. And therapists, even cognitive behavior therapists, sadly, sometimes seem to be allergic to giving homework, checking homework, and making that a priority. So I think that’s very important in a therapist as well.

Now, I get emails from people around the world who have just read my book, “Three-Minute Therapy,” and have never gone to a therapist, and have been dramatically helped. So another option, especially for people who can’t afford the time or the money, or don’t want to afford it, is to read books. There’s my book, “Three-Minute Therapy.” And Albert Ellis has written over 80 books on Rational Emotive Behavior Therapy, which has many, many, many very useful, helpful, practical, and philosophical suggestions for getting over your various problems.

Dr. Grohol: Well, Michael, thank you very much for your time today. You’re the author of the book, Three-Minute Therapy, which I highly recommend to our readers and listeners. I appreciate your spending some time with us and answering our questions.

Dr. Edelstein: Well, it’s been a delight speaking with you, John. I’ve enjoyed your questions, and thank you for having me on this interview.