Resilience or "You're in Charge of Your Own Imagination"

So far, my children have had amazing teachers.  One of my favorites is a teacher Amira, now 7, had in Montessori pre-school.  This woman preached two very important lessons:  "you're in charge of your own imagination" and "everybody is a part of the community."  These two principles are guiding forces for how Amira understands and moves through the world.  

A couple of weeks ago, Amira encountered behavior that really challenged these values.  To be fair, her class has really struggled to get along.  There have been incidents of bullying, biting, and hitting.  Amira has chosen to deal with this by staying out of the fray and spending time with a very sweet group of friends she made last year.   Recently, a classmate formed a group of students to "teach" during recess.  Amira and her friends were excluded because they don't have black hair.  She clearly felt rejected and hurt, and didn't understand how people could be excluded because of the color of their hair.  In her world, everyone's a part of the community, and no one can be excluded.  There were tears and anger and confusion.  At one point, I was ready to march up to the school and have a heart-to-heart with her teacher.  Amira asked us not to. She didn't want to anger her classmate, and she wanted to handle it herself.  OK, I can wait.

As parents, we have worked hard to create and find environments that will nurture the healthy development of our children.  I realize that we can do this because we have the resources, time, and energy to do so. This is clearly not true for everyone. What I wonder sometimes is how resilient can our children be if their lives have limited opportunities for adversity.  How do they learn to trust themselves if they never have to struggle and figure things out on their own?  Where is the line that divides protection from over-protection, that may inhibit the development of self-trust and competence.  

I have a close friend who has a child, "E," who's in high school now.  A while back my friend and I were talking, and I was saying what a star E is.  My friend agreed, because she is, and then stated, "but she's never had to deal with anything hard."  She was wondering the same thing, does she have the resilience to deal with the hard stuff of life?

Another close friend of mine has a son who is graduating from high school this year, and will be going off to college in the Fall.  One of my all time favorite kid stories belongs to him, "J." One day, while in elementary school, a boy came into the bathroom and threatened to beat J up.  J looked him in the eyes and said, "I guess you can try" and then walked past him and out the door.  That incident fizzled away into nothing.  I do think our children face adversity.  The politics of the "playground" can be very challenging at times.  They may not have to deal with life-threatening trauma, but they do have to negotiate complicated relationships and power dynamics.

So Amira had two hard weeks of being sad, angry, confused, and hurt.  Last week, I asked her how school was.  She was talking about a girl in another class.  I asked her if this girl was a friend of hers, and Amira said "no" that she was like her class mate.  Then she said, "You know mom, not everyone has a beautiful heart."   I love that answer.  Now we can collectively assume that all children have beautiful hearts, and that their responses to themselves and others are partly a function of their experiences.  So what IS so great about Amira's answer?  She didn't personalize the rejection.  

Back to resilience.  In the above example, Amira didn't let the other child control her internal narrative.  Amira's classmate decided that because Amira doesn't look a certain way, she wasn't allowed in this exclusive club.  Instead of taking it personally and/or shaming herself, Amira decided that that kind of thinking doesn't work for her.  She's bounced back, as only a first grader can, and is learning that she's in charge of her own beliefs and her own imagination.  If you can take charge of your internal dialogue, then you can better manage difficult situations.  In the story involving J, he heard the threat, apparently didn't get lost in all the possible implications, trusted that he could handle it, and walked away. Now that's power.

Fifty Shades of Grey and the Longing for Redemption

What?  That's what I imagine you said to yourself when you read the title.  Just bare with me for a few seconds, I think I can get us there.

So the very smart women of the feminist therapy reading group I belong to decided to read Fifty Shades of Grey.  We were all a little ambivalent given the criticism the book has received, but there was also curiosity.  Why was this book such a huge success (bigger than the Harry Potter seiries)?  Why is this poorly written novel so compelling to women? What need is it meeting?

Let me begin by admitting that according to my Kindle, I only completed 35% of the book.  So all of my thoughts come from those few pages and the discussion that followed in the reading group.  Let me also acknowledge that, based on my limited experience, much of the criticism the book received is true.  It is poorly written with almost no character development and not much of a plot.  It's like a modern version of a Harlequin Romance or Cinderella story in which a highly anxious, clumsy, super-naive, disempowered young woman with painfully low self-esteem is swept away by a dashingly handsome, extremely controlling, billionaire.   Obviously, the power dynamics are the theme of the book, both overtly and covertly. He initially has all the power, but apparently that gets re-negotiated over the course of the series, as he continues to fall in love with her.  

And that's what I found compelling: what seemed to me in the first 35% as the longing for redemption.  By redemption I mean the hope that we can heal the most damaged parts of ourselves by fully engaging in a deeply intimate, loving relationship.  Through the healing, we find hope, not fairy-tale hope, but real, grounded, based-in-reality hope.

A couple of nights ago, I woke up at 4 am from a dream about my father.  I don't remember the dream, but I was instantly flooded by a memory from college.  I was probably 20, and was going to his house for Christmas.  I was scheduled to have all four of my wisdom teeth pulled before the holidays.  At the time, my father was living with his wife and my two siblings in a beautiful house in northern Virginia.  The older part of the house was built in the early 1600s and sat on 60 acres of beauty, complete with a stocked pond, an old barn, and several quarter horses.  It was an amazing place.  The kitchen of that house had a false ceiling where escaping slaves were hidden as they made their way up the underground rail-road towards freedom and hope.

The experience of that Christmas was less than idyllic.  

A couple of days before Christmas, my father took me to work with him.  His extremely nice secretary (that's what administrative assistants were called then) took me to the dentist then brought me to her house to recover.  In the course of my recovery coma, I tossed my cookies all over her floor. Nice.  She cheerfully cleaned it up.  So awful.  When he was done with work, my father drove me back to the house.  Now, don't get me wrong, my father is not a bad person, he's just not much of a hands-on dad.  Like most fathers of the time, taking care of his family financially was more his thing. For the next four days, including Christmas, I stayed in bed in a Percodan fog.  it was kind of nice.  I told myself I needed to take it for the pain.  Thinking about it at 4 am, yeah, it definitely helped with the pain, but what I was really doing was sleeping through that empty feeling and false, somewhat manic cheer that was my family at Christmas.

Fast forward many years.  As my husband and I were talking about having our own children, a multitude of questions, longings, beliefs, and values coursed through my thoughts.  One of the stronger feelings was my need for redemption, though I don't know that I had put it into those words yet.  It just felt like hope.  That unarticulated feeling was that I could somehow heal my painful childhood by doing it differently with my children.  I really believed that my husband and I could create a very loving home for our children, and I knew I would throw myself into that commitment.  In working through that decision, I started to feel hope for the first time in my life. What really grounds my beliefs and hope is my husband, and his experience of family.  Consisted, involved, day-to-day loving, comes naturally to him.

So now, when I spend time with my family, and my children are not being annoying, I feel grounded in hope.  As I'm with them, I feel like I've been given the opportunity to rework the broken relationships that I experienced early on and have carried throughout my life.  I believe in myself and in them, but more importantly, I believe that we can work through life's challenges together. 

Back to the Fifty Shades series.  Apparently, as I've said before, the relationship changes both people.  They are able to work through some of their deep hurts and move away from the patterns that have reinforced their isolation and loneliness.  Feels a little like redemption.

Asking and Accepting

One of the things I love most about our elementary school is that it teaches life skills that help students grow socially and emotionally. Every week, they discuss and practice a different skill. I definitely could have used this training growing up.  Even as an adult, it's a great re-frame in times of frustration:  "This situation is helping me develop my life skill of flexibility."  Though I believe long division is important, and I use it daily in my work (not ever), being able to negotiate relationships with yourself and others is crucial to happiness and success (however you want to define it).  The life skill we are working on at home with our children is gratitude. Every day, and this was my husband's idea, my daughters state something they're grateful for, and how they want to show their gratitude.  So, for example, the other morning my six year old stated she was grateful for the car that takes her to school, and will show her gratitude by practicing her reading.  Nice.  

Last week, I was hanging out with my friend Elizabeth Sylvester and complaining, a skill I'm particularly good at, and one I'm somewhat proud of.  It's hard these days to let your negativity fly publicly without getting a redirect to look at the bright side.  Luckily for me, though, Elizabeth is also a psychologist, and has a lot of tolerance for the art of creative negativity. Anyway, I digress, so I was complaining, and Elizabeth quoted one of my favorite novel characters, Inspector Gamache, in her response.  She was pointing out a life skill that I'm lacking.  For those of you who are unaware of the Inspector Gamache series, it's definitely one to check out, especially if you need a source of soothing wisdom.  The mystery series is by Louise Penny, and goes down like a cup of hot chocolate after a particularly difficult, blustery day.  Very warm and cozy.

According to the wise Inspector, there are four statements that lead to wisdom:  "I was wrong. I'm sorry.  I don't know.  I need help."  The life skill Elizabeth was suggesting I might need to work on is "I need help."  This has always been true of me.  Even when I think I'm asking for help, I'm not.  The truth is that I'm not really good at it, AND it makes me feel profoundly uncomfortable, like I'm putting someone in a difficult position.  You know, because everyone is so busy and all, and they really don't need one more thing on their plate, and I don't want to be a burden, and blah, blah, blah.  The truth is I enjoy helping people when they ask directly.  It makes me feel useful and important, like I'm someone who can be relied on or trusted.  So why am I hesitant to ask others?

I have two thoughts about this.  One is that our society is based on the relentless pursuit of independence.  You know what I mean.  We value the idea of people going off on their own, creating their own lives, and accomplishing great things, as if that can be done in a vacuum of relationships.  That's the ideal isn't it?  When the reality is that we build our dreams and identities in the context of very complex reciprocal relationships.  No-one does it alone.

I think therapists are particularly prone to this way of thinking.  Our professional, and sometimes personal, lives are organized around helping others.  I can't tell you how many flyers I get advertising workshops on self-care for therapists.  But this does not only apply to therapists.  The compulsive need to be helpful, and the difficulty asking for help, can come from early experiences in learning how to relate.  In some families, parents are often incapable of taking care of themselves, let alone their children.  In these homes, children become exceptional care takers of the adults at their own expense.  These hyper-responsible individuals grow up believing that there is no real help out there for them, and become comfortable doing things on their own and for others.  You see the pattern.  Asking for and accepting help becomes foreign.  

So what I'm suggesting is, that for those of us who value independence, and not being a burden, it might be useful to see how the other half lives.  What does it feel like to ask and receive?  Can we sit in the vulnerability and fear of judgement and disappointment?  What happens if someone says "no?"  It's time to be a burden occasionally, and revel in the real world of inter-dependence and support.  For example, there's a trend, at least among some of my friends to request that people not bring gifts to their children's birthday parties.  Now this is in part because we all have too much stuff and very small houses.  And let's be real, our children probably don't need more material things.  But I wonder if there isn't something else going on.  Are we passing this trait on to our children?  What would it be like to let them want things and received things joyfully and within appropriate limits, AND learn to enjoy and explore the art of thoughtful giving?  

So back to the ongoing list of life skills I'm working on.  Thank you Elizabeth, I will add asking for help to my list.

Remembering With Love

I continue to think about saying goodbye.  This year both my grandparents died. They lived in Beirut, so I hadn't seen them much lately.  Two years ago, maybe longer, I took my family to meet them.  They had the most wonderful time.  We saw relatives and went to the beach, but the happiest time was the time spent with my grandmother.  The first morning we woke up there, we were greeted with a joyful "Good Morning!"  Followed by a "Are you hungry?  Would you like cake?"  That's the memory my kids still talk about:  "Tatti, (as we called her) was so much fun, and she let us eat cake for breakfast."

When I was growing up, I'd visit them for the whole Summer.  We'd spend our mornings at the beach, and my grandmother would arrange a play date for the afternoons while she played cards.  On weekends, we'd go up to the mountains and stay with my aunt and cousins.  Usually once during the Summer, my grandmother would take me to see "The Sound of Music," and she would tear up while the Von Trapps sang Edelweiss.   As  I got older, and the war made it too difficult to travel there, they would come to the US to visit for a couple of months each year.

My grandmother was a very spiritual person.  She reported having conversations with her mother in her dreams. When I called her to tell her I was pregnant with my first child, she said she had already been informed, but "thanks for telling me."  One such conversation she told me about still haunts me today.  During the war in the middle of the night, my grandmother woke up and told my grandfather that they had to get up and leave the house immediately.  Apparently, my great grandmother had come for a visit that night, and told my grandmother that she couldn't keep her safe, and that my grandmother had to protect herself now.  They left their apartment that night with a few belongings and drove up to the mountains to stay.  The next day, when they came to check on their apartment, they found it partially destroyed.  A bomb or bombs had destroyed most of their home, and they got out just in time. 

One Summer I was visiting and the fighting had gotten really bad.  I was spending the weekend with my other grandmother, and started feeling unsafe. We had to stay away from windows, and could hear the constant sound of machine guns, t t t t t, from outside.  I called my grandmother, and told her I wanted to come home.  Not being able to refuse her scared little granddaughter, my grandmother sent my grandfather out into the fighting to come and get me. On the way home, we carefully walked, hiding in shadows, staying close to buildings, and ducking into doorways, when the machine guns sounded too close.  It was a scary time.  I think now that this was an incredible act of love.  I wasn't in any more danger at my other grandmother's, but they wanted me to feel safe at home.  

Tatti loved chocolate, and not the cheap stuff.  She always had it around, hiding in various drawers and decorative containers.  I would love to snoop when I was there, to see what I could find.  I always found something delicious, and she was happy to share.  When she would visit the States, she would always bring goodies from the old country, which invariably included some chocolate for me. My grandfather died last Fall, and my grandmother followed in February on the Monday after Valentines Day.  She had been in the hospital for a long time, and her body was failing.  On Valentines Day, I brought a bag of chocolate hearts to work to put in the waiting room.  On the day she died, I got into my car, and found a chocolate heart on the seat next to me.  It must have slipped out of my bag the Friday before, but it felt like a gift.  It was as if she was sending me love, with a wink, a reminder that even if she was gone, she would always be with me.

My grandmother had a great sense of humor.  She was a card player, actually more of a card shark.  She would play in the afternoons, with or without my grandfather, and would often win.  If others were playing poorly, she would compare them to her cousin, Marco Paparelli.  Poor old Marco became legendary in the card community.  No-one wanted to be compared to him.  I asked her one time who this Marco was, and why we haven't ever met him.  She stated that she'd made him up to keep people on their toes. 

She was loud, assertive, and very passionate, which was a huge contrast to my quiet, measured, and introverted grandfather.  She loved arguments, and she loved to win.  What she loved most was to read.  When she would come to the US, she would spend hours at Barnes and Noble, sorting through books to bring home with her.  At least one suitcase was dedicated to books. She would always ask me to save any fiction I read during the year for her to read when she came. She would devour it all.  There's no real way to summarize her life, but if I could, I'd say she loved living, embracing it each day fully.

Psychotherapy: It's All About the Relationship

Most people I talk to don't really understand how psychotherapy works.  Insurance companies are all about the least expensive, most efficient method of symptom reduction.  For this reason, they often recommend short-term approaches that focus on symptom reduction.

It's important to understand that symptom reduction is different from problem resolution or understanding.  It's about returning the person to their pre-symptom state, not addressing the underlying issues that may have created the symptoms in the first place.  In addition to symptom reduction, psychotherapy offers change/growth and self-awareness.  Unproductive patterns are understood, dismantled, and replaced by self-care and compassion.

An example might help clarify what I'm talking about.  If you suffer from chronic headaches, the quickest, most efficient intervention might be to take some ibuprofen.  It gets rid of the pain, and you can quickly move onto the next thing.  And that might be the best approach to take.  An alternate approach might be to figure out what's causing the headaches, so you can understand what's happening, and make the necessary changes to decrease your headaches.  Is it stress, hormones, diet, brain chemistry, etc?  

What does psychotherapy offer?  Psychotherapy helps you develop self-trust and self-control.  It helps you identify relationship patterns (both with yourself and others), understand where they come from, and make positive changes.  It can help you accept and work with what you can't control about yourself.  Psychotherapy can also help you move forward when you're feeling stuck or trapped.

Some therapists take a purely symptom management approach, but most therapists tend to be more integrative, having a primary theory they work from, and adding other methods as necessary.  What we have learned from the research, after years of outcome studies, is that the single best predictor of therapy outcome, regardless of how it's defined, is the quality of the therapy relationship.  Basically, having a good working relationship with your therapist is the most important factor to meeting your therapy goals.

So how is a good relationship transformative?  I think about the therapy relationship on multiple levels.  The first level is about liking and trusting your therapist enough to begin sharing personal information.  The therapist's job is to create a safe enough environment for you to share, reflect, and explore.  

Another level involves using your therapist as a guide.  Good therapists have done their own psychological work.  They have spent a lot of time reflecting on how they moved themselves through various life struggles and developmental moments.  By mining their own journey, they are able to use their experience to guide you through yours.  It's not advice so much, though it can be, as sitting with you in the dark and using their flashlight to draw your attention to the markers along your path.

The third level, the transference level, also plays a key role in change.  This level involves the unconscious of both the therapist and client.  Transference is a process in which thoughts and feelings from a relationship or situation in the past are projected onto a relationship or a situation in the present.  Therapy involves bringing unconscious projections into conscious awareness, thus changing how we experience relationships and situations.  Symptom focused approaches may not allow for the exploration of this phenomenon.  They tend to focus on conscious thoughts and behaviors, leaving much of the meaning behind the patterns out of our awareness.

How Protecting the Guilty Keeps You Stuck

"Protecting the guilty" is a phrase I use a lot in therapy.  To be honest, I didn't coin the phrase.   I learned it from a very wise local psychologist named Patricia Tollison.  So what does "protecting the guilty" mean, and why do we do it?

First a little background.  As children, we are extremely vulnerable.  Without the love and protection of our parents, we would not thrive or, in some cases, even survive.  Regardless of the amount of severe abuse or neglect they've suffered, clients will often report that they had "good parents."  They go on to say that there was always a roof over their head and food to eat. "Some people don't even have that."

Why are we so willing to protect people who have hurt us?  As I've said before, children are in a very vulnerable position.  They need to stay close, both physically and emotionally, to their caretakers to survive.  Even in extremely chaotic or abusive situations, children will idealize their parents.  One way they accomplish this is to justify whatever treatment they receive.  They believe that since the parent can't possibly be at fault, they themselves must truly be bad. They internalize what they hear and feel.  And often in these families, other available adults are not questioning the status quo.

This pattern is so ingrained that, fast forward a few decades, they're still living it.  This way of thinking is internalized:  "I am bad."  "I will never amount to anything."  "I don't deserve to be treated well."  "I don't even know what healthy relationships look like."  The way to break the cycle is to stop protecting the guilty--to stop justifying bad behavior and to see your younger self for who she/he was.  The process involves acknowledging your anger, hurt, and sadness, to put the responsibility for the abuse, neglect, or chaos where it belongs.  Easier said than done--it requires seeing old relationships in a new light, which feels like separation anxiety and loss.  This does not, however, require you to confront your parents.  You can do this work with yourself.  

Due to their own unresolved issues, not all parents love or have their children's best interests at heart.  Letting go of the need to protect and justify abusive behavior allows you to break the old patterns and negative beliefs about yourself, and move forward with a new sense of self-worth and confidence.

Finding the Courage to Grow Toward Complexity

Two ideas have been swirling around in my brain this week:  courage and self-soothing.  How are they related?  I've been thinking about courage as I watch my clients struggle through life's big dilemmas.  Often there are no immediate or right answers, there's just the courage to sit with and explore difficult and complicated emotions.  Answers usually come, but not until you've done the hard work.  I define courage as walking towards what is hard and painful, when you really want to walk away or avoid.  Maybe that's where self-soothing comes into play.

Last week, my 4 year old didn't want to go to school.  She said her knee hurt.  Historically when her leg hurts, it's because something or someone has upset her, and she wants to stay home where she feels secure and loved.  My husband asked her why she didn't want to go to school. She said it was because her teacher told her to stop screaming and to stop sucking her thumb. The redirection on the screaming I can understand, but I had a very strong reaction to the teacher allegedly telling her to stop sucking her thumb.  

Children can be intense, sensitive people.  One of their life tasks is to learn (with the help of the adults around them) how to manage their feelings.  One way my youngest manages her very big feelings is by sucking her thumb.  This is her form of self-soothing.  Why would anyone want to take that away from her?  It's her coping strategy.  It's her way of self-regulating.  As she gets older, she will develop other age-appropriate strategies, but this works extremely well for her now.  What I think is most important here, is that in difficult, emotionally-intense situations, she has found a way to comfort herself.  When I told her that we would talk to her teacher, and that she can suck her thumb whenever she wants to, she angrily said that she will never suck her thumb at school again. Now that would be the real shame.

So I guess I'm saying is, that in order to manage life's difficulties, we need courage to face what is uncomfortable and ways to soothe ourselves when we feel overwhelmed.  To paraphrase Daniel Siegel, M.D., our goal as adults is to move toward complexity, and to learn how to tolerate and manage the intense and often conflicting emotions that come with it.  Those incapable of looking at those emotions are left with black and white, right and wrong type of thinking as well as limited problem-solving skills.  If you can't see a situation from multiple, well-developed perspectives, your options are limited.  It's a coping strategy that may inhibit your ability to grow and adjust, to life's ever-evolving demands.


After the Honeymoon: When Your Partner Becomes Your "Tormentor"

Something happens after the honeymoon.  The person you love, and have agreed to spend the rest of your life with, becomes your emotional tormentor.  How did this super-great person become the enemy?

This is a scenario I see a lot in couples therapy.  Two lovely people come into my office after a few years of marriage (and I use "marriage" to mean two people in a committed relationship, regardless of sex, gender, or sexual orientation) unsure if they can continue.  They hate their partner.  What happened?

Marriage can be a powerful, archetypal experience that unleashes all of our primitive longings and unmet needs.  The unconscious expectation is that our partner will make us feel whole again; they will heal old wounds created by childhood traumas.  I see this idea displayed in marriage ceremonies, in which there are three candles at the altar:  two candles lit, with the one in the middle left unlit.  At some point during the ceremony, the two side candles get snuffed, while the center one gets lit, representing the union of two separate individuals into one whole person.  I strongly dislike this ritual: it's a set-up for failure.  The question isn't how can my partner make me whole, but how can they support me in my journey towards wholeness. 

One of the many reasons we are attracted to our partners is that on a deeply unconscious level they stir up longings and unmet needs, and then begin to meet them.  This experience is intoxicating in the beginning when the relationship is the focus of both people's lives.  How amazing and exciting to have all of your needs finally met.  Then life happens.  The relationship is still a priority, but other life commitments take up time.  There's a reason why Romeo and Juliet's relationship didn't last long.  It's hard to maintain that level of engagement.  So, for many people, disappointment and loss start to settle in.  Your partner and the relationship are not what you thought they would be.  Early on in the commitment process, there's often a period of adjustment.

So how do you work through this early adjustment?

The first step is to take a deep breath (or several).  The intensity of the disappointment, hurt, and anger is often extreme.  It might help to realize that the feelings are partly about your current relationship, but mostly about very old, unresolved, and often festering emotions from the past. That explains the intensity.  Our partners are inadvertently pushing our buttons.  And even though it's painful, it's an opportunity to heal.  We unconsciously pick relationships that will re-stimulate unmet childhood needs so that we can heal the wounds and grow more whole.  

Step two involves identifying the feelings to yourself or a therapist.  Are you disappointed, frustrated, angry, hurt, sad?  When have you felt that way before in your life?  Do you have an early memory of feeling that way?  Spend some time reflecting on and feeling past hurts. Journaling is often a good way to remember.  This process feels like grieving:  remembering, acknowledging, and feeling the impact of the losses.

Step three is differentiating childhood pain from present pain.  It's not fair to carry childhood expectations into our adult relationships.  Your partner can't re-parent you, and that kind of neediness is a turn off.  Questions to ask yourself include:  What can I reasonably expect from my partner?  What do I have to work on myself or get met through other relationships?

And finally, can you have this conversation with your partner?  Can you tell her/him what your needs/expectations are and discuss whether s/he can meet them?  This is best done explicitly and in behavioral terms.  "I need to feel more connected" may be too vague and unhelpful.  My experience with couples therapy is that partners want to meet each other's needs when they can, and when it doesn't feel like they're sacrificing their own boundaries, but they need to know what they are. The key is to be honest and explicit, knowing that your partner may say "no."

This process is very hard, and it may be why many relationships don't make it.  If you and your partner are struggling, contact a therapist to help you sort it out.

Decreasing Anxiety by Putting Away Your Crystal Ball

Like with all of the topics I discuss, there are so many ways to think about anxiety that I couldn't possibly cover them all in one blog.  Today I've decided to focus on the predictive nature of anxiety, since it comes up a lot in my practice.  Predictive anxiety comes from imagining a future scenario that we want to avoid.  For example, I have some social anxiety.  When I am around people I don't know well, I feel anxious and uncomfortable.  This anxiety can manifest itself in dreading social events. When I break my thoughts down, I'm predicting feeling awkward and uncomfortable, not knowing what to say. I'm also imagining that people will not like me, and no one likes rejection. So, if I'm predicting rejection from the start, why wouldn't I feel anxious, which leads to feeling awkward, which then reinforces the negative spiral. 

Given that anxiety creates the hell that we're trying to avoid, why do we have it?  In this example, my anxiety is a protective strategy I learned long ago.  By predicting the future based on events from the past, I'm trying to protect myself from getting hurt.  Unfortunately, it's a strategy that's outlived it's usefulness.  Since most of us don't own crystal balls, and the magic eight ball is only accurate about 50% of the time, we should probably stay out of the predicting business.  Most predicting is based on past trauma and, as I've mentioned, recreates the hell we're trying to avoid.  So how can we begin to have different conversations with ourselves?

A few years ago, mainstream psychology started to embrace the Buddhist notion of mindfulness and the importance of meditation. The idea is that living in the present moment keeps life manageable.  We have no control over the future or the past, all we have is the now.  What are you thinking, feeling, experiencing right now? What thoughts are running through your head? What sensations do you notice in your body? What are you picking up from your environment? Noticing these experiences, without attaching judgement or meaning is what this practice is about.  

Another approach involves becoming "friends" with your anxiety, being curious and trying to understand it better. As I mentioned before, your anxiety may be trying to protect you from getting hurt again.  It's like flashing lights warning of the danger ahead.  Instead of avoiding the possible danger, treading lightly might be more useful.  Extend a little self-compassion and understanding your way:  "Of course I feel anxious, this experience reminds me of times I felt rejected."  At appropriate times, maybe in journal or with a therapist, allow yourself to explore your painful memories and grieve the old wounds, so you can heal.  If you heal the past, you'll be less triggered in the present.

Self-Regulation and Increasing Your Emotional Bandwidth

I've been talking to clients about feeling overwhelmed by both their own emotions and the emotions of others close to them (partners, children, friends).  One way of dealing with how overwhelmed we all feel is to check out.  This is evident in the prolific use of screens.  You go to a restaurant and two people sit across from each other texting on their phones.  You hang out with your kids in the evening and you're talking to them while catching up on email or surfing the web.  You're halfway listening to your partner and playing Candy Crush while she's unpacking an emotional experience from the day.  We can acknowledge that this behavior is at least rude, but I think there's a bigger price we pay.  

So what is the price?  It's hard to have intimacy in relationships if you're not present emotionally. In this way, all of our relationships suffer.  We don't feel connected, seen, or understood--fundamental aspects of being in a solid relationship.  I also think your relationship with yourself suffers.  If you're always avoiding, you become fragile and brittle, less resilient in the face of life's inevitable hardships.  How can you trust yourself or believe you'll be OK, that you'll figure out how to negotiate life's complexities, if you're overwhelmed by the day-to-day?  And of course, our kids need to be mirrored.  They need to feel heard, seen, and understood, and they need you to help them process and make sense out of their experiences.  So clearly being emotionally available and present to yourself and others is important.  So how do we do that?

The first step involves making some structural changes.  As a psychologist, I take in and emotionally and intellectually process a lot of experience during the course of the day, both good and bad.  This brings up a lot of personal feelings that I also have to work out.  At 5pm, I leave work and go home to a very vibrant family life.  Needless to say, it's hard to fully engage all that greets me at the door, even if it's positive.  I need transition time.  I use the drive home and the first few minutes after I walk through the door for that.  On the drive home, I review my day and give myself a chance to check in with myself emotionally.  What am I feeling?  What's unfinished from the day?  When can I give myself time to sit with those feelings? Phase two involves walking into my house, giving everyone hugs and kisses, and going to my room to change into "play clothes."  In those moments, I'm making the symbolic shift from Karen the psychologist to Karen, partner, and mother.  This reminds me of when I was working at a university counseling center just out of grad school.  At that time, I could only see 15 clients/week without feeling totally overwhelmed.  It was partly because of all the other adjusting and work I had to do as a new professional, but also because I hadn't exercised my brain in that way and to that extent before.  What structural changes can you make?  Do you need to simplify or take in less, or do you need to build in some transitions?  One of my clients takes off early from work a couple of times per week and goes to yoga before he walks through his door.

So how can we increase our emotional bandwidth?  Step one is changing how you take information in and respecting your limits.  Implied in the first step is step two:  take time out to process your feelings.  Don't avoid.  That's how people stay overwhelmed.  Journal daily, talk to friends, meditate, talk to a therapist.  Do something that allows you to acknowledge what's been going on in your life.  This is how you begin to increase what you can tolerate.  Spending time with feelings builds a sense of competence and self trust, and allows you to be more comfortable with yourself and your internal world.  This, in turn, lets you sit more comfortably with other people's emotions.

Step three in the process involves learning how to soothe yourself when you do feel overwhelmed.  It's important to know when you're feeling overwhelmed.   Notice when you feel like you need to check out?  Is there a pattern?  What's going on during those times? What are you feeling?  Once you've identified what's going on and why, you can begin to think about changes you want to make and ways in which you can soothe yourself.  At first you may have to be very deliberate in monitoring your ability to self-regulate.  Over time you'll learn to regulate your emotions automatically, and increasingly feel more in control.  It's much easier to be available to yourself and others when you feel in control of your own emotional experience.

The Soul-Killing Nature of Shame

I hesitate to write this because it's such a huge and overwhelming topic.  Unfortunately, it needs to be talked about because shame is so pervasive and so destructive.  Maybe I'll just begin talking about it today and add to it over time.

Two non-personal memories of watching and hearing others being shamed still haunt me.  One time years ago, I was with a friend at an outdoor festival at Laguna Gloria.  A little boy had apparently done something that was upsetting to his parent.  The parent berated this child for several minutes, going on and on about how unacceptable his behavior was, and how he was such a bad person....  The child's face was so painful to watch.  I could see something slowly dying in his eyes.  The hostile and cruel nature of the parent's intense focus and the child's despair still haunt me today.

More recently, I was at a multi-family play date, and a young girl was acting out.  Her behavior was out of control and disruptive.  Again her parent, in front of everyone, started yelling at her. Her behavior was "unacceptable," and the parent was "disappointed" and "disgusted."  The child had a sad, glazed look in her eyes, was clearly very embarrassed, and put her head down on the table and cried.  Now don't get me wrong, her behavior did need to be reigned in, but there was probably a better way.

Shame is that super-caved in, worthless feeling we all sometimes have.  It's paralyzing.  It's different from guilt in that guilt is about remorse--feeling bad about hurting someone.  Shame is about harshly judging or verbally abusing yourself.  As far as I can tell, there's nothing positive that comes from shame.  It's soul-killing.  Imagine how those kids must have felt, and what those non-isolated, I'm sure, interventions had on their sense of self.  Every time we shame ourselves, we destroy a part of our self-worth and efficacy in the world.  It's hard to be a positive, productive, creative person if you feel bad about yourself.  

How do we dismantle shame?  The best advice I've heard is that shame, much like depression, is anger turned inward.  So we must find a way to either neutralize or externalize the anger.  In the above examples, both of those kids probably walked away from the interactions, having internalized the message that "I'm a bad person."  Kids don't have the psychological sophistication to challenge shaming messages.  But as adults we do.  

The first step is to try to remember where the shaming messages of "I'm not good enough,"  "I'm stupid," or "I'm worthless" come from.  Are there specific memories that you can identify?  How did you feel at the time?  How do you feel now thinking about it.  The problem with shame is that it's traumatizing, therefore sadness, hurt, anger as well as other feelings are cut off.  You go into survival mode.  Remembering allows you to have the feelings you didn't then, which will help you heal the old wounds and let go of the negative thoughts.

The second step involves externalizing the anger.  Yes, those kids may have behaved inappropriately.  But did they "deserve" to be verbally humiliated?  Do you?  Fight back.  Redirect the anger to where it belongs.  Be angry with the people or situations that are negatively affecting you, causing you to unfairly judge yourself.  

The Positive Power of Anger

Anger gets such a bad rap.  When we think about anger, we think of its extreme negative expression:  of anger acted out destructively or inappropriately.  Anger is a powerful emotion, and when acknowledged, understood, and channeled correctly, can be very positive.

First of all, anger just is.  As humans, we're all going to feel angry from time to time. Avoiding it, or pretending it doesn't exist, is destructive. The best way to handle anger is to feel it, and to try to understand where it's coming from.  Anger is our way of protecting ourselves.  It's the big red light that goes off in your head when someone hurts you or violates a personal boundary. Acknowledging your feelings and trying to understand what happened allows you to decide on the best course of action (after you calm down, of course).

So what happens when anger is repressed or ignored?  

Psychologists like to say that depression is anger turned inward.  In this instance, the person may not want to or is afraid to feel angry, so they redirect the anger towards themselves.  They may say things like, "I should have known better."  "That person is clearly better than me, that's why they got the promotion."  "I'm having trouble learning this, I must be stupid."  "He rejected me for someone else, what's wrong with me?"  All of this negative self talk leads to shame and depression.  I think it's always useful to look at your contribution to a situation, to learn from your experience, but if you're angry with the other person, it's important to be truthful with yourself.

Another consequence of repressed anger is fear and anxiety.  We may project out what we don't acknowledge. For example, if I was teased or abused as a child and still have a lot of unprocessed rage about that, which is totally understandable, I may not be willing to trust others. instead, I may project my anger onto them and see them as potential bullies.  It may impact the quality of my relationships and my ability to get close to people.

Because anger is such a powerful emotion, it can come out indirectly and in destructive ways if not acknowledged.  People often use the phrase passive-aggressive to refer to statements or behavior that are indirect and undermining.  All of us have experience with this dynamic.  It's the person who is very nice on the surface, but their comments or behaviors might have an undercurrent of meanness that betrays their true feelings or intent. You really don't want to be that person.  

So what do you do with anger?

  • Acknowledge.  Tell yourself you're angry, and that it's OK to feel angry.  It's just an emotion.
  • Understanding.  Understand why you're angry.  What's happening?  
  • Self-Compassion.  Be kind to yourself.  You may want to say things like, "Of course I'm angry.  Anyone in this situation would be angry.  I feel hurt (betrayed, violated, slighted,...).  I'm trying to protect myself."
  • Calm Down.  Think about what would feel soothing.  Would it help to talk to someone, journal, take a long walk, write a letter that you don't send, listen to music?
  • Action.  What, if anything, do you want to do about it?  Often, an honest, diplomatic, but direct conversation can clear the air and make you feel heard and understood.  Sometimes that's not an option. This is where an honest, emotional letter can be very powerful.  Pour your feelings out in a letter (and it may take several), but don't mail it.   This allows you to process the experience, acknowledge the feelings, and then let them go.  

So what are the positive aspects of anger?

We already discussed how anger is a protective emotion.  It lets us know when we are not being treated well.  It also helps us see when others are not being treated well.  Anger is an energizing emotion--it calls people to action.  When channeled correctly, it is the fuel needed for change.  It fuels assertiveness, problem-solving, and activism.  It can be the energy and motivation required to change what isn't working.

The Medicalization of Psychology and the Dilemma of Managed Care

As a professional community, psychologists have not adequately debated the pros and cons of managed care and the resulting medicalization of psychotherapy.  Because we have charged blindly towards medicalization and the complete adoption of the disease/symptom-based model of mental illness, we have sacrificed the focus on developmental approaches to mental health that involve integrating dissociated parts of the self and strengthening the whole person.  Since it's the model we're adopting, let's focus on the benefits of managed care and symptom reduction or the medical model.

There are clearly many positive aspects of this type of treatment.  First of all, because of the Affordable Care Act and Mental Health Parity, many people who did not have access to a mental health practitioner now do.  As long as you have identifiable, symptoms and can afford copays, monthly premiums, and deductibles, you can see a mental health practitioner who can help you reduce the severity of your symptoms.  So if you're depressed or have anxiety, for example, your insurance will pay for treatment until these symptoms no longer interfere with daily functioning.  It's very similar to the western medical model.  If you have an ear ache, you go to the doctor, they diagnose an ear infection based on observable symptoms, and you're given an antibiotic.  Treatment stops when symptoms go away,  The symptom management approach to psychology is useful in so many ways.  If you've ever had severe anxiety or depression, quick, effective, symptom reduction is what you need to return to your day-to-day life.

What if that's not enough?  What if you want to understand why you have these symptoms?  What if you want to make sure they don't recur?  What if you want to understand yourself better, and continue to grow and feel more whole as a human being?  What if you don't have any severely limiting symptoms, but feel generally unhappy, or find yourself in unhealthy behavioral or relationship patterns, or feel like you're not reaching your full potential? Where does that fit into this model?  Well, it doesn't.  And maybe it shouldn't, but it feels like a loss of what psychology can bring to enhancing the quality of people's lives.  Maybe this is just a problem of the priviledged. Maybe.  I will tell you this, though.  My daughter has allergies from October to April.  She goes to the doctor several times for ear infections.  They give her an antibiotic, it goes away, and she's back in a few months. She also takes allergy medicines, which probably help significantly.  The questions I have from a more holistic perspective are, is there something we can do to strengthen her immune system?  Should we be looking at changing her diet?  I don't feel like I understand or even have a framework to understand what's going on with her from a wellness/whole body perspective.

This reminds me somewhat of the differences between Eastern and Western Medicine.  I heard a story a while ago, that may or may not be true, but it's a model I like, so I'll include it.  Apparently, in communities in China, the doctor is paid regularly based on how well people are.  Her/his job is to keep people well by treating and healing the whole body.  Prolonged illness is a function of one or more of the body's systems being out of balance.  The goal is to restore balance.  Compare that to what we have here.  Antibiotics don't restore balance.  Not that I'm against them--I'm grateful.  But are we giving something up when we don't include the other?

Psychology, especially all the exciting work on attachment and brain development, has a lot to offer us in terms of our ongoing growth and well-being, as well as the quality and depth of our relationships.  Unfortunately, that is not being considered or even addressed in the larger community discussion.  It might be worth thinking about.

New Year Resolutions

Several years ago, I stopped making "New Year Resolutions."  Now my focus is on "Organizing Principles."  "So what's the difference?" you may ask.   Resolutions are specific, behavioral goals you want to achieve.  Organizing Principles, at least how I define them, are areas in your life you want to generally improve.  So for example,  I may ask myself, "What 2 or 3 areas of my life do I want to be better in 2014?"  It's basically a commitment to focus time and effort on these 2 areas of life.   What I like about this approach is that there is no failure, and it allows for more creativity and flexibility as the year progresses.  So for example, a New Years Resolution might be to lose 20lbs, or go to the gym 4 times/week.  If you don't meet that goal one week, you might get down on yourself and begin losing momentum, or you might use it as a justification to completely slack off, telling yourself that you'll start over next week, etc. If you're anything like me, you can see where this is going.  Whereas, if you choose a couple of areas of life to focus on and help organize your decision-making, every decision is an opportunity for success.

This year I picked 2 organizing principles.  The first one is getting out of the house for active family fun.  My children are fairly young, and we've been somewhat house bound since they were born.  Now, as they get a little older, and our youngest is slowly giving up her naps, we have more opportunity to get out and be active.  When we have free time, I use this principle to decide what to do.  Two activities we've begun are Sunday morning roller-skating lessons, because the girls got roller skates for Christmas, and bike riding, now that I replaced my old bike that was stolen several years ago.  

The second principle involves building the behavioral consulting branch of my business.  What this means is that almost all the free time I have at work is devoted to doing something towards that end.  So now I'm working on this blog, for example.  The bottom line is that you use these principles as guidelines for how to organize your positive, creative energy  and free-time over the course of the year, without overly focusing on specific outcomes.  

Matching Your Child's Intensity--some thoughts

Children come into the world with different levels of emotional and energetic intensity. Intense children are often seen as brilliant, precocious, creative, and sensitive, on one hand, and/or needy, oversensitive, dramatic, and quick to act out, on the other.  Where they fall on this spectrum depends, in part, on how well their experiences are reflected in their important relationships.  Mental health professionals use the terms empathic attunement to describe the quality and depth of the connection.  Children who don't get the right level of attunement may feel unanchored and lonely.  

This makes me think of my friend, Dr. Elizabeth Sylvester who runs Austin Child Therapy. When she comes to my house, she greets me and my husband, and even the dogs, in a calm, affectionate way.  But when she greets the girls, her energy level and focus increases, her eyes open wider, her manner is more animated, and her attention is often on small, positive behaviors and efforts the girls are making.  The children love her!  They clearly feel seen and valued, and brighten up when she walks in the door. Elizabeth sees and matches their intensity level.  

Wherever they fall on the intensity spectrum, children (and adults for that matter) need accurate mirroring from their adult relationships.  What happens when high intensity children don't get the right kind of positive attention?  That's when you start seeing an increase in acting out.  All children need to have their feelings and experiences reflected back to them in a meaningful way.  If they can't get the attention they crave in a positive way, they'll get it negatively.

So what does this mean for the parent of an intense child?  I think of it in two ways. One way is about matching the child's emotional energy.  This involves responding to the child using words, body language, and facial expressions that acknowlege and mirror what they're trying to communicate.  When this is done well, the child will calm down. But if you try to ignore or minimize their experience, chances are they will escalate their behavior until they get what they need.  So, for example, yesterday my intense child was crying because she missed her dad while he was taking the dogs for a walk. Typical dog walks last 20 minutes, but for whatever reason, my daughter really missed her Dad.  I started off with, "He'll be right back."  "He won't be gone for long."  "He always comes home."  Let me just say that none of this was helpful.  When I earnestly sat with her and hugged her and talked to her about how sad she was, and how much she misses her Dad, she began calming down.  I then praised her for being so brave and strong in the face of her sad feelings.  This brings us to response number two, which I have learned from Dr Sylvester.  

Response number two involves consistently articulating and praising the behavior you want to continue seeing, and ignoring (unless it's dangerous, or extreme) behavior that you don't want to encourage.  Negative attention can be as reinforcing of behavior as positive attention.  So on a good day,  I might calmly ask my daugther to stop throwing the ball in my face.  When she does it again, I might take the ball away and remind her that we don't throw balls at people's faces.  If she manages to redirect her attention to something more positive, then I jump on the opportunity to praise how well she listens and how much I appreciate her response.  If her father is there, I might tell him what a great listener she is as well.  It ends up being a mini celebration that reinforces and teaches children how to get their need for attention met in a good way.  If she picks something else up to throw, I would turn and walk away and let her know that I'd be happy to play ball with her when she stops throwing things at my face.  Again, a mini-celebration when she cooperates.


Deepening Intimacy in Your Relationship

One of my clients recently asked me how she could deepen the intimacy in her relationship.  This got me to thinking, "Wouldn't it be nice to have a step-by-step guide to intimacy?"  Here are some steps I think might be useful.

  • Self-Awareness
  • Communication
  • Listening Empathically
  • Repair
  • Time Together/Time Apart
  • Working as a Team  

Self-Awareness is actually harder than it sounds.  I think we all go through life unconsciously repeating patterns.  The question is, "How do you improve your relationship with yourself?"  "How can you feel more present in your own life?  Self-awareness means understanding yourself without judgement.  This involves knowing how you're feeling at any given moment, understanding your relationship patterns, and understanding your hot button issues and how to handle them when they're being pushed.  Two good ways to improve self-awareness include individual and/or group therapy and writing in a journal daily. Sometimes I give people the homework assignment of setting the alarm on their phones to go off four times a day.  The specific times don't matter.  When the phone goes off, ask yourself the following questions: "What am I feeling?" "Why?" and "What do I want?"  This simple check-in increases your emotional awareness in the moment.

Deepening your self-understanding is a prerequisite to sharing yourself with someone else.  Sharing yourself with someone does not necessarily involve disclosing deep, dark secrets.  It involves being present with yourself and what you're feeling in the moment, with someone else.  Good communication involves blurting diplomatically.  In other words, thoughtfully sharing what you're thinking or feeling in the moment as appropriate.   In addition, having really good boundaries, and being comfortable saying "no" when you need or want to, goes a long way in helping you feel comfortable in your own skin around the other person.  Self-betrayal. or crossing your own boundaries, just breeds resentment.  

Listening empathically involves paying attention to your partner and trying to really understand what they're saying and how they're feeling, even if it makes you uncomfortable.  Unless someone asks for advice, don't give it.  Statements that reflect feelings are much more supportive and tend to deepen the connection. 

M favorite of these steps, and I think the most important one, is   repair.  Hurting someones feelings happens regularly in relationships.  It may not be what we're shooting for, but it can't be avoided.  This is where repair comes in.  If hurts go unaddressed over time, they start to poke holes in the foundation of the relationship.  If you're partner is hurt by something you did or said, even if that was not your intent, acknowledge their feelings and apologize.  Explanation is OK, but only after you've said "I'm sorry."  This process goes a long way towards rebuilding trust and maintaining a strong foundation.

Balancing   time together and time apart is good for the relationship.  I'm thinking of a tree metaphor.  Time together is about deepening the connection, or building roots, while time apart develops the limbs and enriches the crown.  Time apart keeps things fresh and new between you.  A tree can't thrive without both.

And then of course there's working as a team , or maintaining a united front.  This is especially important if you have children. Children need to know they can't divide and conquer (but that's another topic).  This step is the belief that your partner has your back in all interactions with the outside world.  Nothing and no-one can come between you.  It feels like an imaginary boundary that separates the two of you from the rest of the world.  It's not rigid, and both people can have their own relationships, but it is secure.

I've tried to keep it short, but there's so much more to say.  Let me know what you think. 





The Importance of Making Mistakes

If you haven't made many mistakes in your life, you haven't taken enough risks. And if you haven't risked much, you aren't reaching your creative potential.  The problem could be a fear of failure, because in our minds mistakes = failure, and all that comes with it.

A few years ago, I started thinking that I wanted to add another dimension to my practice. I thought through a number of ideas, read various articles and books, talked to colleagues, procrastinated, stalled out, felt confused, etc.  My goals at the time were vague.  I wanted to do more, take the work to another level, have a new creative challenge.  But what?  It was a time of false starts, dead ends, and disappointments. The process, though incredibly frustrating, has taught me a lot about how to learn from mistakes.

One of these mistakes was choosing to go on a local news show once/month to briefly talk about a psychological concept.  I feel embarrassed just writing about it.  I tried to keep it light (it was weekend morning news after all), but I was anxious, and I never got to communicate what I really wanted to, and it was very early in the morning, and it was awful.  But...what I realized through that experience was that I really do want to bring psychology to people where they live and work, not just wait for them to come to my office.  A big, uncomfortable step.

Fortunately, I have my share of these type of experiences that when sorted through make adding business consulting to my portfolio an obvious and exciting choice.  So join me in taking a risk.