“There Is No Good Reason To Feel The Way I Feel”

Is this something you find yourself saying? This is something people frequently tell me. Unfortunately a lot of people think this is true. When people think it is true, they often stop trying to figure out the significance of how emotions show up in their life. People will say their emotions come out of the blue, show up for no reason, don’t make any sense, and even create problems in their lives that they wish they didn’t have to deal with.

I actually don’t think that people have no good reasons for feeling they way they feel. In fact, I think reasons are there, but people are often not aware of them. My belief is that emotions show up for a reason, and are important and critical to our existence. However, because emotions can be nebulous, hard to pinpoint, and often elusive; they are sometimes hard to understand and even identify.

All emotions have certain functions. Functions work to serve a purpose or accomplish a task. Functions of emotions include communication, validation, or action. The emotion of sadness, for instance, is an invitation to figure out what is important, grieve losses, search for what is missing, or acknowledge how important something was in our life. Without sadness we would not know what matters, who we love, or what is missing. Sadness gives us important information about all of these things.

Primary emotions are emotions that we have about certain situations, persons, or events in our lives. They are what shows up when stuff happens. They provide valuable information that, if ignored, can create even more problems. Secondary emotions when people have emotions about emotions. For instance, if you feel angry that you are sad, ashamed that you are distressed, or embarrassed that something angers you, you are experiencing a secondary emotion. Secondary emotions generally cause more problems for people because they are ways to judge (or not accept) a primary emotion. When we work really hard to inhibit, hide, minimize, or judge what we feel in the first place, we can create even more problems for ourselves. Sometimes people focus on secondary emotions as a way to avoid focusing on primary emotions. (“If I talk about how angry I am, you won’t really get how much I am hurting.”)

The key point is that people who learn to accept and even value their primary emotions generally have less distress than those who go out of their way to inhibit, hide, or suppress what they feel. If we treat our emotions as useful and valuable means to provide information about ourselves and our environment, the task of addressing emotional pain will be easier. Getting rid of emotional pain because it is uncomfortable doesn’t teach us to be open, present, and accepting of our emotions. While this may seem counter-intuitive, having less shame about how we feel helps us solve the problems of life a bit more easier. (“I am upset because something happened” vs. “Because I am upset I am ashamed, then angry at myself for being ashamed, then guilty for snapping at people because I was angry, then humiliated for how I handled this. Because I have no good reason to be upset.”)

Here are some tips to help you work on your emotions:

  • Treat your emotions as useful
  • Approach how you feel with curiosity, not judgment
  • Assume your emotions are trying to give you important information
  • Be willing to experience the intensity and painfulness of emotions
  • Observe any action urges that come along with emotions
  • Pay attention to how you feel about things more closely
  • Be aware that low levels of distress is still stress, and that minimizing it can sometimes result in a blow up later on

What Is Mindfulness, What Does It Have To Do With You, And Why Is It So Necessary?

Mindfulness is a particular way of paying attention to 1) expand awareness or 2) focus attention. Below is some brief information on these two applications of mindfulness as it relates to your life and to the practice of psychotherapy.

AWARENESS

What are the benefits of awareness?

  • Increasing awareness increases options (less experiences of feeling or getting “stuck”)
  • Increasing options for how to react to stressors increases a sense of confidence and self control when confronted with life circumstances
  • Increasing awareness helps people understand why they behave the way they do and what controls their behavior
  • Increasing awareness helps people to identify patterns of responding, or repeating themes that may show up again and again, and can be better understood with curiosity and analysis
  • Increasing awareness helps to clarify, understand, and organize behavior in a more meaningful way
  • Increasing awareness (ie, awareness of anger) helps people to be assertive/ proactive, solve problems, and organize action

What problems accompany limited awareness?

  • Repeating patterns of getting stuck
  • Minimizes flexible and adaptive coping
  • Can be likened to zoning out, dissociating, not paying attention, missing out, or failing to show up for one’s life
  • Can increase vulnerability to do, say, or behave in ways that are acquiescent/ compliant; no self-awareness leads to responding/ reacting to environment (reduced autonomy, reduced control, reduced capacity for interpersonal influence/ power)
  • Limited awareness is associated with not knowing oneself, what one likes/ doesn’t like, wants/ doesn’t want
  • If you can’t know yourself (trust experience) how you can you know how to pursue a life that would be fulfilling and rewarding to you

Ways Awareness can bring pain

  • Losses associated with missing out on ones life
  • Grieving times/ time in life when things could have been better (had a person been more aware)
  • Awareness of hope and possibility can feel risky or unfamiliar
  • Familiarity and predictability help people feel consistency/ stability, thus awareness of alternatives can be uncomfortable/ unfamiliar
  • If a past history of problematic responses evoked a particular set of behaviors (escalated conflict results in nurturing/ attentiveness from partner), awareness of alternative ways of behaving may be initially aversive / won’t get immediate desired response

Things to be aware of:

  • Emotions, actions, urges, desires, hurts, want
  • Physical sensations, sensitivities, breath, body awareness, gut feelings, instincts, intuitions
  • Your behavior; how you behave/ change behavior, react in certain situations, which people, in different contexts
  • Your history of behavior; how behavior started, what it means/ meant, how it served a purpose/ had a function or role for you
  • How your behavior impacts others
  • How others’ behavior impacts you

FOCUSED ATTENTION

 Why is obtaining skill to focus one’s attention important?

  • Thoughts, emotions, pain, sensation, restlessness, boredom, etc. can sometimes interfere with a person’s ability to live their life in a valued direction.
  • Thoughts and emotions can create problems, be distracting, and get us derailed
  • Obsessive thoughts, unwanted thoughts, self-defeating thoughts, self-hating thoughts, anxiety thoughts, and non-useful thoughts can threaten to take over attention, control action, and inhibit needed action
  • Staying focused can help a person be less prone to intense, unwanted, or problematic thoughts or beliefs
  • Action urges, emotional reactivity, and other behaviors often happen “automatically”, thus practicing focused attention increases your options for limiting your reactivity (For instance, if you are a person that “flies off the handle” staying focused can help you stay grounded)

Does focusing attention get rid of pain?

No, focusing attention helps a person not get consumed by other things that threaten one’s focus (ie, obsessing, ruminating). Pain is considered a normal part of the human existence; focusing mindfulness activities are not done with the purpose to destroy, get rid of, or inhibit pain.

Focusing on sound exercise. For the next 3 minutes (set a timer if you’d like), try to focus all of your attention on sounds you can hear. Pay all of your attention to the sound, and see if it is possible to do this for 3 minutes. You will likely have multiple other thoughts, sensations, experiences, or distractions that don’t keep you 100% attentive to “just sound.” Likely if you had a painful thought, the thought took you out of the exercise. So, instead of heeding that thought your attention (buying into the thought, thinking the thought, rehashing, problem solving, etc.) you simply be aware of that thought (“oh that thought is showing up again”) and gently return to focusing on sound.

Remember:

  • No one is denying you are in pain
  • You are not denying you are in pain
  • You are not refusing to think about that situation, you are simply redirecting your attention for the time you try mindfulness
  • You are increasing your control of what you pay attention to and when
  • You may need to come back to your pain at some point and solve some problems, but for the three minutes this is not your task
  • Urges, cravings, desires, urges to take action/ do something, urges to eat something, etc. may all come and go
  • You are learning over time to increase control of all of this

Often, if your life is disrupted by intense, extreme, demanding emotions your actions often follow. You may feel as if you are controlled by your emotions and your actions. Focusing attention helps people to be more “aware” of urges, emotions, disruptions, or urgency around fixing or doing something NOW. Learning to control what you pay attention to will help you control yourself; your emotions may DEMAND your attention. Focusing attention exercises can help calm you down, settle you in, and even relax you a bit.

What You Should Know If You Have Been Diagnosed With Borderline Personality Disorder

Here is the truth: BPD, or Borderline Personality Disorder, has a historically bad rap with mental health professionals. I’m going to give you some truths to what you should know to not only think about this clearly, but to consider your options in terms of the person you want to be and the person you want to become.

BPD was historically known for “bordering” on the lines of neurotic vs. psychotic. In the olden days, clinicians who didn’t know if a person was living in the confines of “reality” could put them in a category that didn’t really fit either one. Historically neurosis has to do with issues related to anxiety, mood, and depression. Neurosis can also be related to trauma, vigilance, and paranoia about bad things re-occurring. Psychosis is related to problems hearing and seeing things that others do not see or hear, and is often associated with schizophrenia. “Borderline” has often been referred to as a category that doesn’t really fit any category, and in some cases has been the in- between of no-place.

BPD is also historically written about from an extremely pejorative and hopeless point of view. Words like “manipulative, gamey, cagey” are often used, and mental health professionals often refer to this diagnosis when talking about people that bug them, that they do not like, that get them enraged, and people that can tie up crisis hotlines and emergency rooms. In many cases, labeling someone with BPD has become a substitute for observing and describing behavior, providing useful feedback, and encouraging people to behave in ways that make them competent and more effective.

Here are some truths that you should keep in mind if a mental health professional has “informed” you that you have BPD:

Mental health diagnoses are not valid nor reliable. This means that (in terms of validity), if the same professional assessed a person over time (such as an assessment 20 years ago, 10 years ago, and 5 years ago), the likelihood that that professional would give the same person the same diagnosis is unlikely. It also means that if many different mental health professionals assessed the same person it is highly unlikely the all of them would come to the same conclusion about diagnosis. This is assuming that the only measure of giving a diagnoses is a working familiarity with the DSM-TRV, or the “psychiatric Bible” of diagnostic criteria (which is highly controversial. Be aware that homosexuality was once considered a psychiatric disorder, and now it is not). Mental health diagnosis may be more reliable and valid if the diagnosis is given based on a range of valid and reliable assessment batteries; thus if you have had some comprehensive personality assessment and testing this may be less of the case for your situation. Bear in mind that most people in the counseling profession are doing nothing more than giving you their clinical opinion; hence my point about reliability and validity. Also, there are some counseling programs that don’t cover concepts such as instruments of mental health measurement.

For some mental health professionals, telling someone they have BPD can sometimes be a communication of frustration. In a helpful world, telling someone what diagnoses they have can be useful and even helpful- it can validate if a person really is depressed or help figure out specific treatments. In the case with BPD, the “right treatment” is more complicated and may not be readily available. If your mental health professional is telling you have BPD, you might want to consider: So what? How it is it helpful or useful? Does it help people have the resources or tools for solving painful problems? Is it specific enough to describe what behavior shows up- and how behavior can be changed? Does it provide access to literature that is actually helpful? For some people, being diagnosed with BPD can only serve to increase shame and self-loathing. Literature is not always helpful and mental health professionals don’t always shore up resources for how to move forward to obtain resources and supports. Is the expectation to hide in a corner the rest of your life and not tell people who you “really” are? And do you seriously want to live this way?

There is a lot of confusion for most people around diagnosis being a cause. Diagnoses are actually descriptions of behavior, and mainly identify patterns of responding or behaviors that are typical for a person. Many people, including some mental health professionals, actually believe that they are describing reasons or causes of behaviors when giving someone a diagnoses. For instance, if the way that you behave is because you have a disorder, then someone people think they have adequately not only explained the reasons you behave the way you do, but they think they know why you behave the way you do. In terms of diagnosis, this really is not the case. The failure of the mental health system is that people think they are being helpful (“You have problems because you have a disorder”) rather than addressing causes and potential solutions for behavior change. In this case, many problems of pain are not being solved as the focus of attention is on the “correct” diagnosis, which, in my opinion, is a rather useless pursuit. It can be akin to a parent who has several children; one of them is determined to be “bad.” Instead of figuring out how to prevent problem behavior, solve problems, and tend to the child’s needs; the parent simply attributes all problem behavior to the child being “bad.”

What you can do if you have, or think you have, or someone else thinks you have BPD:

Don’t think you are permanently impaired, hopeless, or beyond help. Fear and shame keeps may people paralyzed from acting with self-respect, doing things that are meaningful, and putting oneself out there in the universe. Universally, fear and shame can prevent anyone from living a decent life. You are not an exception.

Learn to talk about yourself and your behaviors in a descriptive, non-judgmental, and matter-of-fact ways. This will make you competent, understandable, and respectable. This also means that if you go around and tell everyone you are disordered, people may treat you as fragile, incompetent, incapable, or helpless. Create and practice ways to talk about yourself outside of the realm of “mental illness.”

Pay attention to providers, mental health professionals, or family members who attribute your behavior to being “mentally ill” or “bad” or “personality disordered.” Realize that everyone has vulnerabilities and that many, many people struggle with giving accurate, helpful, and specific feedback. Consider how giving and receiving feedback is either helpful or not helpful, and don’t seek out relationships where blame seems to be an acceptable solution for reducing pain or resolving differences. Finding “fault” only works if the consequence is taking responsibility and making changes; not amplifying shame and paralysis of action.

Be aware that if you do delve into literature on BPD, you may encounter a wide range of confusing terminology that attempts to define you; which may not only be disconcerting but also downright confusing. You might encounter terms like object relations, transference, countertransference, self-objects, self-soothing self-objects, object mirroring, intrapsychic processes, or projections. Don’t get bogged down by mental health-ese. Bear in mind that some mental health professionals have a lot of trouble observing and describing behavior and giving useful feedback and sometimes hide behind their own jargon.

Find other things that provide you a sense of identity, that define you, that make you the person you are, and that you value. Consider roles you take on in society; engage in them and be proud of them. What is important to you? Why would you let a diagnoses get in your way with pursuing what is important to you? In what ways do you not “show up” because you have shame around a diagnosis? Life is bigger than the world of “mental health.”

Bear in mind that many mental health professionals are obsessed with political leaders that they believe to be personality disordered. In truth, political leaders are still political leaders, and political leaders have made great gains, influenced many, changed laws, and maintained power. Being diagnosed with something “bad” hasn’t deterred people from being politically active, advocating, having power, or being influential. There is no good reason why you have to be shamed from participating in the universe just like everyone else- people with a lot of problems still manage to be successful and competent in a myriad of different ways.

Finally, feel free to visit the National Education Alliance for Borderline Personality Disorder, a nonprofit that may be more helpful than the general google search. Their website (www.borderlinepersonaltydisorder.com) has some useful non-pejorative literature, trainings, and free services for friends and family members.

What if your depression and anxiety was not something you actually “have”?

Depression and anxiety are often considered something that a person “has”. Once they “have” depression and anxiety, there seems to be a mentality both in the general public and among mental health professionals that it is very hard to not have. Or that the obvious solution is to get rid of it- and in most mainstream ways of thinking, that solution is often medication.

Part of being a successful professional means that I need to help people think about the treatment of their think depression and anxiety differently- and figure out what to do about it. If depression and anxiety were a thing a person had, it would be a permanent condition: not subject to change. There would be no point in getting help. When people think of depression as a thing a person has, it becomes a noun. It is a reified, concretized, objectified, thing. People might think of it as actually existing or residing within them, somewhere in their brain or their heart. It feels bad and they will do anything to avoid or get rid of it if possible.

Depression is not only seen as a “thing” a person “has”, but it is also often cited as a cause. In other words, the reason you may be depressed is because don’t get out of bed. Yet the reason you don’t get out of bed is because you are depressed. The reasoning is not only rhetorical; it doesn’t solve any problems. Telling people that the reason they have problems is because they have anxiety or depression isn’t usually helpful- and doesn’t provide any solutions. If only people were interested in what actually causes depression or anxiety!

I think of depression and anxiety as verbs: aspects of experience and subject to change. Emotions, depression, and anxiety is caused; it is not a cause. It is something that can increase or decrease based on a wide range of factors. Those factors are worthy of exploration and can help a person feel more in control. If a person believed that depression and anxiety was caused, and those causes could be better understood and addressed; a person might have better options for not being depressed. Knowing when and how depression might show up also might make a person more able to predict and control its occurrence; and have less experience of depression and anxiety as an unknown “thing” that creeps up “out of the blue” and remains a static “thing” a person “has.” It’s mysterious, stigmatized entity prevents us from understanding or treating it.

Part of working with people is helping them gain an awareness on causes, reasons, triggers, and stimuli that evoke high anxiety and severe moods. Much of the time people don’t always realize the extent to which they are bothered by losses or threats; and the lack of paying attention can sometimes cost them in very painful ways.

What’s The Fuss About? A Super Brief History Of Behaviorism, Cognitive Behavior Therapy, And What Is Really Meant By Third Wave Behavior Therapies.

Behavior therapies have been around for a long time in helping people address problems of depression and anxiety. Here is a short article about old ways of thinking about behaviorism and what newer “third wave” therapies have to offer.

Old behavior theories are often criticized for this idea that there is no “person” on the “inside”, rather everything was a matter of stimulus and response. For instance, the presence of a stop sign (stimulus) would prompt the behavior or stopping (response), and behavior could be controlled by stimulus in the environment. Criticisms of this way of thinking included the lack of free will or choice. Behaviorism in the current way of thinking would take into account learning history, which would explain how different persons have different responses to the same situations. It also takes into consideration how the context of the situation may influence the outcome, such as snowy weather conditions or the fact that a person was busily distracted with their cell phone when coming to the intersection.

Old paradigms of thinking about behaviorism include methodological behaviorism; the gist of it being that if behavior was not observed, it did not exist and was not worthy of study. Clearly this created problems for people who want to understand emotions. Current ways of thinking of behaviorism (radical as opposed to methodological) refutes the idea that behavior has to be publicly observed in order to exist. All the “stuff” that occurs within the skin (emotions!) are alive, real, in existence, and worthy of study. The more global way of understanding behavior is that any behavior is worthy of analysis and understanding. Thus, an emotion or a highly conflictual altercation (the stuff that comes up in therapy) is clearly worthy of study.

Cognitive Behavior Therapies (CBT) often emphasized the thought process that ensues when a person reacts to a situation. People have a tendency (especially when panicked or a in a bad mood) to think the worst will happen, jump to conclusions, and make assumptions about situations and people that are not accurate. Cognitive Behavior Therapies have often emphasized the thought process/ thinking/ cognition; and often challenged persons’s perceptions of reality. This can get tricky when dealing with paranoia, post-traumatic stress, or psychotic thought processes; and can create even more problems when people are told their perceptions of reality are not, indeed, real. Focusing solely on cognitive ways to solving problems can result in trying to think one’s way out of pain and discomfort, which sort of backfires when people have problems with rumination, over-analyzing, or overthinking. That being said, CBT has been helpful to numerous people and has had a key role in reducing suffering, depression, and anxiety.

Exposure therapies are often considered under the umbrella of cognitive behavior therapies and include specific treatment for anxiety disorders. This is where a person comes into contact with a feared stimulus and behaves differently from the typical response. The goal is to increase one’s tolerance to anxiety, increase the repertoire of responding adaptively, and not let feared stimuli control one’s life. Here are some typical examples of treating anxiety through exposures: Obsessive Compulsive Disorder (people that are disgusted by dirty things are encouraged to touch dirty things such that they become less bothered by dirty things over time: watch the move Dirty Filthy Love), Social Anxiety (people are encouraged to join a small group and share more openly than they otherwise would and feel less isolated and have better social abilities), and Borderline Personality Disorder (exposures help people tolerate emotions better such as practicing breathing when angry instead of ranting angrily or picking a fight).

Behavioral Activation is a treatment for depression that includes engaging people in life situations that increase natural reinforcers. In a nutshell, the behavior of depression is often one of detachment, withdrawal, inhibition of activity, loss, flatness, tearfulness, loss of focus, and sometimes aggravation. Activating behavior may include increasing pleasurable activity, engaging in meaningful behavior, doing things to build mastery and challenge oneself, managing stress and time management, and decreasing commitments that result in being overwhelmed. These are ways of managing mood that don’t include medication. (A really great book on this is Overcoming Depression One Step At A Time, which can be found under “books I recommend.”)

The newer behavior therapies or “Third Wave” therapies are often considered an offshoot of Cognitive Behavioral Therapy. Technically, behavior is given an emphasis over cognition. This is because behaviorists consider the thought process to be only one aspect of behavior and is not given any kind of special treatment. For political purposes (and for the general lay population) this distinction can be confusing and for some, probably not necessary. However, all behavior is open to analysis and one’s thought process is not the only focus of treatment. The idea of Third Wave therapies is a return to radical behaviorism (hence the analysis of behavior), an acknowledgement of the ways behaviorism has been both hurtful/ helpful/ misunderstood, and an expansion of how behavioral ways of thinking have been making phenomenal comebacks (and changes) on intimate, psychotherapeutic relationships.

Third Wave behavior therapies are different in that they are interested in two things: 1) Context and 2) Function. Behavior (which can include anything you want to analyze for the focus of your therapy session, such as an emotion) can happen anywhere in time and space. Current conditions (ie., the context under which behavior occurs) will influence behavior. Behavior does not happen in a vacuum and is not situationally isolated. It is fluid and subject to change. Consider how “repressed” memories “show up”, and if you more or less likely to remember repressed memories if you have a warm, caring therapist who is expressing curiosity about your past. How you remember, what you remember, and what you are willing to tell this person are all influenced by the current context. If, in your learning history, people are not to be trusted; a warm caring person asking you this personal information may result in you changing the subject or talking excessively. Learning history clearly plays a part in how a person will respond to a therapist, and again shows how the overly simplistic stimulus-response models of early behaviorism fall short.

The function of behavior has to do with the purpose it serves. The same behavior of two people can have very different purposes, show up in different settings or circumstances, and have different outcomes or consequences. The behavior of vomiting after eating (such as the case of bulimia) can serve to communicate, validate, express anger, maintain privacy, prove a point, assert independence, or prevent the discomfort of feeling full. The fact that the same behavior does different things for different people and has different consequences makes it such that two people with the same diagnosis can need very different treatments. This is partly why there is so much confusion and controversy over mental health diagnoses and their varying treatments, and why any one “template” approach doesn’t work the same way for any two people.

Third Wave Behavior therapies are also coming to terms with spirituality. While past therapies focused on making unwanted emotions/ thoughts etc. dissipate, new wave therapies are getting people to look at what they want more of, what they value, and what is important to them. Instead of saying “What do you want to avoid or get rid of in your life?” they are saying “What do you want more of in your life?” or “How are you missing out on what is important because anxiety/ depression gets in the way?” There is a renewed focus on mindfulness and acceptance and a recognition that painful thoughts and emotions are part of human existence.

We’ve worked really hard to eradicate pain and that hasn’t worked, so what can be done instead? Making peace with our discomfort by not letting anxiety and our depression control our life is done through some applied principles from Bhuddism, mindfulness, and the concept of being “zen.” Spirituality clearly has helped many people cope, come up with their “why”, and rely on powers outside of their control to help them survive emotional pain. (Ie., “Let go and let God”). The shift in Third Wave Therapies is to look towards a more expansive way of thinking and also addresses a more existential concern. You don’t have be clinically depressed to benefit from examining values, enhancing your quality of life, and growing as a person. And at least one of these treatments, ACT, is being used in non-psychotherapy settings such as organizational and business consulting. (The Association for Contextual and Behavioral Sciences is the umbrella organization of the growing interest in Third Wave Behavior therapies, and offer an annual international conference to interested parties. Click here to visit their website.)

Third Wave Behavior Therapies are generally considered to be Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Functional Analytic Psychotherapy (FAP), and various mindfulness and compassion based therapies. DBT was somewhat of an early forerunner in bringing acceptance based practices to psychotherapy, the “dialectic” being that of acceptance vs. change. This was somewhat in response to the fact that Cognitive Behavior Therapy, despite the multitude of people that it helped, was a therapy based solely in principles of what needed to be changed. DBT skills include prayer, radical acceptance, finding meaning, and value-based goal setting. DBT’s founder, Marsha Linehan, grew up Catholic and developed the treatment based on her exposure to Eastern thinking and Bhuddism; she has written multiple articles on spirituality.

ACT is complex and a bit tricky to explain, but here are two principles that ACT encompasses: 1) Flexibility, or a flexible repertoire of responses to life’s challenges. A metaphor I heard recently was like a car hitting a pot hole- a car with no “bounce” or “give” is like a person who has difficulty adapting to life’s bumps. The more shock absorption that a car has, the more likely the car can navigate the pot holes and not get “tied up” or “stuck”. 2) Impermanence, or “self-as-context”. This means that the self that is “you” will change over time but still be the same “you”, and this “you” can change perspective in time and space. This matters in the sense that people who are really and truly “stuck” sometimes experiences their situations and self-criticism as permanent. The self-as-context concept often entails compassion focused exercises that allow you to see yourself differently; with compassion, and as an observer who can take a step back form being “fused” with emotional pain and rigid thought patterns. Compassion based practices have capitalized on the approach and address concerns related to extreme self-hatred, shame, and the ubiquity of human suffering. (Compassion Based Therapy is also considered it’s own independent treatment).

FAP at its heart has based its tenets on the principles of Awareness, Courage, and Love. (Known as the ACL model). Clients are encouraged to consider how their relational problems outside of session also show up inside of session, and to bring these similarities under direct observation as they show up in the relationship with the therapist. Immediacy (ie., What are you feeling right now as you are telling me this?) can evoke the discomfort clients often feel when in intimate situations, and encourage clients to develop more meaningful and fulfilling relationships via the interaction with their therapist. FAP is highly evocative, and clients grow in the courage to address things in therapy they tend to avoid. Because lack of intimacy is associated with mortality, intimacy and connection is a value that shows up consistently across FAP. If you think about this treatment from a behavioral standpoint, the environmental context (how a therapist responds) can have a profound influence on generating change. If the relationship with the therapist had no influence on the client, there would be no such thing as psychotherapy. Thus the focus on the environment (ie, the behavior of the therapist) is consistent with a behavioral approach to treatment.

The best way that I think of behaviorism is that there is no permanent, fixed, or reification of private experience such as thoughts, emotions, or sensations. The fluidity and impermanence of how we experience “self” changes across time, contexts, and situations. Problems often ensue when our thoughts are treated as structures, things, or objects. Problems crop up when we think we “have”, possess, or own the experiences within our skin. In order to “not have” depression, something would have change. Consider the difference between “having” depression vs. “experiencing” oneself as depressed. Which do you think is more hopeful, temporary, and subject to change? Third Wave Behaviorism, or “radical” behaviorism is making its comeback.

 

 

 

Why Isn’t My Teenager Honest With Me?

One of the problems teens struggle with is honesty. And it’s not only honesty with one’s parents or authority, but honesty with oneself.

Part of psychological distress comes from hiding the more difficult and disturbing aspects of experience from oneself. While this can sometimes be adaptive, it can become problematic when it comes to drinking, sexting, drug use, teen pregnancy, domestic violence, and other situations teens can sometimes get themselves into.

Being honest about a situation means admitting it is actually happening, admitting it is real, admitting the distress is real, and addressing potential consequences. Not admitting it is real, not asking for help, and not coping with the situation can lead to even more problematic consequences. Addressing something openly- while often difficult- can lead to prevention of further problems.

Admitting to the reality of a situation also may involve admitting to one’s role or part in the situation. Teens can sometimes not be honest because they have a fear of getting into trouble or a fear that it will escalate an intense reaction in the person they tell. They would rather avoid the short-term pain of intense reactions than the long-term problems of the situation. And teenagers are often not thinking about long- term consequences! The double bind is to deal with it all alone. A teenager who is all about gaining independence and relying less on one’s parents may believe that secret keeping is the only way to gain privacy and independence.

If you are a parent and want to increase you teen’s ability to confide in you, consider the following:

What are you doing to invite conversations about difficult topics, and what are you doing to punish conversations about difficult topics?

Are there topics or themes in your own life that are “off topic”? Are there conversations that would be too emotional for you to handle if someone were to ask?

Is the short-term anxiety of “not knowing” something worth avoiding based on the long-term consequences of not having a conversation at all?

What types of things do you “hide” from yourself because if you admitted they were true, you’d have to face the consequences?

If you were being completely honest with yourself, what situations would you have to confront?

What types of things did you keep from your parent/s when you were a teen, and what do you wish could have been different?

Being open about emotionally “forbidden” topics will help create an environment where openness is encouraged. Being more and more comfortable with intense emotions, painful life situations, and one’s own ghosts will help you develop deeper relationships. Avoiding painful life situations can sometimes create more psychological distress than seeing what is in front of you, admitting it exists, and taking steps to address it.

Should I Get Back On The Horse? Two Ways To Approach Your Fear That Won’t Work.

If you get thrown off a horse, should you get back on? Some people will suggest that you need to get back on the horse immediately so that you will gain mastery over your fears. If you don’t get back on the horse, then your fear will haunt you the rest of your life.

Is this really true? Here are some ways of approaching fear that isn’t very effective. The first is to fight your fears or treat the situation like a battle zone. It means taking the reins, having control of the situation, bucking up, grinning and bearing it, tightening your muscles, and powering through. It can be coercive and forceful. In some cases it means blinding yourself, dissociating or disconnecting from the fear, or minimizing or reducing the value of what your fear might be trying to tell you. Generally it is doing the thing that you are afraid of as a way to prove yourself or prove your point.

The reason this doesn’t work is because it often means engaging in life as if it is a battle. Staying in the battle field often means getting hurt, risking relationships with others, being coercive, or putting the other on the defensive. Getting back on a high strung or agitated horse to gain mastery over fears is not an effective way to manage fear.

The other ineffective way of handling fear is to completely avoid anything associated with the fear. This means that any mention of the feared object or situation is avoided. Conversations stop, people stop making eye contact, the air becomes stilted and stale, people avoid people, and people avoid a wide range of stimuli that becomes associated with the feared situation. The person may be humiliated that they gone thrown off a horse, so they go out of their way to hide it. While people lead perfectly fulfilled lives without riding horses, the person who can’t drive past a barn, watch a television show with a horse on it, have a conversation about what happened when they were thrown off a horse, or set foot on a farm may find themselves restricted in ways that have nothing to do with riding the horse itself.

Handling fear effectively means being able to approach the situation with a flexible style that involves both challenging oneself, listening to the validity of the fear, being kind to oneself, backing off when things are too overwhelming, identifying smaller steps to approach the fear, and figuring out why the situation/ issue/ activity is important to you.

Fear is a useful emotion in that it provides information about oneself and one’s situation. Fear protects us from danger, gets us out of threatening situations, and helps us cope adaptively. Fear can also be so extreme that it takes over our lives, restricts our ability to do the things that are important to us, or prevents us from having a life- the life we want.

Here are a few questions to help you figure out your fear:

  • What about the situation, event, activity, or relationship is important to you? You may decide not to ride horses ever again, but does this fear bleed over into other areas of life that prevent you from doing what matters? If riding horses is not important to you, and it doesn’t get in the way of your life otherwise, it may not be an issue.
  • What does your experience- and your fear- tell you? Your fear may be telling you that getting back on an agitated horse is indeed a bad idea. So don’t go out and get hurt if it isn’t necessary. If horses aren’t your thing, let it go and move on. Don’t let your humiliation keep you attacking something that isn’t going to service you.
  • If you want to approach your fears, what would be the smallest step? Watching a TV show about horses, visiting a barn, feeding a horse, brushing a horse, walking a horse, and hanging out with horses are all behaviors that don’t include absolute avoidance but don’t force you into a situation that is potentially unsafe. You could also ride a smaller, more mellow horse with the help of a trainer.
  • If you are going to do the smaller steps, don’t white knuckle it. Relax your facial muscles, soften your jaw, breath slowly/ deeply/ evenly, maintain an open body posture, and take in the situation fully. If this feels threatening, do a smaller step- or limit the time you spend doing the activity. For instance, you could watch a TV show about horses for one minute, five minutes, or fifteen minutes. If this doesn’t challenge you, up the ante by going out to a barn. Find your middle ground, back off when you are overwhelmed, give yourself credit for your efforts, treat yourself kindly, and challenge yourself at some point in the future when you are in a better place.

Manchester By The Sea- A Psychologist’s Point Of View On How To Work With Lee

Recently I went to see an excellent movie: Manchester By the Sea. Here are some thoughts I have about how I would work with Lee.

As a provider of clients who experience intense, severe, and painful emotions; Lee really does fit the bill. General questions that I might consider asking include: What would it take to reduce pain, survive loss, and manage or cope in a way that made things better? What would help Lee feel less stuck? What resources or connections could sustain him better, enable him to bear the weight of his pain, or enhance his quality of life? What could him grieve more fully and to get through this crisis? What is he doing that is working, and what is he doing that is not working? Could he be more likable to himself, sustain the burden or his guilt, or have more fulfilling relationships?

One agenda item I have is getting Lee to stop doing things that could potentially make his current situation worse. Often times I have clients who have severe emotional pain and it is so intense and unbearable that they are looking for any distraction to take away the pain. The distractions sometimes have a short-term effect of feeling better, which makes them hard to stop. However, in most cases these distractions can make problems worse- and are not effective long-term strategies to mitigate the severity of what they feel.

So one treatment agenda is to reduce risk taking or crisis-generating behavior. Specifically, Lee tends to get drunk, pick fights, and throw punches. The natural consequences for this behavior can result in serious injury, concussions, brain damage, head injuries, broken jaw, soreness, swelling, or other various medical trauma. Drinking heavily can result in poor decision-making, hangovers, dehydration, and liver damage. Other natural consequences of his behavior include legal problems, court dates, jail time, being seen as a threat in the community, increased relationship conflict, and isolation. Grabbing the gun of an officer might result in unintended harm to other people. Not only would Lee have the current dilemma of living with the intense and painful losses he has suffered, but he would have to address the above consequences in addition to everything he has already gone through.

Some people actually believe Lee’s behavior is justified. They would say that because he is in unbearable pain, he should be able to act the way he does. Or he should be let “off the hook” because his behavior is understandable. I would encourage those people to consider: Would you recommend your closest confident or best friend- who is deeply hurting- do something that could result in head trauma? Liver disease? Incarceration?

Another “justification” for Lee’s behavior is that he has significant guilt and self-hatred and he is trying to punish himself. After all, the law did not punish him enough! What would be an effective punishment, and how long does he need to punish himself for his actions? Are self-inflicted/ high-risk behaviors actually effective in making him feel less guilty? What if a police officer was shot by accident? What type of effective repair work needs to be done? What lifestyle habits could he change to prevent bad things from happening in the future? What would he need to do to redeem himself in the community? And what would it take for members in the community to find forgiveness, employ him, or tolerate him being around?

How would treatment move Lee towards growth, movement, and decreased pain? There are several ways to approach this- the key being a sensitivity and flexibility to what Lee would be able to handle at the time he seeks help. One is a baseline ability to talk about what happened. As he pieces together his story, there may be parts that are difficult to talk about. Avoiding these topics might show up in the form of escaping, not talking about it, dissociating, becoming numb, becoming argumentative, keeping one’s distance, staying detached, avoiding intimate relationships, leaving, drinking, or even picking more fights. The difficulty is that there are multiple reminders (or stimuli) that will show up throughout his life that he may not be able to avoid. These may include:

  • Conversations about young children
  • Seeing a house fire in the news
  • Talking to his ex, Randi
  • Seeing Randi’s newborn
  • Getting news that young children die or are dying
  • Randi saying “I love you”

For instance, what if he is watching the evening news and suddenly there is coverage about a house fire? What if Lee has a building tenant who loses a child to death, and Lee is present when the tenant tries to discuss it with him? What if Randi tries to contact him again or “shows up” in an unexpected manner? Maybe Lee can try to avoid these situations in the short term, but inevitably life, reminders of life, and young children are the life that surrounds us.

Therapy would work on staying present with emotional discomfort when these topics come up; and doing so in the presence of one or more people. That means not attacking, hiding, or getting drunk. It means being willing to experience grief, pain, discomfort, or tears. It means staying in a conversation and having a willingness to tolerate the stuff that seems unbearable. The more Lee does to avoid it, the worse it is going to get.

Healing results when a person’s grief can be managed, survived, and tolerated. Healing is about experiencing, talking about, and coming to terms with what happened in the presence of others. Healing happens when people can forgive themselves and each other and can make changes to prevent bad things from happening in the future.

Healing doesn’t happen when a person is literally “stuck” in blocking out all things reminding them of pain, and lives a life where they are blind and deaf to such triggers; avoiding any stimulus in real life that will inevitably show up at some point.

Healing doesn’t happen when emotions literally control lives, and people can’t engage a full, meaningful, rich, and productive life as a result. Healing doesn’t happen when there is no compassion for self or others, when there is no forgiveness, and when there are no second chances.

 

Depressed? Anxious? Here’s What You Can Gain and Obtain

Most people who have more than their fair share of depression and anxiety are often seeking ways to decrease depressive and anxiety symptoms. In other words, they want to not be depressed and not have significant anxiety. If the symptoms are extreme or significant the person may start to avoid a lot of things, such as getting out of bed and going to places to that prompt panic attacks. Lifestyles can become restricted and the person may stop going to events or venues where they have the feelings they don’t want. Medications might be pursued, evaluated, and re-evaluated to see if they “work” or they “don’t work”.

If you are a depressed or anxious person, it might be worth considering what it is that you want more of, you would like to have, or what you value in your life. Instead of thinking what do I want to avoid start thinking about what you want to have more of in your life. What is it that would make your life more fulfilling, more engaging, more interesting, more desirable, or more alive? What is actually important to you? Sometimes people are so focused on what they are trying to get rid of they stop pursuing what they want.

Figuring out what you want more of ties in to your values, your energy, and your time. Are you sacrificing what is important to you because you are avoiding negative feelings? Have you stopped seeking activities that give you pleasure, fulfillment, obligation, a sense of contribution, or the opportunity to enhance an important relationship? If depression and anxiety interfere, this is a good time to evaluate what you might have to tolerate to go after more of what you want.

Sometimes, if people have more of what they want, their buffer against depression and anxiety can be tolerated more naturally. Some people get panic attacks at work, but because their job is important to them, they find a way to bear with them. Sometimes people get depressed when important things are lost, but because they have other important and meaningful activities in their life, the depression is bearable.

People who have fulfilled lives often have a wide range of things that give them pleasure, provide a sense of work/ mastery, invest in important relationships, and find new relationships when important ones end. Diversity and stability of the good things can help people shore up more resources when things go south and important jobs and relationships end.

 

 

 

 

What if I’m wrong?

Here are a couple of thoughts on the business of being “wrong.” First, the question itself begs a certain dichotomy to form in a relationship. It implies a one-up, one-down position. It can make one person more powerful, keep another at a distance, or in extreme circumstances serve as an opportunity to belittle or berate. What does being “wrong” imply about the relationship, the importance of keeping a relationship, or the way that people will continue to relate to each other? Is it worth it to damage or hurt a relationship to be “right”? If one person is “wrong”, then how is the relationship handled in the future? How do people move forward?

Next, being “wrong” might be rephrased as being technically inaccurate. If you are responding in a way to that does not match reality in a reasonable sort of way, you may be considered “wrong.” However, in some circumstances this begs the question of differences in opinion, perception, feelings, and agendas. A person can have a valid point of view, see things differently, or see aspects of a situation that another person is not able to see. This can prevent communities from being rigid, thinking “inside-the-box”, refusing to consider alternatives, or being racist or non-diverse in their thinking. Trying to understand the validity in where others come from can help us be more understanding, have better relationships, be more forgiving, and become less “stuck” in the right/wrong dichotomy. If you are technically “wrong”, this also might be your opportunity for self-correction, learning, or growth. Consider teasing out the differences of being “wrong” vs. being technically accurate, and if being “wrong” has anything to do with conflict around perspective, perception, intention, or emotion.

In addition, there is a certain cost to being “wrong.” Everyone at some point in their life has probably had an experience in which they thought something to be true, accurate, or reasonable but found this to not be the case. The cost to being “wrong” is often related to embarrassment, shame, humiliation, or perhaps the loss of trust or leadership. Are you able to correct your actions based on what happened? Can you tolerate the pain of your own humiliation and consider what really matters? If the inability to bear the cost of being “wrong” results in isolation, criticism, withdrawal, and becoming more adamant that you were “right”; you may want to give some thought to what it is costing you in terms of your relationships.

Here are some final questions for you to consider:

  • What are your intentions? Sometimes we are in long term work, romantic, or family relationships that must be giving careful consideration.
  • What are the intentions of the other person? (Are you sure, or are you assuming? What evidence do you have?)
  • What is the true cost of being told you are “wrong”? What do you have to gain by making sure others know you are “right”?
  • If you are “wrong,” can you tolerate your embarrassment enough to grow, learn, regroup, or reconsider how you will handle future situations?
  • Is it more important to be right than to be effective? (Consider what the relationship means to you and if your own self-respect in handling the situation is on the line).
  • Are you unforgiving of other people when they are “wrong”, thus unable to forgive yourself? Is your own criticism preventing you from moving on, getting unstuck, or responding in a way that is potentially painful but perhaps necessary?