2:27 The "CBT Triangle (no relation to the Bermuda Triangle...)
3:45 Watch me do a magic trick with my dog!
3:46 List of "thinking traps" - click here for more.
I don't know about you, but I've been hearing therapy jokes since I was a kid. That's all well and good, and I get it, I really do. When I would see a character in a movie about to get really mad, take a deep breath, and go to their "happy place," I snickered and phfft'ed. I joked with friends about Al Franken's SNL character "Stuart Smalley" ("I'm good enough, I'm smart enough, and - doggonit - people like me,"), joked about anyone trying to get a sense of peace who dared to sit cross-legged, their thumb and forefingers together, chanting, "Ommm."
As a therapist, I can now see how these jokes minimize the therapeutic effect of some actual coping strategies and really turn people off to simple things that might work for them. For example, in doing a therapy called EMDR (Eye Movement Desensitization and Reprocessing), one of the preparations for trauma processing is a resource called "calm, safe place." Yep, you guessed it: It's going to your happy place. In the EMDR version, however, guided eye movements are involved as the client imagines a place with as many sensations possible that makes them feel calm and safe, and then use this later to counteract many of life's little annoyances.
Should we throw out these simple strategies when they seem like tired cliche`s? I don't think we could, even if we wanted to. There are very practical reasons why things like deep breathing, affirmations, and visualization work.
Deep breathing. I wouldn't advise foregoing a deep breath every now and then. In fact, this article on MindBodyGreen provides five very practical reasons and concrete effects from deep breathing. This includes improving fat loss by oxygenating our cells, helping the lymphatic system remove toxins, and easing pain and increasing relaxation through the release of endorphins. And this article on Selfication talks about how our shallow, tense breathing habits can really mess up our body functions - constricting blood vessels and airways, unbalancing the nervous system, and decreasing our overall energy. It's easy to forget how important breathing is, especially because we mostly rely on doing it unconsciously, but I always appreciate reminders of just how vital it is for mental health, not just, well, life itself.
Affirmations. Bringing it back to our non-therapist friend Stuart Smalley, affirmations are quite helpful - and theatrically portrayed as totally ridiculous. We use negative affirmations all the time via our internal mind's anxious chatter: I'm such an idiot. My life sucks. I hate my body. So we need to be aware of this and counteract these with positive statements, because we get what we concentrate and focus upon. To illustrate this, think about how often you find things you aren't looking for versus finding things you are looking for. Lost your keys in the morning before work? Can't find your wallet? Well, you're probably not going to have a lot of luck finding them if you never try. Same goes for affirmations: if you make a point of naming the positive aspects of yourself and others, even if they are just potential aspects, you're much more likely to find them.
Visualization. This can be more than a "happy place." There are many guided visualizations (or guided imagery) on YouTube that you can follow for many purposes, such as insomnia, quitting smoking, relaxation, or self-esteem. Some I like and have listened to include the following channels: Jason Stephenson, Michael Sealey, and YouAreCreators. Inner Health Studio is a website providing free scripts for meditation on a variety of subjects, mostly for relaxation, but they also include a nightmare reprogramming script which is a very good technique for stopping recurring bad dreams. Read the scripts in your own voice into your phone or computer voice recorder and play whenever needed.
I hope you find something helpful in the above links - if not, keep looking for something that helps you do your thing.
And as always, contact a therapist or helpcenter like this, this or this if you are in crisis and need personal help right away.
Click here to read Part 1.
In my first post, I talked about what to expect from therapy, which included a focus on change. I am devoting extra time to this in Part 2 because change is so important and yet so misunderstood.
Recently a nine-year-old girl, whom I've been seeing twice a month for a while, came into the room and started by saying she was having a really hard day. This was somewhat unlike her because she had been putting on such a brave face for most of our time together. She then described the compulsions she had engaged in, and how it caused a big problem. She didn't think that her OCD was part of why we were there until that day, when she admitted that the behaviors actually can and do get her into trouble.
I thought, Finally, we're having a breakthrough! My mind momentarily raced to all the new work we could start: we can talk about the compulsions and gain understanding, we can talk about all the positives from change and gain motivation. . . But no sooner did I think of these things than she slumped into her chair and, with all the stubborn sullenness a nine-year-old can muster, said, "And the worst thing is it's never going to be better because it's my brain that makes me do it and my brain can't change!"
Even though I could hear her using words that were a bit beyond her, like she was repeating someone else's explanation, I knew this idea was etched deeply in her mind: if the problem is my brain, then I can't change it. There's a big piece missing from this theory, but I get where it came from. There is a biological reflection of each mental health disorder within the body, especially in the brain. So often, mental health disorders have been stigmatized and treated with the flippant disregard of the (possibly) well-meaning friend or relative who says something like, "Get over it." A logical response is to point out that there is a physical component that anyone, were they looking inside your brain, could physically see. While I understand that the "get over it" point of view is to say that some mental toughness is needed, just pulling yourself up by your bootstraps is not going to cut it when it comes to mental health disorders. They are called disorders because they cause an impairment in function, i.e. in one's ability to "just get over it."
There's no denying that a mental health disorder can be reflected in the brain. But what I want to add to that is: this does not mean there is nothing you can do to about it. In fact, we do something about it all the time.
It's called neuroplasticity: neuro meaning "of the brain" and plasticity meaning "the quality of being easily shaped or molded." In biology and specifically evolution, plasticity refers to the ability of an organism (plant, animal, bacteria, human) to change and adapt to their environment. Have you ever heard the saying, "Use it or lose it," when it comes to people's ability to use their brains as they age? This is because of neuroplasticity. When you learn something, your brain makes new physical connections, connecting pathways to other pathways. When you practice that thing over and over again, you're making those connections stronger and deeper. If you don't practice, they become like a path through a grassy field that no longer gets used: the once clear path starts to grow over with grass and weeds. It may all but disappear. Neuroplasticity is lifelong. That's why they say: use it, or lose it. It goes for a 90-year-old as much as a 9-year-old. In the case of my 9-year-old, she has repeated certain behaviors over and over, strengthening and clearing the pathways, which makes them more obvious, deep and strong. The result she now feels is a compulsion. It isn't going to be obvious that she can change it, because the pathways that exist now are already so obvious that it will seem like she must follow them. But it only seems that way. She wasn't so keen to believe me that day, but I taught her the word neuroplasticity, and she liked knowing that. Knowledge and observation of this is where we can start. Later, we'll move on to the next stages of change.
Stages of Change is a model that was first introduced and applied within the field of addiction by DiClemente and Prochaska. It is also called the transtheoretical model of change. We know now that these stages can be applied to anyone with a problem that can be changed. Sometimes you'll see the stages listed as such:
Learning about how we change, and then accepting and expecting the phases of change, helps people feel empowered. I've seen it happen. It normalizes change. It illustrates the path. And it can do this for you, too.
Change is a vital part of life. We are doing it whether we know it or not, and we can use the available knowledge and research about change in order to empower the process of change for ourselves. Expect it if you're going (or considering going) to therapy.
Change can be good. You can do it!
And you already are.
There are two kinds of people: people who think there are two kinds of people, and people who don't.
Okay that was a joke to the effect that dividing people into two kinds is oversimplifying. That being said, sometimes people (of any kind) simplify things in order to make a clearer illustration of those things. Let's say your therapist were to ask you to name five words to describe yourself. It's not because you can be reduced to five adjectives and that is all you are. It's because to simplify things is to notice the biggest, most standout qualities in a given time. And what stands out in a particular time has particular meaning.
Now that I've qualified my next statement to death, I should actually make the statement. Ready? Here goes. As a therapist I've noticed there are two kinds of people who come to therapy: those who say, "There's something wrong; fix it," and those who say, "There's something wrong; I need to talk about it." Of those two kinds, the first are usually dissatisfied with therapy pretty quickly. They're the ones who come back maybe once or twice, and who say about counseling, "I tried that; it didn't work." They are the ones who may define themselves as "broken."
And if they don't give change a fair chance, they are also the ones who get to be right, but probably not happy.
The second group - those who need to talk about something - can be broken down further into two groups: those who expect that talking about what's wrong is going to "fix it," and those who don't. Of those, the ones who don't have expectations of fixing the problem by talking about it make up the largest number of people I see on a regular basis.
So, what IS therapy if it's not talking about problems you want to fix? Well, it is that - but it has to be much more than that. Therapy also has to:
Define what "fix" means to you. This includes whether and how it may or may not be done. Let's say you start with something like: I need to fix my spouse/make the chronic pain go away forever/make sure I never have another panic attack again/prevent my teenager from cutting. These kinds of statements are a place to start, but unfortunately these are not goals. Therapy is honing in on what is fixable, feasible, and in your control. A good therapist will help you with this. Then, you can work on the next steps.
Be collaborative. Essentially, you should have your own goals. A good therapist will help you figure out what yours are. I keep saying "a good therapist" because, unfortunately, not all therapists are good. Some of them out there basically just want to play the expert and tell you what to do. Now, I've had a client tell me that is what I should do, but I would neither want to be nor see a therapist like that. There are no two ways about it: therapy is work for you as the client. Unless your safety is in question and you need to seek medical or other crisis help, your therapist should not tell you what to do. They are also not the expert on you. Part of therapy is change and part of change is empowerment. If you start working toward change with someone who's telling you they are in control, or tell you each and every step you need to take, how empowering is that? Which brings me to my next point that therapy should . . .
Be honest. I've done a lot of different types of therapy. I once worked at an inpatient facility for dual diagnosis - the same one that Augustin Burrows of Running with Scissors talks about. I don't know what it was exactly, maybe the fact that some people were not there by choice, but many of those who came to therapy just wanted to tell stories. And when I say stories, I mean lies. I didn't always know it in the moment. But after consultation and some time, I realized that people sometimes come to therapy and just plain don't tell the truth. It's a tough situation, and it can be for a variety of reasons. I mean, I've had clients tell me they thought they were boring, or weren't doing therapy right, or needed to be a "good patient," so they lied. I was so glad they admitted it because then we could really get to some good work! Also, because I use CBT which involves homework, people have either told me they did something they didn't do or called in sick because they didn't "do their homework." This is also not great therapy. But I know people aren't always honest because, honestly, it's hard to be honest! All I can say to that is that you are human and so am I. Change is hard. You won't always do your homework, and it's okay! Just try to be as honest as you can, for your own sake. (And then, also try to do your homework.) Last but definitely not least, therapy must . . .
Focus on change. The scariest thing sometimes is facing change, but if there is a problem you want to be different, therapy must focus on change. And it is a process, not a product. In the next blog, because it is so vital, I will focus exclusively on the need for, theory about, and possible paths toward change.
There is what would now be considered an old phrase, “There’s no two ways about it,” which the American Heritage Idioms dictionary defines as: No room for difference of opinion, no alternative, as in We have to agree on the nomination, and no two ways about it. [early 1800s].
To have no room for difference, no alternative, just clarity as far as the eye can see - what a desired state of being! Life must be so easy in the world in which there are no two ways about it. But wait - what planet is that on? Because certainly, clearly (maybe? probably?) it is not this one.
I’ll say it in a word: ambivalence. Literally broken down, ambi means “two” or “both” and valence comes from the Latin for “go.” Put that together and you have someone who is ambivalent, or going in two different directions. Sometimes it’s easy to see just how this doesn’t work. Imagine for a moment you feel like a road trip and are torn between going to California or Washington either tomorrow or next week. As long as you’re ambivalent about the time and place, you’re not going anywhere.
It’s not so easy to see when the problem is internal, not represented by distinct places in time and space but rather by feelings. What happens if you want to meet new people, but you don’t like leaving the house? You admire your father but hate how he treats you? You love your spouse but you can’t stand him? Ambivalence, that’s what. Ambivalence is a major issue in counseling – I wanted to say problem, but it’s so much more than that. It’s sometimes the most uncomfortable feeling that people identify, even worse than anger or sadness. At least when you’re sad, it’s pretty easy to know.
A lot of people, much more than I would say realize it, come to my office ambivalent about counseling. Many times I’ve heard some variation on, “I wanted to come, but I almost canceled.” Maybe it was anxiety – they didn’t want counseling, but they wanted to get rid of anxiousness. Maybe their partner suggested they come, or a doctor or nurse. Kids, by the way, rarely say a parent made them come, and I believe them. Kids, especially adolescents, really find ambivalence distasteful and won’t tolerate it for long, even if they don’t have a word for it.
I guess ambivalence is the biggest problem when people don’t recognize it. I may recognize it, but that doesn’t mean I can tell someone, “You are ambivalent about counseling.” That’s the old stereotype about psychotherapy – someone telling you how you feel – but with me it’s exactly the opposite: you’re here to tell me that. On top of its invisibility or the lack of acknowledgement is impatience, usually with the process of counseling itself. People who are ambivalent about going to counseling are umpteen percent more likely to quit before things get better. I’m not going to pretend I have statistics, but in my experience, it’s a major issue I’ve seen play out over and over again. I can’t count how many times I’ve heard, “Oh, I tried that, and it didn’t work,” but I can tell you that, when this is said, it wasn’t by someone who gave it a lot of time or patience.
It’s a difficult concept, ambivalence, and hard for people of any age at any time to distinguish the feeling, let alone acknowledge or even accept it. I mean, is it even really a feeling, or is it more a state of being – usually, of being caught between two opposing feelings? Whatever it is, ambivalence usually involves opposing feelings, but they are also complicated by some mix of confusion, indecision, and uncertainty. This makes it especially insidious. And when it comes right down to it, a total bummer.
But no: ambivalence is not just an all-around, unavoidable bummer. It’s actually a step toward positive change. According to the Transtheoretical Model (also called TTM or the Stages of Change Model), developed by Prochaska and DiClemente in the 1970s, ambivalence must be part of change. Think about it: there’s a pattern in your life, a status quo that no longer works for you (e.g. TTM was originally developed to address addiction), and for a while, two patterns must exist – the old way and the new way. So you have this addiction to (alcohol, sugar, nicotine, etc) and you crave the substance, and you want to rid yourself of it. You feel two ways about it. It would be a lot easier, were this not the case, but if there were “no two ways about it,” you’d be either 1) unconcerned about change, because you still love to drink/smoke/binge, so why are we even talking about this? or 2) in the active stages of change, ridding yourself totally and easily of the clearly unwanted, unhelpful substance (so why are we even talking about this?).
But that’s just not how it usually goes, now, is it?
Let’s say your problem is not a substance, but a situation or relationship. It’s bad enough when you’re in the stereotypical “love/hate relationship” – classic ambivalence at its finest – because it is so painful, so intense. What about outright abuse? I met with a woman over several months who was very clear that her years-long relationship was unhealthy and not what she wanted. She didn’t like the lies, cheating, substance abuse, emotional instability and manipulation. That was for sure. In no uncertain terms, this woman knew what she was getting, that it wasn’t a new story, and that it would very likely continue unchanged. Just when things had reached “rock-bottom,” as they had for her before, and we were developing the plan of escape, and it was all going to change . . . she bailed. She was with him for years and it was going to take a lot to change her life and the lives of those involved. She felt two ways about it. That was for sure.
Timing is all-important in therapy: timing for change, for revelation, for endings and beginnings and decisions and goals. People don’t – dare I say shouldn’t? - give up their feelings before they’re ready. All shoulds aside, I often encourage people to process their anxiety while it’s hot, hold and examine the insecurity, wear the protective shell of trauma for as long as you truly need it. Feelings were developed by nature as signals for our minds to recognize, think about, and only then to do something about them.
If you’re looking to tackle a problem, set a goal, make a change, or just learn more about your feelings, you may want to say yes to therapy for a time. But please remember: you’re very likely going to feel two ways about it. Like ambivalence, you may love it and hate it. Maybe your first goal could be to learn to recognize ambivalence. Give it some time. Then you can tell your therapist or counselor when it happens. Then, and only then, can you do something about it. Maybe you’ll take a break from therapy. Or you can look at the TTM model, place yourself in the steps of change, and let it give you some hope that things can and will be different for you. The cloud of confusion will clear.
If you are depressed right now, feeling isolated, lonely, and in pain, you may need to reach out and ask for help. Sometimes our feelings of depression come and go and come back again, and we function and go on with our daily lives without intervention. This can still be lonely, and it can feed the feelings of hopelessness, loss of interest, lack of motivation, and suffering.
No one can read your mind or make you tell them you're not okay. The following is an exercise designed for those moments in which you need help, but it's still your secret. You can do this mindfulness exercise in five minutes from whatever quiet place is nearest you, and it can bring a sense of immediate relief, in some small way. You may also want to practice this at times when you're not feeling down. it can be a way to practice changing your thinking habits or simply feel the humanity of compassion.
Positive Connection Through Painful Emotions - 5 minutes
1. Think of a situation that causes you stress. You may be in that situation now.
2. Turn your attention to what is happening on the inside, to your feelings and thoughts.
3. Open the door to the intensity of the emotions for a moment, or allow yourself to recall the highest intensity you ever remember experiencing this pain.
4. Now say to yourself: "This is a moment of suffering." You may call it suffering or pain, but if you can label it more specifically, do so, e.g. resentment, guilt, self-loathing, regret, or grief.
5. Now tell yourself: "This [suffering] is a part of life." Think of all the people around you who may have experienced this feeling in their lives, and imagine people around you in greater and greater circles until you have included all the people in the world.
6. Know you are connected. Place your non-dominant hand over your heart and say: "I am not alone in my suffering (or pain, or struggle). May I become patient with this, and with myself."
7. Finally, as you take in four deep breaths, repeat any words that feel comforting, ring true, or bring softness. Patience. Kindness. Acceptance. Peacefulness. Yes.
I am Lisa and I believe we create our reality. I hope to help empower people to create more mindfully, be kind to oneself and others including animals and the environment, and just generally feel better.