This Is Me

Self Dialog

2012-02-12T13:11:00.001-05:00

I admit it: I talk to myself. And quite frankly, I don't see anything wrong with it. In fact, I actually encourage my patients to talk to themselves. Honestly, I suspect most people talk to themselves anyway; some do it out loud and some do it mentally. It pretty much amounts to the same thing.

So yes, I talk to myself. Sometimes it's just mental chatter (e.g., wondering if I remembered to lock the door, asking myself what in the world the lady that just walked by was wearing; planning my weekend, remembering something that happened last month or last year, etc.). Sometimes I have full conversations with myself; sometimes, I have arguments with myself. A typical argument taking place in my mind might go as follows:

Me #1: God, you look terrible this morning. Maybe it's because you're getting old. You did just turn 30.

Me #2: You know, it really isn't very nice to say things like that to yourself. It does't make you feel any better. Besides, you look fine. And 30 isn't old.

Me #1: I'm not being mean to myself, I'm just being honest.

Me #2: No, you're not being honest. You're being judgmental and unkind.

Me #1: Well I'm sorry if you can't handle the truth. Get over it.

Me #2: I will not get over it. Why don't you get over it?

Me #3: Why don't you both get over it. This conversation is over. Now stop looking at yourself in the mirror and finish getting ready.

I sometimes share this little anecdote with my patients; it usually gets a laugh. I laugh too because, after all, it is kind of funny. But I also let them know that I'm serious; it really is okay to have these kinds of conversations with yourself.

Initially, my advice to my patients was not based upon any scientific evidence or clinical practice theory. Instead, it was based upon experience. I know from my own experience that talking to yourself -- and sometimes talking back to yourself -- can be a powerful change agent.

Recently I discovered, quite by accident, that there is actually a theory to support the knowledge that I've gained from personal experience. The theory is called dialogical self theory. This theory asserts that for each person there is not one self, but many. These separate selves communicate (or dialog) with one another to maintain psychological stability, thereby creating the illusion of a single, unified self identity. From this perspective, there is no core self in charge of integrating and making sense of all of our experiences, beliefs, emotions, and perceptions. Rather, there are multiple selves that work together to make sense of these things.

So what exactly are these separate "selves?" There are actually several opinions about this, depending on who you ask. Some dialogical self theorists conceptualize these separate "selves" as internalized representations of the important figures in our lives. These internalizations are like templates that contain the norms, values, and beliefs of our early caregivers, culture, peer group, religion, etc. Other theorists conceive of these "selves" as past, present, and future versions of our personal identities. Still others visualize these "selves" as sub-selves called "I-positions," each with a different voice representing different aspects of an individual's identity. Others see these "selves" as "sub-personalities," some of which are more conscious than others.

Despite these differing views, there is one thing that all dialogical self theorists seem to agree on: what we perceive as a core "self is really a collection of parts. These different parts communicate with one another, often through dialog (hence the name dialogical self theory). It is therefore normal and in fact necessary to engage in internal dialog in order to preserve psychological stability and to maintain a sense of individual identity.

I think intuitively we all know this. We have all, at some point, probably said, "Part of me thinks...but another part wants to..." We have no difficulty conceptualizing ourselves as being made up of different parts. So why shouldn't these parts talk to each other? It is common knowledge that communication is the key to a good relationship. In order to have a good relationship with yourself, then, it is important for all of the parts of you to communicate.

Does your name say anything about who you are?

2012-02-05T13:43:00.004-05:00

Human language is necessary for reflecting upon and giving meaning to the world we perceive. Language enables us to identify objects that are not present, to refer to sensations that are not tangible, to recall experiences that took place in the past, and to envision a future that has not yet occurred.

Naming is one of the processes through which language assigns meaning to the world around us. Naming an object, a person, or a concept allows two people to refer to something that neither can see and yet both be able to understand what is being referenced.

When a child is born, he is given a name. To give a child a name is to endow him with a unique identity in the eyes of other people. This occurs long before the child develops any sense of personal identity. A person's name, then, begins to first impact his identity in the way others respond to it. Research has consistently demonstrated that people react emotionally to a person's name, even before ever meeting that person. The way others respond to one's name in turn affect how others react to the person himself, even if only in subtle ways. These reactions ultimately play a role in shaping the way an individual comes to think about himself (i.e., his self concept).

For example, some children have names that make them targets for ridicule by their peers. (For instance, I recall feeling particularly bad for a classmate in high school with the unfortunate name of Harry Johnson). Recent research has shown that boys with names that are traditionally associated with females do fine during early childhood but have, on average, a significantly higher rate of behavioral problems in middle school compared to their peers. College-aged women with names traditionally associated with males are statistically more likely to take classes in math and/or science than their peers with more "feminine" names (who tend to take classes in liberal arts). Other studies have shown that teachers respond differently to children with names they associate with low socioeconomic status. Specifically, they have lower expectations of these students than they do of their peers. Research has also found that adolescent boys with "unpopular" names are more likely to be involved in the juvenile justice system than their otherwise similar peers. These are just a few examples of how our names influence the way others perceive us.

So do our names define us? Well no, not exactly. There is far more to a person than his or her name. Our names do, however, play a role in how others define us and in how we come to define ourselves.

Hedonism and Happiness

2012-01-29T17:41:00.001-05:00

The Institute of Economic Affairs (IEA) in London recently published the results of a large scale research study on happiness. The publication, entitled "And the Pursuit of Happiness: Well Being and the Role of Government" can be downloaded from the IEA website here: http://www.iea.org.uk/publications/research/and-the-pursuit-of-happiness. (Click on the link that says "download publication for free").

The publication is divided into different sections with different authors. One particular section, written by Marc Devos, is called "The Unbearable Lightness of Happiness Policy." Devos talks about the fact that Western societies tend to promote hedonistic happiness. This is, Devos asserts, reflected in how happiness research is conducted, namely by measuring the level and frequency of positive emotions against the level and frequency of negative emotions. Efforts to increase the overall level of happiness in society focus on promoting activities that offer immediate pleasure: relaxing, watching television, going out to dinner, taking a vacation, socializing, or shopping. Devos argues that this is a very superficial approach to happiness. I agree.

A society dominated by consumption and materialism breeds desire. For most people, desire is an insatiable state. We see something we want and we buy it. Immediately, we experience positive feelings associated with our new purchase. These feelings, however, are always transient. Over time, the novelty wears off. We may still like what we purchased but it no longer generates the same degree of positive emotions it once did. Eventually, we see something else we desire and the process beings again. Desire can never be permanently satisfied. No matter what we acquire or even what we achieve, if we do it for the sake of pure personal pleasure we will eventually find ourselves wanting more.

Pursuing hedonistic happiness encourages people to seek out things that make them feel good. Success becomes measured by having the means to obtain goods and experiences that stimulate positive emotions. In Western cultures, this means that people with the most money are considered the most successful.

If hedonism leads to desire then desire, being insatiable, leads to greed. We constantly crave more, more, more in our efforts to experience positive feelings and to avoid experiencing negative ones. There is no enough; we always want more. The more we want more, the more we are willing to do anything to get it; greed flourishes.

The relationship between mindful participation and "flow"

2012-01-22T16:07:00.000-05:00

Most people are probably familiar with the concept of "flow." "Flow" falls under the realm of "positive psychology" and was formulated as a psychological theory by Hungarian psychologist Mihaly Csikszentmihalyi. Csikszentmihalyi describes flow as a state of consciousness that occurs when a person's attention is completely absorbed by a given activity. During a state of flow, all sense of time is suspended. A person becomes fully immersed in a given experience; he is no longer conscious of himself. His actions and attention are completely in sync. In a state of flow, a person is not conscious of external distractions. Neither does he experience any internal distractions; "mental chatter" does not occur in a state of flow.

According to Csikszentmihalyi, only certain activities can stimulate flow. To enter a state of flow, a person must engage in an activity that is challenging, but within his ability. Challenging activities, Csikszentmihalyi asserts, require our attention. Simple tasks, on the other hand, are frequently performed on auto-pilot.

It seems to me that a lot of people tend to think of flow as something that just "happens" when you find the right kind of challenge. I am sure this is sometimes the case. We start doing something; we become so immersed in it that when we next look at the clock we are shocked to find that hours have passed. So to a certain extent, the experience of flow does seem to depend upon finding the right activity. It is not, however, a given that once you find the "right" activity, flow will just come naturally. There is also no guarantee that it will be easy to find the activity that compels you to fully immerse yourself in it. For these reasons, flow depends upon more than just finding the "right" challenge.

If we leave it to chance, flow is likely to be a state of mind that we achieve spontaneously, but infrequently. Flow is the type of experience that allows us to fully engage in our lives; as such, it has the potential to enrich our quality of life and to add to our sense of purpose or meaning. Why leave something like that to chance?

When I teach mindfulness to my patients, I use the model designed by Marsha Linehan, Ph.D., creator of Dialectical Behavior Therapy (DBT). The DBT manual distinguishes between mindfulness "what" and "how" skills. The three "what" skills are observing, describing, and participating. I see the skill of "participation" as the sort of culmination of mindfulness practice, i.e., as something you work towards. The more you practice observing and describing the world around you (and within you) without judgment, the better able you are to participate mindfully in whatever is happening in the present moment.

The practice of mindfulness is concerned with process, not outcome. Flow, too, is about process. Flow is achieved through mindful participation and is its own, intrinsic reward.

I will be the first to admit that I do not experience flow very often. As a very task oriented person, it is difficult for me to take time to engage in the process of doing something. Often, I am so focused on needing to get things done that the process of doing brings no satisfaction at all. Because of this, I cannot jump straight to mindful participation when I practice mindfulness. Instead, I must practice non-judgmentally observing and describing. Gradually, this will enable me to maintain contact with the present moment more and more frequently. The more I engage with the present moment, the better able I am bring mindful presence to my daily activities. Mindful presence leads to mindful participation; mindful participation leads to flow.

Name and identity

2012-01-15T21:45:00.001-05:00

The degree to which a person's name is a significant part of his or her identity varies from person to person. I see it, in some ways, as a matter of attachment. If your name is integral to your conception of who you are then you are probably quite attached to it; if not, then you probably aren't.

I became interested in the role that names play in personal identity when I got married. I did not want to change my name; you see, I had grown quite attached to it. My name was comfortable and familiar. When two people used my name in a conversation they mutually understood that they were talking about me. My name connected me to my family, to my parents and to my sisters. My name was what I used to represent myself to others. It helped me to communicate who I was. Most importantly, my name was a gift, to me from my parents. My name was something special they'd given to me and no one else.

My husband had very different feelings about this. (I believe part of it is that he is Jamaican and that his is a more "traditional," less progressive culture). He was deeply hurt when I told him I didn't want to change my name. He told me it felt like I was rejecting him (an indicator that he, like me, sees a strong connection between his name and his identity).

After numerous discussions (disagreements), some tears (on my part), and a lot of introspection, I finally decided to make the change. My husband made a good point, namely that sharing the same last name was a symbol of our new family, the one we created when we got married.

So when I started looking into names, I wanted to know if other people are as attached to theirs as I was to mine. I wanted to know more about the relationship between name and identity. I sifted through a lot of philosophical opinions on the subject but they really didn't answer my question. (It seems like whenever I think I've chosen an easy topic to write about it turns out to be more convoluted than I ever imagined). Finally, though, I stumbled upon some articles that really addressed my concerns. The most interesting of these was by Laura Heymann, a professor at the College of William and Mary Law School. As opposed to being central to our identity, Heymann asserts a name is like a personal trademark. If a name were synonymous with identity, she argues, then the common practice of changing one's name would be viewed as committing fraud. Or a company, she says, that tried to modernize its logo would be accused of trying to deceive the public. (Notwithstanding the public outcry that occurred when the Gap tried to change its logo about a year ago).

This makes a lot of sense to me: changing my name didn't change who I am. Rather, I'm like Starbucks when it removed the words "Starbucks Coffee" from its logo last January. Like the Starbucks logo, my name change was merely an "update," a reflection of the changing times (i.e., me getting married).

Still, the connection between name and identity is not resolved for me. I'll stop -- for now -- but I am almost certain to revisit the issue. Another facet of the name-identity issue that interests me is the process of naming a child.

For now though, I'd be happy to hear what other people think about this. Are you attached to your name? Have you, for whatever reason, ever changed your name? If so, was it an easy decision for you?

Technology and Mindfulness

2012-01-08T13:20:00.000-05:00

Recently, I've read several articles about how technology and social networking are causing us to be less present in our daily lives. These articles were all from relatively mainstream news sources, which kind of surprised me. (You don't typically read a lot about present moment awareness in the news). One of the articles was by the granddaughter of Emily Post, aka "Miss Manners." The article talked about the etiquette of picture taking in the digital age. She advises putting the camera (or phone) away if we find that our picture taking is preventing us from fully participating in whatever is going on around us. Yes, she says, it is nice to have a million pictures of your sister's baby shower. However, your sister would also like you to really be there to share the special occasion with her. A shared smile between you or an assuring shoulder squeeze could end up being more memorable and meaningful than a photograph.

Another article talked about how Facebook is "making us miserable." The author explained how the ways we use Facebook can create a lot of unhappiness. One of the things the article mentioned was that people no longer just use Facebook on their home computers. Now, we use Facebook at work and on our smart phones and Blackberries. No matter where we are or what we are doing, we can always jump on Facebook to update our status (and to check on our friends' statuses). But what if status-checking your Facebook friends interferes with your ability to fully connect with the real-world friend sitting right next to you? Are we so busy playing on Facebook that we miss out on what's going on around us right now? The article's author interviewed several people for his story. One person admitted that she was almost hit by a car while crossing the street because she was using Facebook on her phone and wasn't paying attention. (I like that anecdote. It shows that not attending to the present moment has real -- and potentially fatal -- consequences).

When I did a Google search of the terms "mindfulness" and "social media," I discovered that there are two contrasting approaches to the issue. A few of the search results seemed to promote "unplugging" from our cell phones and the internet periodically to get in touch with the present moment; these results were, however, in the minority. By far, the majority of hits I got from my search talked about the mindful use of social media; they also talked about using social media (and other technology) to promote mindfulness. Some of the headings included, "10 mindful way to use social media" and "Mindfulness based social media." One title asked, "Can mindfulness be tweeted?" I concluded that most people have embraced technology as a means to facilitate and to promote the use of mindfulness. Those that warn of technology interfering with mindfulness seem to be in the minority.

In my opinion, people who are motivated to enrich their lives by being conscious of their internal and external environments will find a number of ways to support their efforts, to include online sources and social media. Those who have no desire to seek spiritual and psychological growth will approach technology the same way they approach everything else in life: without mindfulness. Which side of the debate do you support? Does technology help or hinder our efforts to be more present in our daily lives?

Beginner's mind

2012-01-01T18:15:00.000-05:00

"Nothing will ever be as exciting as it was when we were children." That's what I was thinking the day after Christmas as I sat down to reflect on the excitement of the previous two days. Christmas was a whirlwind of torn wrapping paper and the ecstatic squeals of children as they opened their presents. On Christmas Eve, my stepdaughter was so fraught with anticipation that she could hardly sleep. One of my nieces greeted me at the door when I arrived at my parents' house on Christmas morning. "Come see my new doll!" she exclaimed, barely stopping before taking off in the opposite direction to lead me to see her new doll. The unbridled joy of my nieces and stepdaughter made me smile again and again. It also made me feel a bit envious. As I reflected on this the next day, I concluded that nothing is ever as exciting to me as it was when I was a child. But why?

Most of the world's major religious and spiritual traditions talk about approaching life with a childlike mind. It must be the childlike mind that enables the kind of enthusiasm and exhilaration I saw in my nieces and stepdaughter on Christmas. What is it we possess as children that makes this kind of vitality possible? When do we lose it? And why?

After thinking about it, I realized that it is not what a child has but what she does not have that allows her to fully immerse herself in a pleasant experience. As we grow, we develop mental filters that help us to better understand the world we live in but that also inhibit us from fully engaging with the present moment. Included in these mental filters are social and cultural rules about what people should and should not do and what behavior is and is not acceptable. Our sense of self and our habitual patterns of thinking and behaving are also mental filters. Our personal values are mental filters. Even our memories of past experiences serve as mental filters, in that they influence how we perceive and interpret similar experiences in the future. Most importantly, our beliefs are mental filters; this includes beliefs about ourselves, about other people, and about the world.

Mental filters explain why one person reacts positively to a given event while another person has a negative reaction. The events are the same; the interpretations and perceptions are different.

The creation of mental filters, I believe, is an inevitable part of human development. Mental filters serve an essential function in helping us make sense of the world we live in. Without them, we would probably be inundated with information and stimuli from our environment with no way to decide what is important and what isn't. We would quickly become overwhelmed. Still, it is always useful to be aware that we experience the world through our filters and that our perceptions are not necessarily accurate reflections of reality.

How does this relate to having a childlike mind? If we are able to recognize and identify our mental filters, we can begin to look beyond them for brief periods of time. We can be conscious, for example, of our belief that, "Christmas is for the kids." We can then take the time to turn our attention inward, to focus on the sensations that accompany the emotions we are experiencing. We can intentionally observe certain aspects of our environment, mentally describing, for example, the sounds we hear or the smells of Christmas brunch. We do this without judgment. These brief efforts enable us to make complete contact with the present moment without interference from our mental filters. These efforts will allow us to notice and accept the feelings that arise; because we attend to the sensations associated with these feelings, we can briefly bypass the mental filters that might otherwise change our emotions. Small steps like these, repeated over time, will gradually help us to more frequently adopt a childlike mind.

Meaning from Suffering

2011-12-25T19:25:00.000-05:00

I believe it is often essential to find meaning in suffering before you can move past it. When I say this to people, their typical response is, "How am I supposed to do that?" There is no universal answer to that question. Still, I believe it is vital for a person who is suffering to find a satisfactory answer before he or she can move beyond his or her pain.

A lot of my patients are people who have experienced some sort of trauma. Some of these patients are able to "recover" from the symptoms caused by their trauma (or traumas); some patients are not. Some patients seem to fall into despair. One thing I've noticed about those who fall into despair is that they often view their suffering as meaningless. When they look back on the trauma and consider the pain they have endured and how much they have struggled as a result they conclude that they are somehow being punished or that they are irrevocably damaged. They say to themselves, "All of this pain, all of this suffering, and for what? For nothing!"

So how can a person grow from his struggles? How can he look at a terrible experience and see a silver lining? Again, every person must answer this question for himself. Still, there are some common "categories of meaning-making." These "domains" were developed after an extensive review of the research on posttraumatic growth and were ultimately incorporated into something called the Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996). They are:

1. An increased appreciation for life (especially its simple pleasures) and a change in priorities: I've heard survivors of potentially terminal illnesses (like cancer) talk about appreciating a sunset for the first time. Minor irritations and petty squabbles no longer seem important. Time with family and friends seems more precious and is therefore appreciated more.

2. Closer, more intimate relationships with others: People might rally around a person who has experienced a trauma, offering love and support; this can lead to closer relationships with these people. In addition, people who have had similar traumatic experiences (e.g., rape victims, children of alcoholic parents, bereaved parents, etc.) often find particular comfort from one another. This can lead to a whole new network of mutually supportive relationships based on common past experiences.

3. A greater sense of personal strength: After surviving a trauma, a person might conclude, "If I can survive that, I can survive anything!" You can't really know how strong you are until you are faced with a situation that forces you to tap into your inner strength. You might find that you are stronger in a crisis than you thought you would be.

4. Recognition of new possibilities or paths for one's life: Sometimes an event changes a person's life so completely that he is forced to change paths. In his quest to renegotiate his goals for the future, a person might find himself considering possibilities that had never before come to mind.

5. Spiritual development: Perhaps you've heard the saying, "There are no atheists in foxholes." People often look to a higher power when confronted with a life or death situation. Sometimes, when faced with his own mortality, a person begins to seriously consider some of life's existential questions. This in and of itself can be a profoundly spiritual process.

Just some things to consider...

Music and Emotion

2011-12-18T14:29:00.003-05:00

Last weekend, I decided to turn on some Christmas music to try to get into the "Christmas spirit." I used to listen to music fairly frequently, but from some reason I rarely turn on the radio when I'm doing things around the house. (In the car, I listen to the news and talk radio on NPR). I guess that's why I'd forgotten how strongly certain music can affect my emotions.

It's not just me. There is a large body of research demonstrating that music affects people's moods. (It's also been shown to impact physical health). Even without the research though, haven't we all had some personal experience with this? Maybe you've heard a sad love song after a bad break up and had to change the radio station immediately or risk bursting into tears. Or maybe you like to put on something calming like jazz or classical to help you relax after a stressful day. Perhaps when you hear a great new song with an irresistible beat you are suddenly overcome with an overwhelming urge to start dancing. Maybe you've been driving along mindlessly when some old song from years ago triggers a sudden wave of nostalgia and transports you back to a long-forgotten moment in time. Music just has that effect on people.

A lot of my patients need help learning to cope with situations that induce strong negative emotions (or learning to cope with strong negative emotions that seem to arise spontaneously for no identifiable reason). Often I'll work with patients to generate a list of coping strategies that they can pull from in a crisis. From inner city teenage boys to prestigious military officers, almost every patient I've ever helped to create one of these lists includes "listening to music" as one of their coping skills. It seems that the impact of music on emotional experience is universal to the human condition.

When I put on a Christmas album this weekend I was doing some work around the house. I wasn't really paying much attention to the music until the song "Someday at Christmas" started to play. Suddenly, a bolt of emotion surged from my stomach to my chest. I stopped what I was doing. For a moment I felt...full. Though it lasted only a moment, it was easily the most intense emotional experience I'd had in months.

If there is anyone out there who, like me, forgot how moving a good song can be then please, allow me to remind you. This is the perfect time of year for remembering...

Making decisions

2011-12-11T15:24:00.001-05:00

When my husband and I were shopping for wedding rings it quickly became apparent that we have very different decision making styles. My husband is analytical. He likes to identify all possible options and discover everything he can about each one. True to his nature, he wanted to go to every jewelry store in the area to see what they had before deciding which rings to buy. After two days of going from one store to another (and realizing that most of them had basically the same inventory and price range) I was frustrated and annoyed.

I am a task oriented person. Buying our wedding rings was just one on a list of many things that had to be done in preparation for the wedding. When there is some task that needs to be done my mind will not rest until it is completed. In terms of decision making, this means I like to identify a few acceptable options that meet a short list of criteria and choose from those the one that seems to be the best fit. The task gets completed in an acceptable manner and I am free to move on to other things.

I realize there are drawback to the way I make decisions. In prioritizing efficiency I might miss out on finding an "ideal" solution or getting the best deal. In the case of the wedding rings, maybe the perfect ring was out there somewhere, and on sale; if so, I missed out because I didn't take the time to look everywhere. Still, I'm happy with the rings we decided to get and never once have I wished we'd shopped around a little more.

There are also drawbacks to my husband's method of decision making. Sometimes, he gets so lost in the details of the various options that he misses the big picture. For example, he might spend so much time looking for the best bargain on a birthday gift for a relative that he misses the person's birthday altogether. He might give the gift belatedly or he might just decide to cut his losses and send a card.

My experience ring shopping made me curious about the different ways people make decisions. I thought a simple google search would turn up a short list of specific "decision making styles." I was wrong. Apparently, there are as many theories about how people make decisions as there are ways for people to make decisions. There are also different sets of ideas depending upon the context in which a decision is made (e.g., organizational or management decision making; consumer financial decision making; personal, day to day decision making; career and occupational decision making; etc.). So much for a quick and easy way to satisfy my curiosity.

I ended up reading a huge amount of information about decision making and pulling out what I thought was relevant. There were a few common themes. So without further ado, I present to you a (VERY) basic (and by NO means comprehensive) list of individual decision making styles:

1. Rational/Analytic: This style involves identifying all potential options and gaining as much information as possible about each one. Once all options are identified and explored, each one is systematically evaluated based on a list of pre-determined criteria, to include costs, benefits and probable outcomes. Using the results of these evaluations, each option is compared to the others and the best one is selected.

2. Intuitive: This style involves selecting an option based on your "gut feeling." In other words, you choose the option that feels right, maybe without knowing exactly why.

3. Consultative: This style involves seeking feedback and advice from several trusted individuals. You take this feedback into consideration when forming your own opinions and evaluating available options. In other words, the feedback you receive from others influences your opinions and shapes the way you think about your options. You might also use a consultative style after you form your own opinions and evaluate available options. In this instance, you would use some other decision making technique to reach a tentative conclusion about the path you want to take; you would then seek feedback from others as a cautionary measure. If others support the decision you want to make then you will be confident in implementing it. If those you consult bring up points that you had not previously considered, you might go back to the beginning of the decision making process and re-evaluate your options.

4. Dependent: Like the consultative style, this method also involves seeking direction and advice from several trusted individuals. The difference in the two methods is that someone using a dependent style is looking for someone to tell him what he should do (as opposed to using feedback from others to guide him in making a decision for himself). Essentially, a "dependent decision maker" tries to avoid making his own decisions by having someone else make them for him.

5. Avoidant: This style involves putting off making a decision until the last possible moment. The extra time is not used to gather information or to weigh available options. Rather, the time is spent trying to avoid thinking about the decision at all. Basically, an "avoidant decision maker" doesn't like making decisions and tries to put off doing it until he absolutely has to. Avoidant decision makers tend to procrastinate in other areas of their lives as well.

6. Spontaneous: This style involves approaching all decisions with a sense of immediacy and urgency. A spontaneous decision maker is driven by his desire to get through the decision making process as quickly as possible. (THIS IS ME! I was elated to find my decision making style described as "spontaneous." In reality, the appropriate adjective is probably something more like "anxious").

Decision making is a more complex topic than I initially realized. A person's decision making style is typically influenced by his or her personality. Obviously, personality is an infinitely complicated concept that I will not even try to tackle here. How do you make decisions? Does your decision making style seem to "fit" with your personality? Is your style one I talked about in this post or are there some decision making styles I completely overlooked?

Quick Fixes

2011-12-04T16:42:00.001-05:00

If there is one thing I've learned about personal change it is this: there are NO quick fixes. In fact, I think this is a principal that extends beyond personal change, to just about every aspect of life. There are very few things in life that can be achieved without focused intention and extended effort. In my opinion, the very belief in a quick fix (or "gain without pain") can lead to a lot of unnecessary suffering.

A lot of my patients enter therapy expecting me to perform some kind of "procedure" that will fix their problems within a few sessions. These are the patients who tend to eventually leave therapy prematurely, often feeling disappointed. I admit that sometimes this makes me feel really inadequate. Maybe there are times that I expect myself to perform some sort of "procedure" to alleviate a patient's suffering. When a patient looks at me in obvious desperation and says, "I'm still so depressed," it's difficult for me not to want to take responsibility for "fixing" it.

But therapy is simply not that way. Going to therapy is not like going to a medical doctor. A psychotherapist is not going to "run some tests" and then perform some kind of surgery. Psychotherapy is more like going to a general practitioner for help managing Type II diabetes. The doctor will probably give you some medication (just as a therapist might send you to a psychiatrist for medication). The doctor will then tell you that you can control or even "cure" your diabetes by changing your diet and exercising regularly. If, after leaving the doctor's office, you don't try to eat healthy and exercise you can hardly blame the doctor when you still have Type II diabetes a year later.

In other words, the most important factor in change is what the patient does outside of session. In session, I give feedback and point out patterns the patient might not have noticed. If the patient internalizes the information and uses it to identify and interrupt negative patterns in his day to day life then he is likely to improve. If the patient decides the information is not important then he will not think about it again after leaving my office. In session, I might share techniques and strategies that I think could be helpful to the patient. If the patient goes home and attempts some of these strategies we can discuss it when she comes back to her next session. We can identify obstacles to successful implementation and make alterations as needed. On the other hand, if the patient decides that the techniques "won't help," she will not think about them again after leaving my office.

There are a lot of other arenas in which the "quick fix" attitude seem to be prominent (and frequently problematic). The two that most readily come to mind for me are accumulating monetary wealth and weight loss. Think about all the billions of dollars that are made on "get rich quick" schemes and weight loss pills and fad diets. These products all play on people's desire for a simple, no hassle solution. Unfortunately, most of these products do not produce the results they promise, leaving their users feeling disappointed and defeated.

The fact is, in life there really aren't any "quick fixes." The surest way to accumulate monetary wealth is to save as much as possible and to invest wisely. The surest way to lose weight is to eat healthy and exercise regularly. As for change, I can't say what the "surest" method of personal growth is; I can, however, say with certainty that it almost always requires a long term commitment.

Over-thinking

2011-11-27T17:18:00.001-05:00

Being a "thinker" is, for the most part, a positive quality. Careful consideration about what's going on in the world around you results in improved decision making. As with most things in life, however, thinking too much can create problems. Most of us have, at some point, probably commented or heard someone else remark, "I think I'm over-analyzing the situation" or "I'm probably just over-thinking this."

So what is analytical thinking? Mary Blast, PhD (www.breakoutofthebox.com) describes it as "understanding a situation by breaking it apart into smaller pieces, or tracing the implications of a situation in a step-by-step causal way." She states that, among other things, analytical thought includes setting priorities, recognizing several likely causes of events, identifying likely consequences of an action, anticipating obstacles, and thinking ahead to one's next steps.

What does it mean to "over-analyze?" In my opinion, analysis crosses the line to over-analysis when it turns into rumination. The purpose of analysis is to gain a clear understanding of a problem or issue with the ultimate goal of developing solutions to a problem or identifying effective ways to approach or cope with an issue. In other words, the process of analysis should eventually lead to 1. Clearer understanding of a problem or situation and 2. Possible answers, solutions, approaches, etc. to the issue under consideration. If thinking about a problem's possible causes, consequences, etc. makes the problem less clear and makes you feel more confused about it then you can be fairly certain that you are over-analyzing it. If considering how to approach a given situation causes you to become so overwhelmed that you are unable to act then you can be sure you are over-thinking things. If contemplating the implications of a particular issue leads you to conclude that you have absolutely no control over the situation or its outcome but you continue to contemplate them again and again anyway, you are no longer engaging in productive thought; you are ruminating.

When dealing with a problem, concern, etc., there comes a point when the best thing to do is to stop thinking about it; you know you have reached that point when thinking about it ceases to be productive and begins to make you feel anxious, upset, or depressed.

I'll give you a personal example of how this can play out. Lately I've been spending a lot of time thinking about my finances and planning for my long-term financial security. I finally became eligible for my company's 401k plan about a month ago. Now that I'm contributing 10% of every paycheck to my retirement account I've had to adjust the amount I'm able to spend and save. It didn't take long to realize that I don't have a lot of money left over for leisure spending. I've considered several possible ways to free up some more money. I've looked into refinancing my mortgage at a lower interest rate; I discovered that I don't qualify for any of the government refinancing programs and don't have enough equity in my home to do it through the bank that owns my mortgage. I am currently exploring other options. I've thought about increasing the deductibles on my health and auto insurance policies - which would only cost me more if I had a health or automobile emergency - in order to decrease my monthly payments. I haven't reached a firm decision on whether or not to do it.

All of these ideas and decisions are a result of productive analysis of my financial situation. Thinking about my finances is not, however, always a productive endeavor. Here's an example of what goes through my mind when I'm engaging in unproductive thought:

Man, I hardly have any money left from this paycheck. But at least I'm putting a lot of money away for the future. Plus, when [my husband] finishes his master's degree he'll get a good job and be able to help out more. But what if he can't find a job? I can't pay all the bills by myself AND save for the future. Plus, I want to eventually have a kid. What if it takes him so long to find a job that I'm too old to have a kid by the time we can afford it? Would I still be able to lead a happy life if I never have a child? Will we end up becoming two lonely old people with no one to visit us? Wait, will we even be able to afford to retire? I'M saving money for retirement but he hasn't started yet. I don't think my money will be enough to take care of both of us. Man, am I going to have to keep working until I'm 80 years old? Well, I might as well. It'll keep me from feeling so lonely when we have no one to come visit us...

By this time I've usually started to feel anxious and depressed. I also feel helpless because I have absolutely no control over how long it will take my husband to find a decent paying job when he graduates in May. He may not even have that much control over it.

So I tell myself not to think about it. I push it from my mind and find something else to occupy my attention. Of course, these thoughts eventually creep back up again, but I do my best not to indulge them. They are just thoughts. Like all thoughts, if I don't grab onto them they will come and then go. If I label them as thoughts and refuse to accept them as truth then they will not have the power to make me anxious and unhappy.

So that's it. Being a "thinker" is mostly an asset. The problem with us thinkers is that we sometimes get carried away by our thoughts. It is important to keep in mind that thoughts are just thoughts. When they cause us to suffer, we can choose to let them go.

Why do we keep re-enacting the past?

2011-11-20T10:59:00.001-05:00

Human beings have a tendency to re-enact their pasts that seems almost compulsory. People who are physically abused as children are more likely to abuse their own children or to later marry a physically abusive partner. Boys who are sexually abused as children are at an elevated risk for sexually abusing others as they get older. Girls who are sexually abused as children have a greater risk than others of becoming strippers or prostitutes. A girl with an alcoholic father is more likely as an adult to marry an alcoholic man. A boy with an alcoholic father has a higher risk of becoming an alcoholic himself. Women who have been sexually assaulted as teenagers or adults have an elevated risk of future sexual assaults.

This is the stuff of therapy. Unfortunately, the negative patterns people repeat or re-enact over and over again in their lives can be extremely resistant to change. This is particularly true for patterns that developed as a result of early childhood life experiences. The foundations of personality are laid down and solidified during childhood. Any sort of traumatic experience (even something like being repeatedly criticized by a parent or having a parent who never shows affection) that occurs during this time becomes woven into the very fabric of an individual's personality. It becomes part of who they are.

This can be exceedingly frustrating for therapists. It is very difficult to work with a patient who continues to repeat the same problematic behaviors despite recognizing the negative impact they have on their lives (and on the lives of those they love). It's easy to conclude that the person doesn't want help or doesn't want to change. I've had a few patients like this over the years. I eventually concluded that they needed a more experienced or more competent therapist. I just reached a point where I'd tried everything I could think of and I didn't know what else to do.

I can also recall several instances in my own life when I knew I shouldn't take a particular course of action -- knew I would regret it later -- but did it anyway. It's almost as if, for those moments, logic and reason simply didn't matter to me. I can't say that reason abandoned me -- I can clearly recall thinking to myself that whatever I was about to do was a bad idea and that I shouldn't do it. But there was something else -- some sort of pull -- that was stronger than reason. It was that pull that led me to decide, "I know it's bad for me but I'm going to do it anyway."

I think that is what is must be like for those of us who repeat the same negative patterns of behavior over and over again. There is some sort of pull that compels us to do these things, despite knowing that there will be undesirable consequences.

My issue was that in the course of looking for a committed romantic relationship, I repeatedly became involved with men who had "commitment issues." It was never done intentionally; remember, I was looking for a committed relationship. When I became interested in someone it was not usually readily apparent that this person had problems with commitment. It was only after we became involved that the commitment issues became apparent. Even so, I would remain in the relationship, always against my better judgment and always to my personal detriment.

Despite all the personal growth and self healing I was able to achieve, I never really "resolved" this issue. When I met my husband he initially indicated that he was looking for a committed relationship. About a month after we started dating he changed his mind; he needed to focus on getting his life together first. Despite knowing this, I continued to see him maybe twice a week for several months. Eventually, he worked through some of the problems he was having and told me he was ready to be serious. So I never really stopped getting involved with "unavailable" men; I just happened to get lucky.

The point is, if I couldn't stop my own self-destructive behavior patterns, how can I help someone else stop theirs? Whenever I have a patient who presents with repeated self-destructive behaviors I end up feeling powerless to help them and completely defeated. I keep working with them and trying to help but I never really feel like I'm accomplishing anything.

In theory, however, just being there to listen without being judgmental, to validate the patient's feelings, and to accept that person exactly as he is -- is, in fact, helpful. ("It feels like what I do with my friends," I always say to myself. "How can it be therapy?").

Author David Wallin (www.davidjwallin.com/PDF/DavidWallin/AttachmentInPsychotherapy.pdf) explains why this kind of mindful presence is therapeutic. "If our early involvements [with our parents or primary childhood caregivers] have been problematic, then subsequent relationships can offer second chances, perhaps affording us the potential to love, feel, and reflect with the freedom that flows from secure attachment. Psychotherapy, at its best, provides just such a healing relationship."

When I think about it, maybe that's what all of us who repeatedly engage in the same problematic behaviors need - a second chance relationship. Maybe my husband is that second chance relationship for me. And maybe for my patients I can provide that second chance...

Countertransference

2011-11-13T13:15:00.001-05:00

We don't often admit it, but all therapists have patients they don't like very much. It's usually a relatively infrequent occurrence. Over time, however, a pattern tends to become apparent; for an individual therapist, there is a certain "type" of patient that consistently evokes a negative response.

Personally, I have trouble working with patients who excessively and consistently complain about their problems but show no real interest in making any changes. They often respond to feedback or suggestions with a litany of reasons why these ideas won't help them. They frequently fail to attempt any therapeutic strategies in between sessions, despite my encouragement. Sometimes, they insist that they only way to make things better is to change the circumstances in their external environment. Inevitably, these are circumstances over which they have absolutely no control. I fairly consistently point out that they have no control over this particular aspect of their external environment but suggest that they can learn to cope with it more effectively. Usually, this makes them angry. I find this exceedingly annoying. I just don't think there is anything to be gained from repeatedly complaining about circumstances you can't change.

One of my coworkers recently gave a brief presentation on countertransference that made me start to think about how I react to certain patients. Countertransference refers to any emotional response on behalf of a therapist that stems from his or her therapeutic interactions with the patient. The idea is that a therapist's emotional reactions to a patient frequently have to do with the therapist's own unresolved issues. Instead of being annoyed with the patient for causing a negative emotional response, the therapist should look at herself to figure out why she is reacting the way she is.

Honestly, I can't tell you why this one particular type of patient bothers me so much, at least not yet. I did, however, find a good suggestion for dealing with my countertransference by a psychologist named Dr. John Martin (www.4therapy.com). When dealing with a patient who triggers strong emotions, Dr. Martin suggests setting aside one full session with that patient to pay attention to myself. In other words, I should avoid any challenging or deep conversations during that session so that I can pay attention to what I am thinking and how I am feeling. Specifically, I should notice my feelings about my interactions with the patient (e.g., How do I feel about what I say to the patient? How do I feel about how he/she responds to what I say?, etc.) and about my relationship with the patient overall. As my feelings change throughout the session, I should try to notice what is happening to the patient's behavior. After the session, I should ask myself, "How am I contributing to the dysfunction in my relationship with this patient?"

It's funny how things always seem to point back to mindfulness. It seems to offer a solution (or at least an approach) to every negative thought, feeling, behavior, or situation that life presents. Dr. Martin doesn't call his approach to countertransference "mindfulness," but that is exactly what it is. Giving my nonjudgmental attention to my emotions as they arise will make me less reactive to them. Dr. Martin offers this as a technique that will prevent me from being drawn into a patient's "emotional drama."

Self growth

2011-11-06T12:08:00.000-05:00

I consider myself to be a relatively self aware person. Over the years, I have engaged in a lot of self-analysis, soul searching, and self reflection in an effort to understand what my problems are and to figure out how to deal with them. I spent a lot of time learning to like myself as a person. I taught myself not to immediately act on feelings of insecurity or jealousy, which ultimately led to me having fewer feelings of insecurity and jealousy. I learned how to portray self-confidence (even though I didn't feel self confident), which eventually generated feelings of confidence. I learned to listen when someone gives me negative feedback and to avoid becoming so defensive that I am unable to consider the validity of what I'm being told. I learned to accept responsibility for my role in a conflict, even if part of me clings to the need to be right. I learned to say no and set limits as needed. I started forgiving myself for making mistakes.

When I compare how I used to be to the way I am now I think to myself, "Wow. I've come a LONG way." I worked hard to become a better, happier person. I experienced a lot of emotional pain but I grew from it. When I consider how far I've come I feel proud.

And then I got married. A romantic relationship is, without a doubt, the best context for personal growth to occur. In my opinion, personal growth has to occur for a relationship to be a satisfying one. Why are romantic relationships so uniquely suited for self growth? Because while these are the relationships that typically bring out the best in us, they are also the relationships that are guaranteed to bring out the worst in us.

Think about it. What other relationship makes you feel as vulnerable as a romantic one? What other relationship so consistently triggers your insecurities? And who besides your romantic partner is likely to be as forthcoming with you about the not-so-pleasant parts of your personality? A romantic partner typically spends more time with you than anyone else; he or she will notice things about you that others never have the opportunity to see.

Needless to say, my new marriage has provided innumerable opportunities to re-examine myself. I firmly believe that people should always seek to know and understand themselves and should always be willing to grow. These are lifelong endeavors. Still, it's been really difficulty for me to re-examine the way I do things yet again and make changes. I suppose that because I'd only just reached a point where I was satisfied with who I am I wanted to sit back and enjoy it for a while.

For years I've devoted so much time and energy into learning to love and accept myself. Maybe I'm just tired. Yet I can't stop. I have to learn to accept things about my husband that sometimes drive me crazy. That might require me to consider why something that is relatively unimportant bothers me so much. Then there are the things that bother my husband about me that I never really saw as a problem before. Some of these my husband will have to learn to accept; others I will have to work on changing.

So now is really not the time to sit back and enjoy my hard-earned self-esteem. Maybe I was kidding myself anyway, to think you ever reach a point where it's ok to stop growing, even for a little while.

A Personal Life Story

2011-10-30T17:18:00.001-04:00

We all have a life story. A life story is my personal account of all the important events and experiences that have contributed to my becoming who I am today. Because my life story explains how I became who I am it plays a significant role in shaping the way I define (and perceive) myself.

Throughout life, we accumulate an endless number of experiences, the majority of which we later have no memory or recollection. Our brains cannot possibly store a detailed account of every waking minute of every day we are alive. Thus, it must filter and prioritize in order to decide which experiences to preserve and which to discard. For this reason my personal life story - my self narrative - consists of events to which I ascribe a particular meaning (and that I deem important). The meaning I ascribe to a given event consists of the conclusions I have come to about why the event occurred and how it affected me. Meaning is therefore highly subjective. If someone else were asked to select the most significant events from my life, that person might create a narrative that differs significantly from the one I've adopted.

When a patient first comes to me for therapy he tells a story. His story explains, "What's wrong?" and sometimes "How things came to be this way." Often, his story continues to unfold over the course of several sessions until I ultimately get a pretty clear picture of how this person defines himself. For example, one patient recently summarized the theme of his life story as follows: "Everyone I have ever cared about has either died or betrayed me. Everything I have ever worked to achieve has been taken from me by some other person." This short summary speaks volumes. It tells me that this particular patient perceives himself as powerless over his environment; he thinks of himself as a victim of external circumstances and of the malevolent intentions of others. This worldview causes him to have no hope that he will be anything other than a victim for the rest of his life. Because "everyone" he has cared about either abandoned or betrayed him he does not trust anyone. This prevents him from even attempting to establish meaningful relationships with others.

We allude to the themes we've taken from our personal narratives when we say things like, "I've always fought for what I wanted. I'm not going to give up now" or "I've always been emotionally sensitive, even when I was a child," or "I've blown every opportunity life has ever given me. I'm a complete failure."

A life story is always a work in progress. We can always choose to add a previously forgotten anecdote that reveals our inner strength. We can always choose to highlight our successes and accomplishments. We can always convey our setbacks in terms of what we learned from them. There are many ways to tell a tale - even the same tale. When we compose our personal narratives we get to decide which events are important enough to include. We get to connect the dots and draw our own conclusions. In this way, we are empowered to determine how we want to define ourselves, which in turn shapes our hopes and expectations for the future.

Why some people always insist on being right

2011-10-23T17:35:00.001-04:00

All of us have probably known or at least encountered someone who is simply unable to accept responsibility when he makes a mistake or to admit when he is wrong. We have probably all, at some point, known the frustration of dealing with someone who is "always right" and "never wrong." We may have experienced the futility of trying to reason with someone like this; even when presented with irrefutable evidence to the contrary, the person continues to insist that he is right. In situations where it is apparent that a mistake has been made (or an offense has been committed), he will blame someone else; it is NEVER his fault. If backed into a corner, a "never wrong-er" will, for example, insist that his behavior was a justified response to being abused or treated unfairly. (i.e., Yes, he was wrong, but it wasn't really his fault). A person like this will not even accept responsibility for his own emotions; he will, for example, insist, "Well he shouldn't have made me angry."

Nobody likes to admit to being wrong. However, most of us recognize that it sometimes need to be done and we do it, even if we don't want to. So what makes the people who cannot or will not admit to being wrong different from the rest of us? Is there away to get them to acknowledge when they are wrong and to admit when they've made a mistake?

I started thinking about this because of my own frustration dealing with someone who insist on always being right. For me, the worst thing about having a conflict with this person is that since he is "always right" then I always have to be wrong. I quickly started to resent being blamed for every problem that arises. Like most people, it's very hard for me to admit when I've done something wrong. Sometimes it takes a little while for me to recognize that I've made a mistake. Whenever someone I care about points a finger at me to tell me I'm wrong, however, I always take some time to think about it and to reconsider my actions. If, after consideration (and sometimes even consultation with someone I trust), I see that I've done something wrong then I admit it. I apologize and try to identify what I need to do to avoid making the same mistake again. Ideally, the other person involved in the conflict will also examine his behaviors and will accept responsibility for whatever part he played in the situation. It is discouraging when this doesn't happen.

So I wanted to know why it is so difficult for some people to admit they are wrong. After doing some research, it became clear that different people have different reasons for doing this. I am going to list a few of these reasons. However, this list is by no means exhaustive.

I think that most people who always insist on being right do so unconsciously. Denial of wrongdoing is a defense mechanism that kicks in automatically whenever they are accused of doing something wrong. When you confront them with evidence that they've made a mistake they become defensive (hence the words defense mechanism). Exactly what is it that they are defending? They are defending their egos from overwhelming emotional tension and anxiety. A discussion on the theory of ego defense mechanisms is beyond the scope of this little blog post. Suffice it to say that people get defensive when asked to admit they are wrong because admitting they are wrong would deal a serious blow to their self-worth and sense of identity. The person could be a perfectionist who equates making a mistake with being a failure. The person might have underlying fears of being stupid or worthless; these fears are triggered when hey are accused of being wrong. Whatever the reason, these people unconsciously view being wrong as a threat to themselves and their identities.

It is sometimes possible to reason with a person like this. The general rule is to proceed gently and to adopt a non-accusatory tone. You want to address the problem without attacking the person. If the person feels like he's being attacked he is going to become defensive and you will get nowhere. If possible, try to give some positive feedback or point out strengths before bringing up the problem. If the person's mis-behavior seems to be a reaction to difficult external circumstances then acknowledge these circumstances. Let him know you understand how difficult the situation is and try to brainstorm better ways to handle it. If there is a clear way to make amends or end the conflict then let the person know this and offer to help him with whatever needs to be done. Make sure you choose the right time and place to have the conversation. Let the person know you want to talk and ask him if it's a good time. If not, find out when he's available and agree to talk with him then.

What are other reasons people won't admit they are wrong? Well, some who refuse to fess up when they've done something wrong are motivated by the desire to avoid facing negative consequences. Maybe the mistake was an honest one or maybe it was an intentional act of wrongdoing; either way, getting caught means suffering undesirable consequences. How to deal with this really depends on the circumstances. Some criminals, for example, maintain their innocence even after being convicted of a crime. Chances are, the less you are able to prove beyond doubt that the person committed an act of wrongdoing/made a mistake/etc. the less likely he is to admit that he did it. After all, why tell the truth if there's still a chance of getting away with it? If you have irrefutable evidence then ask yourself this: Do you really need for the person to admit guilt? The evidence provides sufficient grounds for implementing consequences, even if the person refuses to admit he did anything wrong.

Then there are the manipulators. These people define right and wrong a bit differently than the rest of us. For a manipulator, something is right when it benefits him. Something is wrong when it causes discomfort for him. In other words, as long as an action benefits him there is nothing wrong with it. It is quite possible that the manipulator intentionally engaged in the act that you consider to be wrong in order to gain something for himself. You cannot convince the manipulator that his actions were wrong because he simply doesn't see it that way. If it benefits him then it's not wrong, remember? The manipulator also has a vested interest in persuading you to accept his alternate version of reality. His primary motivation is to get whatever he wants; it helps is he can recruit others to assist with this goal (or at least prevent them from interfering). Manipulators are often quite charming. A manipulator's endearing nature tends to put people at ease, which makes them more easily persuaded (i.e., manipulated). You will never get a manipulator to admit he is wrong; do not was time trying.

As I said, this list is far from exhaustive. If anyone has any other ideas about why people can't or won't admit when they are wrong please feel free to share.

Alexithymia

2011-10-16T20:14:00.001-04:00

The word alexithymia originates from the combination of three ancient Greek terms:

a: lack of
lexis: word
thymos: emotions

and literally translates to having no words for emotions. It is a clinical term that describes the phenomenon of being unable to express one's emotions verbally. Someone who is alexithymic typically has difficulty recognizing his or her emotions on a conscious level; because he does not recognize his emotions, he is unable to communicate how he feels to others. When asked how he feels about something, a person with alexithymia will often describe what he thinks or perhaps how he might respond behaviorally to the situation in question. Alexithymics often complain of chronic pain, gastrointenstinal problems (e.g., reflux, ulcers, indigestion, etc.), or frequent headaches for which no medical cause can be identified. When a person cannot recognize or express his emotions it becomes impossible to discharge (or process) these feelings in any meaningful way. Experts on the subject speculate that alexithymics' somatic complaints stem from unacknowledged and unprocessed emotions that have accumulated over time.

Dr. Reny Muller (http://homepages.spa.umn.edu/~larry/CLASS/NOTHING/READINGS/NoStorytoTell.pdf) suggests that the inability on the part of an alexithymic to express or process the emotions he experiences physiologically (i.e., the body sensations that always accompany any emotional experience) prevents him from developing a stable identity. "Who we know ourselves to be depends heavily on the story we tell ourselves about who we are," he explains. No words = No story = No identity.

There really is no widespread agreement on how best to treat alexithymia. Essentially, treatment requires teaching someone how to feel. My personal approach is to start with body sensations. I give patients a list of body sensations that are commonly associated with various emotions. I ask them to spend time each day simply noticing and writing down any sensations they experience in their bodies. Over time, I help them start to identify and name the emotion that describes a given set of body sensations.

If you think you or someone you know might be alexithymic, you can go online and complete a short screening questionnaire: http://www.alexithymia.us/test-alex.html

Identity Loss

2011-10-09T12:38:00.001-04:00

One thing I've noticed over and over when working with people who have experienced some sort of trauma is how depressed they often feel. When we start talking about the factors that contribute to the depression people often describe feeling lost and unsure of what to do to move forward. It became increasingly clear to me that whatever trauma they've experienced has fundamentally changed who they are as as people.

Most people realize they aren't the same as they were before the trauma occurred; actually, that's often why they come in to see me in the first place. Maybe they've recognized it themselves or maybe their loved ones have said to them, "You're a completely different person now."

What most of my patients want is to be how they were before whatever happened took place. Unfortunately, that's simply not possible. "You can't un-do what's been done," I explain. Events that bring a person face to face with death make them acutely aware of their mortality. This in itself is a very frightening and yet very profound experience. A close encounter with death or a severe illness or injury forces a person to reconsider his perception of himself as a competent individual who is able to handle threats and is capable of keeping himself safe. He suddenly realizes that there are many threats from which he is unable to protect himself; this makes him feel very vulnerable and defenseless.

My patients are fundamentally changed as a result of their experiences; they cannot go back to being who they were before. This is a difficult thing to accept; acceptance take place over time, not all at once. A person must make a conscious decision to let go of who they were without first knowing who they are going to become instead. They have to grieve the loss of their former selves. "I really liked who I was before," one patient lamented early in his grief process.

After that there is a period of limbo. Creating a new sense of identity takes a lot of hard work. A person may have to re-examine deep seated beliefs about himself, other people, and the world. He may need to find new activities that bring him joy and pleasure. He may have to end some relationships with people with whom he is no longer able to relate. He may have to seek out new relationships with different kinds of people. All of this takes time. Meanwhile, the person feels like he is no one, going nowhere. He is lost.

For anyone reading this who has been through a trauma, did the experience change you as a person? Did you go through a period of grieving the loss of who you were before? How did you come out on the other side of it?

Becoming yourself

2011-10-02T15:06:00.000-04:00

We are constantly in the process of creating ourselves. A person's identity is not a fixed entity, although we often treat it that way. Identity is dynamic and frequently changes over time. (I, for one, am definitely not the same person today that I was, say, in high school). An ever-evolving identity means that we are never "stuck" being some way we'd prefer not to be. If there is some way that we want to be - confident, assertive, social friendly - we can become that way.

This is where the technique of "acting as if" comes in. A person can act "as if" he already possesses the quality he wants to embody. The more often he does this, the more comfortable he becomes exhibiting the desired quality. People will respond to him as if he already possesses the characteristic in question. Eventually, the person will find that he no longer has to "pretend;" he will discover that at some point he actually became the way he wanted to be.

People are, at times, resistant to approaching change in this manner. They argue that it would be "fake" or "phony" to behave in a way that is inconsistent with their emotions. I encourage those who make this argument to take a look at what is driving these emotions. Are they based on unreasonable beliefs that were developed early in life and never re-examined? Take, for example, a person who wants to be confident. She does not feel confident and so believes it would be "fake" of her to pretend to be confident. But why does she lack confidence in the first place? Is it rooted in unreasonable beliefs such as, "I have to be perfect for people to like me" or "My feelings don't matter?" Does it make any sense to allow our behavior to be dictated by emotions that are based on unreasonable beliefs? Wouldn't that, in fact, cause us to behave in unreasonable ways?

The fact is, the way we define ourselves is constantly changing, so long as we don't cling to any one particular set of ideas about who we are. Our feelings and beliefs will at times determine our behavior, and rightly so. This should, however, be a conscious choice, not blind obedience. If we decide our beliefs about a particular thing are unreasonable and that our emotions about it are unhelpful, we can choose to set them aside. In this way, we avoid placing limits on who we can become.

Talk to yourself

2011-09-26T08:36:00.000-04:00

I frequently encourage my patients to talk to themselves, or perhaps more accurately, to talk back to themselves. Most of us talk to ourselves already, although not necessarily out loud. (Examples include, "Man, I'm such an idiot!" "I can't believe I did that!" "Come on. You're almost there; you can do it!" "I wonder why he said that to me." "I hope no one saw me trip on the stairs just now." "I don't think I can do this!"). Our minds tend to produce a constant stream of commentary, interpretations, and judgments. For most of my patients, a lot of that mental activity is negative. Hence the recommendation that they talk back to it.

So what are you supposed to get out of talking to yourself? Well, I'll use my own experience as an example. Part of the reason I decided to study mental health in college is because I wanted to help myself. I had periods of depression throughout my adolescence and young adulthood. I had very low self esteem. I had very few adaptive methods for coping with my emotions. At times, I engaged in risky and/or self-destructive behaviors, usually aimed at trying to numb my emotional pain.

After I finished college I began to work in earnest at becoming emotionally and psychologically healthy; I needed to be if I was ever going to be able to help other people. At some point during this process I realized that if I wanted to feel good about myself I needed to start treating myself the way I would treat someone I care about. This was definitely a change from my typical way of relating to myself. Like a lot of people, I "motivated" myself with harsh words about not being good enough. I would tell myself that failures are worthless under the guise of pushing myself to work harder. Maybe I thought if I gave myself a break I would become lazy and unproductive; certainly a lot of people believe that the only way they'll ever accomplish anything is to "discipline" (i.e., punish) themselves. Unfortunately, this strategy has significant negative emotional consequences. There had to be a better way and I was going to have to find it.

Now old habits die hard and my habit of putting myself down was deeply ingrained. I had to be vigilant in monitoring what I said to myself. Whenever my inner voice started its negative commentary I began imagining a louder voice telling it to shut up. I started thinking of it as my defender. It stood up to the bully that had taken up residence in my mind and had operated unopposed for years. Of course the bully resisted; it wasn't going to give up its territory without a fight. There was a struggle, but over time the bully began to lose power. There was actually a period during which the bully ceded control but would still meekly offer up its negative opinion for consideration. Its opinion was promptly and consistently rejected. Eventually - and almost without me even realizing it - the bully became silent.

This is why I tell my patients to talk (back) to themselves. I like to point out that they treat themselves in ways they would never tolerate being treated by others. (They usually chuckle a bit at this). Really, I encourage everyone to at least spend some time listening to what they say to themselves; you might be surprised at what you hear.

Control and letting go

2011-09-18T14:42:00.000-04:00

The other day I met with a patient I've been working with for the past several months. About a year ago he was involved in an industrial accident; he developed posttraumatic stress disorder as a result of his experience. He was extremely hopeful and enthusiastic when we started treatment. Together, we identified a treatment program that I felt confident would significantly alleviate his symptoms. Things went well initially, but after a few sessions we hit a road block. We spent a lot of time identifying ways to get around the problem. We even decided to meet twice a week in an effort to "speed up" the treatment process so he could get through the hardest part of it more quickly. Unfortunately, nothing we tried was very helpful. The patient was just stuck.

When I saw him this week he was feeling pretty hopeless. He was frustrated and depressed. He told me he no longer has hope that he's going to get better.

I know exactly what is keeping this patient stuck; it's a problem I've run into a quite a few times. The patient himself told me what the problem is, although he didn't realize it at the time. "The anxiety is so bad," he said. "I can't control it."

And therein lies the problem; he is trying to control his anxiety. What he really means by "control" is "get rid of." In other words, he can't make it go away.

Of course, it's human nature to want to get rid of negative feelings (or to stay away from situations that cause those feelings). Most of the time, however, trying to get rid of negative emotions just doesn't work. The feelings might go away for a little while but they keep coming back.

Let's take posttraumatic anxiety, for example. The anxiety a person experiences after a trauma comes from the fact that his illusion of control has been shattered. Most of us go through life believing, "I can keep myself safe. If I am careful and make good decisions I can prevent bad things from happening to me." When, despite all our precautions, something bad does happen, we can no longer believe what we've been telling ourselves.

The fact is, we were never in control; we just believed we were. This belief helped us to feel safe. When we realize that there are a lot of things in the world that are beyond our control, we feel completely vulnerable.

The thing is, you can't fix a problem caused by feeling out of control by trying to control it. What you really want to control is the world around you; that way you can prevent anything bad from happening. Unfortunately, you now know you can't control the world around you; this knowledge causes anxiety. Since you can't control the world, you try to control your anxiety instead. But even if you could control your anxiety it doesn't take away the fact that you still can't control the world. As long as this knowledge causes fear the anxiety is going to keep coming back.

So back to my patient. I told him that his efforts to control his anxiety are a big part of the problem He was able to recognize this. Knowing, however, is not enough. I cannot teach someone how to stop trying to control and just let go. Letting go is an intensely personal decision that requires intention, willingness, and a small leap of faith. Letting go is a "try it and see what happens" approach. Of course, I know that "what happens" is that nothing bad happens. Unfortunately, that is something my patient has to experience for himself. To do that, he has to be willing to let go.

How to trust

2011-09-11T16:14:00.000-04:00

A common complaint among my patients is that they can't -- or maybe just won't -- trust people. This difficulty trusting others typically stems from past betrayals. As a result of these past hurts, my patients conclude, "If I trust someone, they will hurt me. If I don't want to get hurt then I should never trust anyone."

Of course, this too has painful consequences. It makes for a very lonely existence. Refusing to trust anyone simply isn't conducive to living a happy life. My patients typically realize this; they seek my help in learning how they can trust without getting hurt.

The first thing I tell people is that trust ALWAYS involves some level of risk. There is no way to guarantee that a person won't hurt you once you decide to trust them. There are, however, ways to decrease the risk associated with trusting others -- risk management strategies, if you will.

The most important rule when learning to trust is this: only trust a person as much as you know him. In my opinion, the best predictor of an individual's future behavior is his past behavior. If a person behaves a particular way in a given situation he is likely to behave that way in similar situations in the future (unless something significant occurs to change things). Taking the time to get to know a person, to spend time with him and observe his behaviors in a variety of situations, improves your ability to predict how he is likely to act in the future. Trust is a future oriented construct; when you trust someone, you are essentially betting that the person will (future tense) fulfill an agreed upon commitment. Being able to make predictions about a person's likely future behaviors makes trusting that person a lot less risky.

Janina Davison-Forder (themoraltimes.com/?p=2820) makes a very good point about trusting that will serve as Rule #2: trust people to be who they are, not who we want them to be. If, for example, you have a friend who is habitually late everywhere she goes it is foolish to trust that she will be on time to a particular event, no matter how important the occasion. If your brother is terrible with money it is unwise to loan him money and trust him to repay you in a timely manner, even if he swears he will. People can only be who they are; trust them to be exactly that.

A third point to remember (though not necessarily a "rule") is that trust is not an "all or nothing" thing. There are different levels and degrees of trust. It is also possible to trust people in certain areas but not in others. You don't, for example, have to trust someone to take a bullet for you in a gunfight in order to trust him to feed your dog while you're out of town.

Another important principle about trust is this: healthy trust develops gradually, over time. This goes back to Rule #1 (trust someone only as much as you know them). It takes time to get to know a person. Likewise, it takes time to determine how trustworthy a person is. Now there is no standard for how long you should know someone before trusting him. You can, however, take a gradual approach without following a specific timetable. Start out determining if you can trust the person with small things. Does he call you back within a reasonable time when you leave a message? Does she show up on time when you've agreed to meet? Does he refrain from sharing with others information you have told him in confidence? Does she offer positive feedback (versus criticizing everything you do)? Does she self-disclose at around the same level that you do?

The final piece of guidance I offer to help with learning to trust is this: work on strengthening yourself emotionally and psychologically. Earlier I talked about the fear of trusting others as being embedded in the fear of being hurt or betrayed. Implicit in this fear is that being hurt is overwhelming and you simply can't handle it. If your work on building your inner resources you learn to take care of your own emotional needs (instead of depending on someone else to fulfill them). When you are able to do this you learn to trust yourself. This means trusting that you will be ok, even if someone hurts you or betrays your trust.

Shoulds

2011-09-04T15:39:00.004-04:00

"I shouldn't have to go through this!" "It's not supposed to be this way!" "He should know better!" How often do we say or hear these comments and others like them? We think of the past in terms of what we "should have" done differently. We look at our current circumstances and determine they aren't the way they "should" be. We have ideas about how people (including ourselves) "should" and "shouldn't" act and about how events "should" and "should not" unfold. If only things were as they "should" be we wouldn't be suffering!

In truth, it's this kind of thinking that causes our suffering. Think about it; a different version of the past and/or present (how things "should have been" or how they "should be") exists only in our minds. Yet often these versions of reality cause a lot of suffering. When we set expectations for how things "should" be we become critical and judgmental when reality doesn't measure up. Our "shoulds" become absolute rules that govern every area of our lives. These rules are inflexible; there are no exceptions. This rigidity removes the option of acceptance when something doesn't go the way it "should." When you use the word "should" you implicitly make demands of both yourself and other people. While it might be reasonable to expect that you will meet your own demands, it is completely irrational to expect the rest of the world to do so.

The next time you find yourself thinking that something "should" or "should not" be the way it is, ask yourself this: Who says? Who gets to decide how things should or should not be? And who says that things should be any way other than exactly as they are? "Shoulds" are really just products of our minds. It is important to remember that just because our mind creates something does not mean it is true. In fact, frequently the products of our minds are actually the cause of great suffering.

Dealing with people you don't like

2011-08-28T18:46:00.000-04:00

I try, whenever possible, to keep toxic people out of my life. I encourage others to do the same. For me, a rule of thumb is: if the negative things a person brings to your life far outweigh the positive the relationship is toxic.

Unfortunately, it is not always possible to avoid interactions with toxic people. The toxic individual in question might be your boss, your child's teacher, a coworker in the cubicle next to yours, your neighbor, etc. You can - and probably should - limit your interactions with these people. Still, it is simply not possible to avoid them altogether.

That's the situation I find myself in now with my husband's ex wife, who is also the mother of his five year old daughter. This woman is about as toxic as they come! (I won't get into specific details. There's no point in trashing her in a public forum. Neither does it seem particularly appropriate to air the stains on my dirty laundry in such a venue). My strong preference would be to avoid all dealings with this woman. While I do keep our contact to a (bare) minimum, there are still times when I have to engage with her (like when I pick up my stepdaughter for our weekend with her because my husband has to work late on Friday nights).

Interacting with this woman has an emotional and even physical impact on me. On days I have to meet her to pick up my stepdaughter my chest is so tight with anxiety that it aches from the time I wake up in the morning until the whole ordeal is over. When I first met her I tried to introduce myself and be friendly. She was not receptive. Initially, I thought she would become less hostile over time. About a year has passed since we first met; things have not changed much. I have to accept that she might never become less hostile towards me (and my husband).

The reality is that if my interactions with her are going to become less emotionally distressing for me it's not going to be because she becomes friendlier. I am going to have to look inside myself to find peace. But what am I looking for?

I once read that when we don't like a particular individual it is because we dislike the emotions we experience when we are in that person's presence. Something about the person evokes in us a negative emotional response; we interpret this response to mean that we do not like the individual who triggered it. Theoretically, however, our emotional reactions to people say more about us than they say about the people who trigger them.

Cher Huber, noted author and Zen teacher (http://cherihuber.com), goes one step further. She states that not only do we not like being in the presence of someone we do not like; we do not like ourselves when we are in that person's presence either!

I look to my experience with my husband's ex-wife to see if this fits; it does. When I'm in her presence I stop being myself. I become focused on not setting her off. Suddenly, I feel like I'm eleven years old again, trying to be invisible so as to avoid being targeted by the classroom bully.

Cheri Huber suggests that we can make it easier to be in the presence of a person we dislike by turning our attention inward and remaining focused on liking ourselves. I've given some thought as to how to go about doing this. I've decided that the next time I have to interact with my stepdaughter's mother I will be armed with some self-empowering mantras I can repeat to myself throughout the encounter. I'm hoping this will help me to stay in touch with my "real self." I also hope it will help me to reach some sort of peace with the situation as it is. While I have to interact with this woman I DO NOT have to allow it to make me miserable.