Monday, September 26, 2011

Talk to yourself

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.

Sunday, September 18, 2011

Control and letting go

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.

Sunday, September 11, 2011

How to trust

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 ( 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.

Sunday, September 4, 2011


"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.

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