Sunday, December 25, 2011

Meaning from Suffering

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...

Sunday, December 18, 2011

Music and Emotion

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...

Sunday, December 11, 2011

Making decisions

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?

Sunday, December 4, 2011

Quick Fixes

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.

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