Sunday, December 30, 2012

Are emotions worth it?

I recently picked up a book I’d never heard of before by an author I wasn’t familiar with just to have something to read.  The book was “Forbidden” by Ted Dekker and Tosca Lee.  I definitely didn’t go into it expecting any profound insights; I just wanted to be entertained. 

The book takes place in a distant future in which all human emotions except for fear have been selectively eradicated from the human genome.  Fear was left intact because it was considered the “only emotion necessary for survival.”  I’ll agree with this in premise; fear is definitely necessary for survival.  I remember reading about a woman who sustained a head injury in an accident that rendered her unable to experience fear.  As a result, she frequently found herself in dangerous situations.  She’d been attacked and robbed several times.  Her doctors were concerned for her safety.  Without a mechanism to warn her she was in danger, she was unable to differentiate between what was safe and what wasn’t.

On the other hand, too much fear can be debilitating.  I see a lot of patients who are plagued with anxiety.  They see danger or the potential for danger everywhere, even in places that are perfectly safe.  Often, they are completely unable to relax.  They live in a constant state of alertness; they are always on guard.  Many of them avoid going to places where large groups of people gather; they stay away from malls, popular restaurants, concerts, PTA meetings, parties, and they plan their trips to Wal-Mart in the middle of the night when everyone else is asleep.  (This seems a bit backwards to me; aren’t you more likely to encounter a criminal at one or two in the morning than in the middle of the day?  I don’t know). 

In addition to thinking about fear, the book got me thinking about human emotion and what it would be like to live without them.  There are a few characters in the book whose abilities to experience emotions are restored after drinking a serum.  The main character wavers between embracing and cursing his newfound emotional palette.  He is initially exhilarated by his first taste of love.  He realizes that the love he and his mother felt for one another was merely was hollow and motivated by fear.  His mother is killed by people searching for the serum.  He grieves – really grieves – for the first time in his life.  He grieves for the loss of his mother, but also for the fact that he only gained the ability to really love her after she died. 

He sets out with his childhood (female) friend to discover how and why all humanity is bereft of all emotion except fear.  When he sees her for the first time after drinking the emotion-restoring serum, he realizes that he is in love with her.  He wonders why he never realized this before.  (Probably because he was incapable of love before).  He is intoxicated and invigorated by his love.  He sees that it gives his life meaning but also that he is willing to die for it, if need be.

And then the love of his life is killed by their enemies before his very eyes.  He is devastated.  He curses love.  He wants to die.  Life has lost all meaning for him.  He begins to think that maybe humanity is better off without emotions. 
Here he captures a fundamental truth about human emotion: with great joy comes great sorrow.  With great pleasure comes great pain.  There is no happiness without sadness, no love without loss, no hope without disappointment. 

This book lays out a very poignant argument for embracing all emotional experience, even those that are painful.  In many ways, this is the very thing I attempt to convey to my patients.  Sure, you can cut yourself off from your emotions to avoid feeling sad, insecure, or anxious, but at what cost?  Is it worth the loss of joy, happiness, pleasure, and love?  You can’t just cut out “bad” emotions; when you cut yourself off from your feelings, you sever ties with all of them, both good and bad. 

Is it worth it?

Sunday, December 23, 2012

Challenging Perfectionism

For most perfectionists, there is some sort of rule or assumption underlying their need to be perfect.  Each rule or assumption has its own particular variation.  Most, however, take one of the following forms:  "I have to be perfect or ...."  "If I'm not perfect then..." "If I make a mistake it means..." "If I allow myself to accept anything less than perfection then..."  Notice that each of the previous statements suggests the presence of some sort of fear.  "If I am not perfect then..." I must be a failure.  Or people won't like me.  Or whatever.  "If I allow myself to accept anything less than perfection then..." my life will turn into a complete mess.  Everything I do will be mediocre.  I'll never be successful.  Or whatever. 

In this way, perfectionism serves to protect a person from his deepest fear.  Usually the fear is rooted in the belief that one is not good enough as he is.  If he is perfect, however, people will not see how inadequate he really is.  When he is perfect, he can forget about his own perceived inadequacies, at least for a time. 

Oh, but when he makes a mistake...When he makes a mistake, he becomes overwhelmed with the knowledge of his own deficiency.  He berates himself for erring and expects others to do the same. 

Maybe perfectionism has served him well in life.  Perhaps it has garnered him praise and recognition.  Perhaps he has achieved great things.  Would this have been possible if he hadn't demanded of himself perfection?

Perfectionists know well the consequences of their unattainable standards and relentless need for perfection in all things.  Yet because perfectionism can be advantageious at times, there is quite often ambivalence about efforts to change.  Thus, the first step in "challenging" perfectionism is to make a list of its advantages and disadvantages.  Complete a thorough cost-benefit analysis; what does perfectionism cost you and how do you benefit from it?  This enables you to fully explore your ambivalence.  In most cases, it also helps to increase motivation for change. 

So what about the benefits of perfectionism?  How do you let go of something that serves you so well in so many of your endeavors?  Ask yourself this: Is perfectionism the only way to attain these benefits?  Can you still be successful if you set more realistic standards and become less self-critical?  Will people still like and respect you if you're less than perfect?  Will you still do good work?  Will things still get done?  Or will you become just another mediocre member of society who never accomplishes anything notable?

There's only one way to find out; do it and see what happens.  Develop and carry out a few "behavioral experiments."  Start small.  Pick some small job you are tasked with completing each day.  Most likely, you expect yourself to complete even this small task with 100% accuracy.  Determine what this (100%) looks like.  Then decide what 90% looks like, 80% looks like, 70%, and so on.  Designate a specific period of time -- say, three days -- and resolve to perfrom the selected task with 80% effort and accuracy.  Pay attention to what happens as a result.  Do people berate you?  Does anyone even notice?  And how do you feel?  Do you feel more or less stressed?

Alternatively, you can try intentionally making small mistakes and observing the outcome.

What you're really doing is testing your assumptions.  Remember, perfectionism serves as a defense against underlying fears of inadequacy, rejection, etc.  The goal of your 'behavioral experiments" is to see if what you fear actually comes to pass when you intentionally perform in a less than perfect manner.  (Spoiler alert: What you fear almost never comes to pass.  Although you might want to enlist the help of a good therapist to ensure that you've selected appropriate behaviors to adjust). 

Hopefully, these strategies will get you started on the path to change.  Keep in mind that old habits die hard.  Change is never easy but it's always possible.

Sunday, December 16, 2012

Is perfectionism always a bad thing?

Perfection is an ideal faultlessness, a state of being complete and correct, such that nothing is wanting.  It is the highest attainable state or degree of excellence.  Perfection is a standard to which many strive, although most fall short.  I believe this is, in part, because perfection means different things to different people.  What constitutes perfection is quite subjective and therefore depends on who you ask. 

There tends to be general agreement that while a person may achieve perfection (however it is defined) on a given occasion, no one attains perfection in all venues at all times.  Human beings are falliable creatures; we all make mistakes.  Thus, we are challenged to accept a fundamental truth about human nature: nobody's perfect.

Some people have more difficulty accepting this than others.  These are people who believe perfection can and should be always within reach; we call them perfectionists.  The negative implications of perfectionism have been studied at length and are well documented.  It has been associated with chronic feelings of failure, unwarranted guilt, lack of self-worth, pervasive self-doubt, indecisiveness, excessive self-criticism, procrastination, and low self-esteem.  Perfectionism has also been linked to the development and maintenance of several mental health disorders, to include major depression, generalized anxiety, obsessive-compulsiveness, anoerexia, and alcoholism. 

While no one disputes the negative consequences associated with perfectionism, there are some who insist it has positive implications as well.  Adherents to this school of thought distinguish between "normal," "adaptive," or "healthy" perfectionism and "pathological," "maladaptive" or "unhealthy" perfectionism.  They argue that "healthy" perfectionism is often beneficial and its development should be nurtured and encouraged. 

So is there a "healthy" perfectionism?  Or is perfectionism always pathological? The answer depends on how you define perfectionism.  Those who promote the potential benefits of "healthy" perfectionism define the concept differently than those who insist it is always pathological. 

Proponents of "healthy" perfectionism divide the phenomenon into several dimensions:

1. The consistent setting of very high standards for performance and achievement.

2. Extreme and excessive concern about making mistakes.  Mistakes are equated with failure. 

3. Chronic self-doubt, causing one to second guess oneself and one's decisions.  There are frequent doubts
    regarding the adequacy of one's work and/or performance.

4. Strong emphasis on and desire for organization in all aspects of life.

We can clearly see that not all of these dimensions have negative implications and that some of them have the potential to be quite beneficial.  In particular, having high standards for oneself and being exceptionally well organized are qualities commonly labeled as assets.  Together these characteristics (collectively referred to as "perfectionistic strivings") are associated with high levels of conscientiousness, extraversion, endurance, positive affects, life satisfaction, active coping styles, and achievement. 

In contrast, the dimensions of self doubt and conern about mistakes (collectively referred to as "perfectionistic concerns") are associated with increased incidences of obsessive compulsive disorders, depression, anxiety, eating disorders, procrastination, and an increased risk of suicide. 

When conceived of this way, it is clear that certain aspects or dimensions of perfectionism are adaptive and that others are maladaptive; it would be difficult to argue otherwise. 

Still, there are those who maintain that perfectionism in any form is never a good thing.  Adherents to this school of thought define perfectionism thus: a personality style characterized by the setting and compulsive pursuit of unrealistically high standards and/or unattainable goals coupled with the tendency to be over-critical in evaluations of one's own behaviors and efforts.  The psychopathology is inherent in the definition.  They assert that any "healthy" dimensions of perectionism cannot truly be called perfectionism, as perfectionism only refers to that which is unhealthy or maladaptive. 

Personally, I am concerned about beliefs and behaviors that interfere with personal functioning.  In my next post, I'll talk about strategies for overcoming (or at least coping more effectively with) this kind of perfectionism.

Sunday, December 9, 2012

Are there reasons not to forgive?

I've been thinking a lot about forgiveness lately.  I initially had no strong opinions on the subject; rather, I had a vague sense that while forgiveness is a worthy endeavor, there are certain situations where forgiveness would not necessarily be a suitable goal.  After doing some research on the subject, I've adopted a firmer, more coherent position on when I believe forgiveness is an appropriate goal (and when it isn't).  I've come to the conclusion that forgiveness is only necessary when both the victim and the offender want to reconcile and rebuild their relationship.  If there is no desire or intention to repair a broken relationship, forgiveness is unncessary at best and detrimental at worst. 

The currently prevailing models of forgiveness describe it as a process that begins with acknowledging the pain casued by the betrayal and ends with developing empathy for the offender and acknowledging our own falliability and capacity to offend.  We know we have forgiven someone when our negative feelings about that person and his actions have been replaced with positive emotions.

I think back to my own experiences with betrayal.  I no longer feel any anger towards people who hurt or betrayed me in the past, nor do I feel any pain associated with these incidents.  Still, I cannot honestly say that the anger and hurt I once felt have been replaced with positive emotions.  When I think back to a particular time when someone mistreated me or betrayed my trust I don't feel anger or hatred, but neither do I experience a flood of compassion for the one who offended me. 

Historically, when a person has hurt or betrayed me, I have coped with the situation by  acknowledging and working through the negative emotions associated with these incidents; in most cases, I was eventually able to understand the various factors that contributed to the offenders' actions.  Truthfully, I no longer harbor any resentment or ill will towards anyone who has ever hurt or betrayed me.  The caveat: most of these people are no longer a part of my life. 

I'm not the kind of person who is quick to cut someone out of my life at the slightest offense.  Yet there have been people in my life who proved to be toxic; when, over time, I came to realize this, I chose to protect myself by ceasing to associate with these people.  This was never a decision I made lightly.

The problem with replacing negative feelings about a person and his actions with positive ones is that having positive feelings about a person increases the likelihood that you will allow that person to be a part of your life (in some way or another).  In other words, "true" forgiveness increases the likelihood of reconciliation.  If you reconcile with a toxic person who has not changed and thus remains toxic, you enable that person to continue to affect your life in a way that will most likely be negative. 

This assertion is supported by research.  Studies suggest that forgiveness in toxic relationships facilitates reconciliation, even while the offender continues to engage in toxic behavior.  One study found that victims of domestic violence who reported that they forgave their partners for the abuse were more likely to return to their partner (and thus to the abusive relationship).  A recent study by J. McNulty supported his hypothesis that forgiveness can "increase the likelihood that offenders will offend again by removing unwanted outcomes for those offenders that would otherwise discourage them from reoffending."

In sum, I believe that complete forgiveness is not always adviseable.  However, it is not necessary to forgive in order to let go of anger and hatred and move forward with one's life.

Sunday, December 2, 2012

How to Forgive

Forgiveness.  Some of us offer it too readilty; others refuse to offer it at all.  It can be given freely or begrudgingly, conditionally or unconditionally.  The decision to forgive is a deeply personal one and can be quite difficult to make.  Anyone who has ever been forgiven knows forgiveness for what it is: a gift, which bestows upon its recipient a deep sense of gratitude and appreciation.

Often, when we have been hurt or betrayed by another, our initial response is to distance ourselves from the resulting emotional pain.  We become angry because anger is easier to deal with than pain.  This is a natural reaction that serves a protective function in the immediate aftermath of a betrayal.  As a long term coping mechanism, however, anger is far from adaptive.  Anger that is nurtured and fed over time becomes hatred.  Hatred eats at a person until it consumes every aspect of his life.  Thus, the person is twice victimized: first by the one who betrayed him and then by himself, in his choice to remain angry instead of trying to move forward.

We can choose forgiveness instead.  This may or may not mean restoring the relationship between victim and offender.  Sometimes the relationship can be mended.  At other times, reconciliation is ill-advised.  Fortunately, forgiveness does not require reconciliation.  Rather, forgiveness represents a change in the emotional response of one person towards another.  Forgiveness means working through the hurt and the anger and then moving past it.

Forgiveness is not something that happens immediately; it is a process that takes place over time.  There are many theories about forgiveness and each one has its own ideas about the specific path one must take on the way to forgiveness.  Still, most theories agree on a few basic tasks that must be completed in order for forgiveness to occur. 

Before a person can forgive, he must first accept the reality of the offense committed against him.  He must recall the offense in detail and allow himself to experience the emotions associated with the betrayal.  He should acknowledge and explore his anger and hatred.  He will probably find that beneath these emotions lie feelings of hurt, fear, and vulnerability.  He must allow himself to experience these emotions as well.  Hopefully, he will come to view himself with compassion and to let go of any self-blame.

I believe this is the most important step.  It is, in my opinion, where most of the healing takes place.  Personally, I think a person could work through this part of the process and go on to live a happy, psychologically healthy life.  Nevertheless, I have committed to writing about the process of forgiveness in its entirety, so I'll move on to step two.

The second phase of the forgiveness process is building empathy for the offender by learning to view him as human and therefore falliable.  An effort is made to see things from the offender's persepctive, to put yourself in his shoes and try to imagine his thoughts and feelings.  There is an attempt to identify and understand the factors that might have contributed to or motivated the offender's actions.  It is important not to confuse empathy with condoning or excusing the offender's behaviors.  Rather, the goal is to avoid the pitfall of labeling the offender a "bad person."  People are rarely all good or all bad.  Good people often do bad things.  And sometimes even "bad" people do good things. 

The third and final task of forgiving involves acknowledging that we are not unlike our offender in that we too are human and have, at some point in our lives, behaved in ways that were hurtful to others.  In this final task, we are called upon to reflect on our own lives; we are asked to recall times when we were the offender and required others to forigve us.  In some ways this is an extension of phase two, in that acknowledging our own failings makes it easier to empathize with someone else who has done something wrong.  Admitting that we too are capable of behaving selfishly prevents us from being overly judgmental or self righteous.

Keep in mind that every situation is different and that forgiveness is not always the best option.  Still, we should be aware that it is an option and should have the freedom to choose forgiveness if we so desire.

Sunday, November 25, 2012

Seasonality: Energy and Mood in the Winter

As the days grow progressively shorter, my body and mind protest.  I never really have enough energy, but it seems to be in particularly short supply during the winter months.  And when the world around me begins to buzz in cheerful anticipation of the holiday season, I prefer to stay at home.  I used to revel in the spirit of Christmas.  Then, my grandmother died in 2003, just a week after Christmas.  For me -- and for much of my family -- my grandmother was Christmas.  She led the family festivities every year.  It was her holdiay.  Now, I miss her terribly and grieve her most during the Christmas season.  When I feel her absence so acutely I begin to wonder if I'll see her again someday, when my life is over.  Then I start thinking about death.  This leads me down a path of rather morbid thoughts; I end up feeling depressed.

Of course, I'm not the only one who struggles with mood and energy during the winter.  Studies suggest that approximately 10% of American adults experience negative changes in their mood and energy during the winter months that are significant enough to interfere with daily functioning. 

When a person has a history of feeling tired and depressed every winter, he eventually comes to expect it.  He may begin to anticipate the onset of depression and fatigue at the end of summer, long before any symptoms are present.  He begins to monitor his mood and energy level more closely, vigilantly looking for even very slight changes to either.  His hyper-vigilance makes him more sensitive to fluctuations in mood or energy, causing him to notice changes that others probably would not.  (Perhaps he notices changes that even he would not notice if they took place in the spring or summer).  Thus, if he wakes up one November morning feeling a bit down, he might see it as a sign of worse things to come.  "Well, here it is again," he might say to himself.  "Now I'll be depressed until spring comes around."  It becomes a self fulfilling prophecy. 

This is just part of the story; there are a number of factors that cause a person to feel depressed when the seasons change.  Still, one's thoughts and beliefs can contribute signficantly to the maintenance of such problems.  This has been the subject of growing interest to mental health professionals in recent years.  Reading some of the literature helped me to identify some of my own unhelpful beliefs about mood and energy during winter.  I thought I'd share some of the more common unhelpful beliefs (taken from the "Seasonal Beliefs Questionnaire"):

"I am worried about how bad I will feel this winter."
"I am dreading the next few months."
"No one else feels this way every year."
"I'm going to be depressed until spring."
"I need sunshine to feel happy."
"Dark, gloomy days are depressing."
"The weather should not affect me."

Even if your mood and energy have tended to change with the seasons in the past, it doesn't have to be a self-fulfilling prophecy.

Sunday, November 18, 2012

Awareness of Attitude

My supervisor knocked on my door one morning last week.  She peered into my office and asked if I had a few minutes to talk.  I braced myself for bad news.  It's rarely a good thing when your boss comes to your office for a private chat.  My intuition was right.  There was a problem and my supervisor wanted to discuss it.

"I've noticed at our last few meetings [weekly department meetings] that you've been extremely negative," she said.  Fortunately, I seem to have more control over my "automatic" reactions when I'm at work than I do in my personal life.  If, for example, it had been my husband complaining about my negative attitude I probably would have immediately become defensive.  My initial inclination when my supervisor confronted me was, in fact, to become defensive.  Thankfully, I bit my tongue long enough to think before I spoke. 

"Ok," I replied after a moment in what I hoped was a neutral tone of voice.

"I just wanted you to be aware," my supervisor explained.

"Ok," I repeated.  I proceeded to change the subject as quickly as possible.  My supervisor didn't seem to mind.  Maybe this whole thing was as uncomfortable for her as it was for me. 

Afterwards, I thought back to our last few staff meetings, trying to remember if I'd said or done anything "negative."  I was unable to recall anything specific one way or another.  Ultimately, I decided this was irrelevant anyway.  It didn't matter whether I thought I'd been negative.  Apparently, my supervisor noticed some sort of change in my attitude or she wouldn't have said anything to me.  I concluded that something about my attitude must have shifted without me being aware of it.

I did some soul searching.  The truth is, I was aware of a shift in my attitude.  Work has seemed so heavy lately.  I've been looking forward to long weekends and short weeks with more vigor than usual.  The weeks seem too long and the weekends too short; I return to work on Mondays feeling weary and unrefreshed. 

This happens to me sometimes, typically when I'm under a lot of stress and feeling overwhelmed.  I try not to take it out on others, but apparently it comes out inadvertently.

So have I been negative lately?  Probably.  I'm an expressive person by nature and it's difficult for me to conceal my emotions.  I suppose I need to try harder.

I suspect that what I really need is a vacation.  My work takes a lot out of me.  Sometimes, I need a week or two off to refuel.  I try to take at least a week off every six months; perhaps I need to do it more frequently...

Sunday, November 11, 2012

Suicide and Psychache

I distinctly remember attending a memorial service for the brother of a close friend when I was in college.  My friend's brother hung himself from a tree in his front yard; his stepdaughter discovered him when she went out to catch the school bus the next morning.  Funerals are never happy occasions, but this one struck me as particularly heartwrenching.  It seemed like the deceased's parents felt they needed to defend his character.  "He really was a good boy," I recall his father saying.  I was present on several occasions when members of the decedant's family recalled his last days.  They analyzed every conversation and every interaction, wondering if there'd been some sign of their loved one's intentions.  They second guessed everything they'd said and done in the days leading up to the suicide.  "If only I'd done this instead of that," some lamented.  Others blamed themselves.  "I should've known.  I should've stopped him."

Suicide is a tragedy in so many ways, both for those who commit the act and for those left behind.  Ending one's own life seems to go against the most basic of human drives: the will to live.  There are countless examples throughout the course of human history of men and women fighting to live.  Human societies value life and we believe in the inalienable right of each individual to protect the lives of himself and of those he loves.  With the drive to live so fundamental to our very nature, what could possibly provoke someone to take his own life?

This question comes up quite frequently among mental health professionals, as our patients have a higher risk of suicide than many other populations.  If we can understand why people kill themselves, we can use this information to  identify warning signs and intervene before anything happens.  The goal is suicide prevention.

To this end, there have been a number of studies undertaken and countless theories proposed.  One of the most influential ideas about suicide was presented by Shneidman in 1993.  According to Shneidman, people who contemplate suicide all have at least one thing in common: unbearable mental pain, or "psychache."  The desire of those who contemplate suicide is not necessarily physical death, Shneidman asserts.  Actively suicidal people want only to end their suffering; they believe that nothing short of suicide can accomplish this.  The idea is that people only contemplate suicide when their pain becomes unbearable, when suffering becomes a constant presence, and when there is no relief from their pain; they feel trapped. 

So how do you help someone who has reached this level of despair? 

First, we must listen.  We must try to understand the person's pain from his perspective.  What is it the person needs but is not getting?  What are his goals in life and why does he believe they are no longer attainable?  To the person thinking about killing himself, suicide is logical; it makes sense.  We must seek to understand why it makes sense to him.  We need the whole story and only one person has it.

Fortunately, listening does not require any special training; anyone can do it. This means we are all in a position to help someone who feels helpless.  Of course, a person who is suicidal should get professional help.  Still, that doesn't mean we can't all do our part.

Sunday, November 4, 2012

Chronic boredom

Boredom is a state of disengagement from your environment and/or whatever activity you happen to be doing.  Boredom involves desire in that a person who is bored wants to do something that will fully engage his attention.  Unfortunately, the state of boredom renders him unable to identify a sufficiently satisfying activity that will alleviate his condition. 

We all experience boredom from time to time.  For most of us, it is a transient condition that passes the moment we find something that absorbs our attention.  There are some, however, for whom boredom is more pervasive.  For whatever reason, these people are consistently unable to find activities that hold their attention.  For this reason, many are regular thrill seekers; they spend a considerable amount of time searching for something exciting to relieve their inner monotony.  Of course, excitement provides only temporary relief.  No matter what they do, the boredom always returns.  Thus, they find themselves caught up in a never ending quest for the next thrill.

What causes this condition and what can be done about it?  Bernstein attributes chronic boredom to loss of the ability to feel.  This occurs, he argues, as a result of early childhood experiences.  Specifically, chronic boredom occurs when a child is forced to hold his emotions in before he has developed socially acceptable outlest for discharing the tension these emotions arouse.  With no means to express his emotions, he simply learns to repress them.  A chaotic, over-stimulating environment will mask his absence of emotion.  However, when faced with a less stimulating environment later in life, he begins to notice his lack of emotion.  He feels under-stimulated, a condition that manifests itself as boredom. 

Kohut likewise attributes chronic boredom to childhood experiences.  He ascribes chronic boredom to the consistent failure of parents to be responsive to and to provide stimulation to their child.  Consequently, the child comes to crave stimulation and to seek it out in any form. 

Many believe that boredom masks an underlying sense of emptiness.  According to existential theorists, this emptiness is caused by lacking a purpose or meaning in one's life.  (This may or may not be due to childhood experiences).  Without a clear purpose, everything seems pointless.  If there is no purpose to a particular activity, why do it?  For one with no purpose in life, all activities are meaningless. 

So what can be done to help the chronically bored?  I will suggest a few techniques, but these are by no means exhaustive.

In researching ways to alleviate chronic boredom, I discovered that boredom is more prevalent among people with an external (versus internal) orientation.  To be externally oriented is to be habitually focused on the external environment.  When an externally oriented person feels bored he attributes it to an under-stimulating environment.  Because he sees the external environment as causing his boredom, he looks to the external environment to relieve it.  Unfortunately, this strategy is almost always ineffective, at least for the chronically bored. 

The conclusion I draw from this information is as follows: if the external environment doesn't hold the answer, perhaps it would help to turn one's attention inward instead.  What would happen if sufferers of chronic boredom adopted a curious stance towards their condition?  What if they attended to the physical sensations that accompany their boredom and observed how they change over time?  I suspect they might begin to see through (or perhaps beneath) the boredom.  If nothing else, they'd learn to tolerate the emotion and to simply be with themselves.  This alone would go a long way towards quieting their eternal restlessness.

De Chenne suggests that chronically bored people lack knowledge of their emotional and psychological needs.  Consequently, he suggests helping the chronically bored to clarify their needs and interests.  Once they determine what they need, they are better able to seek out activities that will satisfy and  fulfill these needs.

Now for my final suggestion.  If everything seems meaningless (and therefore boring), it seems logical that creating, discovering, identifying, or clarifying one's purpose in life would be beneficial.  This is admittedly a large task and it might seem too daunting for some.  If this is the case, start by simply taking the focus off of self and doing something kind or helpful for someone else. 

Sunday, October 28, 2012

What makes a person boring?

I initially intended to write about the experience of boredom, its potential causes, possible remedies, and the relationship between boredom and suffering.  In fact, I still plan to talk about boredom (and chronic boredom in particular), probably as soon as next week.  While researching the topic, however, I came across a study about boring people.  The study helped to shed some light on why I react certain ways to certain people (including some of my patients).  Since the information was helpful to me, I thought it might also be helpful to others.

We probably all know or have known at least one "boring" person.  Naturally, we attempt to avoid interacting with this person whenever possible.  On those unfortunate occasions when we do have to interact with him or her, we find ourselves struggling to pay attention and yearning to get away.  It's human nature: we simply do not like people who bore us. 

It is true that what one person finds boring another may find fascinating.  Theoretically then, boring is not a trait that is inherent to a particular individual.  The individual in question might be boring to one person but rather interesting to another.

And yet, there are certain things that make a person boring to almost everyone, regardless of the circumstances.   Leary, Rogers, Canfield, and Coe identified some of these factors in their study, "Boredom in Interpersonal Encounters: Antecedents and Social Implications."  The two interpersonal behaviors most associated with being boring were negative egocentrism and banality.  The researchers defined negative egocentrism as a behavioral dimension (or category) that includes behaviors such as making frequent negative comments, excessively complaining about personal problems, being self-centered, and showing a lack of interest in others.  The authors defined banality as a behavioral dimension encompassing behaviors such as talking only about trivial or superficial subjects, being interested in only one topic, and telling the same stories or jokes over and over again. 

Other factors associated with being boring (but to a lesser extent) include "low affectivity" (characterized by low enthusiasm, limited eye contact, low emotional expression, a speaking in monotone) and "tediousness" (characterized by talking slowly, taking a long time to respond, taking a long time to make one's points, adding unneccesarry details, and dragging the conversation on). 

The researchers also found that people respond very negatively to boring individuals.  Not only do they view them as boring, they also see them as unfriendly and disinterested in others. 

This whole thing sort of validates something I've noticed about myself as a therapist.  Throughout my career, I've noticed that there are certain patients who just seem to rub me the wrong way.  I groan when I see their names on my schedule.  In session, I find myself surreptitiously glancing at the clock more often than usual.  Every peek at the clock brings despair, as I realize that only a few minutes have passed since I last checked.  I breathe a sigh of relief when the session finally ends and they are safely out the door. 

Over time, I was able to determine what these patients have in common: they complain about the same problem or set of problems during every session and consistently reject any effort on my part to help them.  I now realize that in addition to constantly complaining without trying to change, these patients almost across the board engage in the very behaviors most strongly associated with being boring.  They complain excessively about their problems, they are completely focused on themselves and how unhappy they are, and they are disinterested in hearing feedback from me (and probably from anyone else).  They show interest in a very limited range of topics, primarily their problems, their symptoms, and their suffering.  And they tell the same stories (about their problems) over and over and over again, as if they haven't told them in every other session we've had. 

Fortunately, I do not encounter this kind of patient very frequently.  I do, however, feel better knowing that my emotional reaction to them is probably quite normal.

Sunday, October 21, 2012

Becoming disillusioned

As young adults, I think most of us start out with a certain number of illusions.  We have ideas about the world and our place in it.  Those with the most ambition seem to have the most illusions.  Many intelligent, talented emerging adults have been praised and lauded throughout their lives for their talents and abilities.  They are told they can do or be anything if they apply themselves diligently. 

And so they graduate high school and set off to take on the world with a head full of dreams.  Most are optimistic about their futures.  If asked, they would probably say that they have an important contribution to make to the world, that they are destined for greatness, or that they are going to do big things.

After spending some time in the "real world," many of these once hopeful young adults enter a period of disillusionment.  They may encounter a world that is not receptive to the kind of big changes they'd envisioned themselves making.  Their power (and thus their ability to enact change) may be limited by virtue of their youth and inexperience.  They may lack the resources, the venue, or the support to achieve the great things they were once certain they would accomplish.  Or they may find the demands of adulthood consume all their time and energy, leaving precious little to devote to pursuing their dreams.

For me, disillusionment came soon after I started my first job after college.  Looking back, I can't even recall what I hoped to do with my life.  I just know I envisioned myself making a big impact on the lives of a lot of people.  I had a lot of ideas that I initially pursued with vigor.  Soon after college, I begn completing the requirements for certification in biofeedback.  I proposed a research project at my place of employment and got the go-ahead from my boss to start doing the background literature review.  I started working towards formal licensure as a clinical social worker in the state of Virginia.  I did a project on the side for a woman who ran a small non-profit focused on suicide prevention. 

And then I hit a brick wall.  I had to put the biofeedback certification process on hold because I couldn't afford to pay for the supervision.  I finished my literature review and reported my findings.  I was told there was no way to implement the study because it would require (at minimum) one additional staff member and the organization wasn't going to pay for that.  (That didn't stop them from going out to other organizations and telling them we were offering the program, even though we weren't).  The person providing supervision for Virginia licensure told me she was too busy and couldn't do it anymore.  The non-profit lady used my work for her presentation; I never heard from her again after that. 

There were other things too, but you get the point.  I was depressed.  I grew cynical.  I hated my job.  I decided I'd chosen the wrong career field.  I was completely disillusioned.

In the end I found my peace.  In the process, I discovered a lot about myself.  I also grew up.  I learned how to function in the world as it is, not how I want it to be. It was difficult, but I think it was also necessary.  Before you can cope with reality you have to accept it as it is, even if you don't necessarily like it.

Sunday, October 14, 2012

Living without pleasure

People tend to think of depression as a syndrome characterized primarily by pervasive feelings of sadness.  To be depressed is to be in such despair that it becomes difficult to function.  Many of us have either known someone struggling with depression or have seen it somehow depicted by cultural media.  As a result, few of us are completely unfamiliar with what it means to be depressed.

Many of my patients struggle with depression.  For every new patient seen in our clinic, we obtain a full biopsychosocial history and perform a complete diagnostic assessment.  Ideally, the goal of this assessment is to generate an overview of the patient's "problem," preferably in the form of a clinical diagnosis.  In reality, however, I find that few patients really need me to tell them what's wrong; most of them already have an idea of what's wrong, which is the reason they've sought help in the first place.  In other words, a person struggling with depression already knows he feels depressed; he gains very little from having me slap a label on it. 

From time to time, however, I encounter patients who seem clearly depressed to me but who are quite surprised to hear me say it.  "I don't feel depressed," they say.  You see, depression doesn't always look the way we think it does.  In fact, it's quite possible for someone who doesn't necessarily feel depressed to meet the diagnostic criteria for Major Depressive Disorder.  Rather than feeling depressed, the problem for such a person might be that he doesn't feel much of anything at all. 

Anhedonia has been described, quite poetically, as the "paralysis of emotion."  It comes from a combination of the Greek a + hedone, literally meaning "not pleasure."  In mental health, it refers to an inability to experience pleasure in activities that one would typically find enjoyable. 

Patients relate how they experience it.  "I just feel 'blah," is a quite common description.  Others talk about lacking motivation.  "I don't feel like doing anything," they say.  "I can't get motivated."  Still others become distressed by what they perceive as a personal failing.  "I don't even enjoy spending time with my kids.  The whole time I'm with them I'm looking at my watch, wanting it to be over;" or perhaps, "I know I love my kids, but I just can't feel it." 

I wish I could conclude my little presentation with some wisdom about how we can all learn to experience pleasure in life.  The truth is, I let out an inward groan everytime a patient tells me he is unable to find pleasure in anything.  That's because as a symptom, anhedonia is notoriously difficult to treat. As a therapist, I can encourage you to engage in activities that should theoretically be enjoyable, but I can't make you enjoy them.  I'm not even sure I can teach you to enjoy them.  How do you teach something like that?  Treatment with antidepressant medications have very limited success as well.  It's a situation that often makes me feel helpless.

But if I feel helpless, imagine how the patient must feel.  Imagine a life without pleasure.  What kind of life would that be?

Sunday, October 7, 2012

Things that don't come naturally

My sister-in-law has a very gentle quality about her and a very sweet demeanor.  She's also very physically affectionate, at least with her family.  Whenever she's around my stepdaughter (and even when she's around my two nieces), it's like no one else exists.  When my sister-in-law enters the room, the kids fight over who gets to sit next to her.  I watch them together - especially her and my stepdaughter - and I can't help but feel a little envious.  My sister-in-law heaps on hugs, kisses, and tickles and the kids eat it up.  "Why can't I be more like her?" I often wonder. 

During a family vacation this summer, I noticed that my sister and her husband are always holding hands, putting their arms around one another, or sharing a quick kiss.  More often than not, the two of them occupied only one chair, even if that meant one of them sitting on the other's lap.  I mentioned to my husband that I was a bit jealous of how affectionate the they are with each other.  "Why aren't we more like that?" I asked him.

I knew what he was going to say before he said it.  It's me.  I know it's me.  I don't have a problem with nor am I averse to physical affection - or even public displays of affection - it's just that it doesn't come "natural" to me.  In fact, it's not even physical affection per se that doesn't come naturally. Almost without fail I give hugs and kisses to family and friends at every hello, goodbye, and goodnight.  And any kid that hops in my lap is always perfectly welcome there.  I'm just not the type of person who instinctively reaches for an embrace or a hand to hold whenever I find myself in the presence of others.  That kind of affection is something that requires a conscious effort on my part.  It's something I have to actually think about and remind myself to do.

I don't know why I'm not naturally drawn towards physical contact.  I certainly wish I were different in this regard.  I suspect that we all have our strengths and weaknesses.  Some things come naturally to certain people and some things don't.  I've never met a person to whom everything comes naturally.  We all struggle with something. 

What I do know is that just becomes something is difficult doesn't mean I can't learn to do it.  I have some experience with this.  I do really well with verbal and written academic work; I have always struggled with math.  I have vivid memories of sobbing over Algebra homework in the eighth grade.  As an adult, I needed to complete two math classes for my college degree.  I took the first class one summer and the second one the next.  This allowed me to focus exclusively on math without worrying about other subjects.  After each class, I went to the math lab, did my homework, and had the tutor check my answers.  He then went over the problems I got wrong.  I sometimes spent hours on homework before I fully understood it.  Whenever we had a test, I was always the last person finished; I also earned the highest final grade in both classes.  I still struggle with math, but now I know I can do it; I just have to put more effort into it than other people. 

I've had similar experiences with art -- I have absolutely NO natural depth perception nor any sense of proportions or spatial positioning.  Yet I have, on occasion, come out with a decent drawing or painting (always after a few false starts, of course). 

The point is, this whole physical affection thing is something I can learn, even if it doesn't come naturally.  What I need more than anything is patience - both from myself and from others. 

Is there anything you've learned to do that didn't come naturally?  Was it frustrating?  Do you still struggle with it?  I'd love to hear your story!

Sunday, September 30, 2012

Not everything is pathological!

Not everything is pathological!  Some of my patients need to be told this repeatedly.  Every session brings a new complaint.  "I had trouble falling a sleep a couple of times last week," one might say.  "I had a nightmare a few weeks ago," another tells me.  "I was really tired on Monday," says another.  Sometimes I recall my own recent experiences and think to myself, "Yeah, I remember feeling tired at least once last week; probably more than once.  And I'm sure there was at least one night when I had trouble sleeping.  It wasn't a big deal." 

Not only are these experiences "not a big deal," they're completely normal.  Who among us doesn't have trouble sleeping from time to time, particularly when we're worried about something?  Who doesn't wake up feeling irritable on occasion?  Who doesn't have a hard time finding motivation to clean the house or run some errands every once in a while? 

At some point we all have these experiences, yet rarely do we become alarmed by them.  Why is it, then, that a substantial minority of my patients find such things concerning enough to bring to my attention?  (At least I assume that's why they share these concerns, since we're there to talk about problems that require treatment). 

When such conerns are raised in session, the first thing I do is to normalize my patient's experience.  I try to explain that not every unpleasant experience is a sign of a larger problem.  In life, I tell them, we all deal with feelings we'd rather not have, events we wish wouldn't happen, and physical aches and pains we'd prefer not to endure.  Such things even occur sometimes without any identifiable reason.  It's important, I explain, to remember that something doesn't have to be problematic just because it's unpleasant.  In fact, labeling something as problematic probably only makes it more unpleasant.

After normalizing, I attempt to help the patient clarify what constitutes a problem and what doesn't.  (While it's not beneficial to classify every negative experience as problematic, neither is it wise to ignore negative experiences that really are problematic). 

So how do we know when something is a problem and when it's just a variation of normal human experience?  When trying to define a somewhat abstract concept, I like to start by consulting a dictionary for a more literal definition.  There are several entries in a standard English dictionary under the word problem.  One entry defines the word problem as "something that causes trouble or difficulty."  Thus, a problem is something that causes difficulty by interfering with your daily functioning or by significantly decreasing your quality of life.  Can you still go to work, pay your bills, or otherwise fulfill your normal daily responsibilities?  Can you still experience pleasure and enjoyment?  Can you maintain at least a few functioning interpersonal relationships?  If so, you're probably doing okay. 

Problem is also defined as "an undesirable condition that needs to be corrected."  The key word here is condition.  A condition is a mode of being or form of existence.  It permeates all aspects of one's life, implying that it exists over a period of time.  Thus, a problem is unlikely to be something that happens just once or even rarely.  Typically, a problem is something that is present over a period of time and in a variety of situations.  (To diagnose a mental illness, the field of mental health requires a set of symptoms to be present for specific minimum periods of time).

Yet another way to define problem is as "something that is difficult to manage."  The implication here is that a problem is something that challenges one's ability to cope.  Those with an average set of coping skills are able to cope with minor annoyances and irritations quite easily.  Something becomes a problem only when a person's usual coping mechanisms aren't effective in dealing with it and the person becomes overwhelmed.

I'm sure I've missed some things and of course, there are exceptions to every rule.  The main point is just that  not everything unpleasant is a problem and that labeling it a problem only makes it more unpleasant.

Sunday, September 23, 2012

Suppressing Emotions

There are people who believe emotions are unnecessary and so seek to distance themselves from their emotional experiences.  There's certainly nothing wrong with gaining some distance from our emotions.  In fact, it's a skill we need if we want to function "normally" in society.  Distancing ourselves from our emotions is only problematic when it becomes our primary method of responding to our feelings.  The eventual result of suppressing every strong emotion that arises is emotional detachment.  To be emotionally detached is to no longer recognize the physiological changes that accompany each emotion.  These changes continue to occur, they just do so outside of conscious awareness. 

At its core, emotional detachment is nothing more than the absence of self awareness.  There are, of course, some who say that ignorance is bliss; you cannot feel pain if you cannot (or do not allow yourself to) feel.  In my opinion, a life devoid of emotion is an empty life indeed.  I cannot imagine living a life without happiness or a life without love.  It is difficult to think one could find meaning in such a life.  And yet, there are those who choose this path; they give up the pursuit of happiness in an effort to avoid pain. 

It doesn't work.  In reality, refusing to engage with our emotions has consequences that go beyond missing out on the richness of emotional experience.  It turns out that actively suppressing emotions impacts our physical health as well.  Several studies have shown that suppressing emotions (both negative and positive) leads to increased sympathetic activation of the cardiovascular system.  When the cardiovascular system is hyper-activated repeatedly over an extended period of time, "such...activation might lead to chronic functional and structural changes of the cardiovascular system that compromise its performance" (Mauss and Gross, from Chapter 4 of "Emotional Epxression and Health: Advances in theory, assessment, and clinical applications," 2004).  Related health problems include hypertension and atherosclerosis, both of which lead to an increased risk of heart attack and "sudden cardiac death." 

Simply stated, chornic emotional suppression is bad for your heart.  Or, as I frequently caution my patients: "If you don't deal with your emotions then your emotions will deal with you."

Sunday, September 16, 2012

Hearing others' stories

Over the years, I've discovered that my patients appreciate consistency.  They like knowing what to expect when they come to see me.  I've noticed that even significant changes to my appearance can be unsettling for some. 

I get it.  People come to therapy when the problems they're dealing with become overwhelming.  Often, their entire world seems unpredictable and chaotic.  Therapy becomes a sort of haven of stability where they can try to sort things out.  The consistency is comforting and provides a sense of safety. 

This works for me.  I too have a deep appreciation for stability.  When I do make changes, it is almost always incrementally.  I like knowing that even if I can't fix a patient's problems, I can at least give him somewhere to feel safe and accepted. 

The first and sometimes only service I provide in this role is to bear witness to a patient's story.  I listen and I validate.  I did not initially realize how important this is.  After all, anybody can listen, right?  Apparently not.  The mission of the clinic I work in is to provide interventions to those who have had one or more traumatic experiences.  A lot of the patients I see have never shared their stories with anyone.  Having the opportunity to talk about what they've been through is often quite powerful. 

So imagine if I were to interrupt their narrative and say, "Stop.  It's too horrible.  I don't want to hear anymore!" It would confirm what they've long suspected: their suffering is theirs to bear, alone.  No one can help them.

All of us at the clinic are aware of the risk for "vicarious traumatization" - being traumatized by someone else's trauma.  I've been lucky; for the most part, patients' stories don't bother me.  Of course I feel bad that they've gone through such terrible things, but hearing about it doesn't unnerve me; I maintain the same steady, reliable presence that my patients have come to expect from me.  For me, tt's almost like when a patient leaves my office he takes his story with him.  I don't hold onto it and I don't really think about it until the patient's next visit.

Something different happened this week.  It was my first session with this particular patient.  She'd seen one of the psychiatrists and was referred to me for therapy.  I wanted to take the initial session to get to know her and to get an understanding of the problems she's dealing with.  About halfway through the session, I asked if she felt comfortable giving a brief summary of her traumatic experiences.  

My patient began sharing her story.  I interjected a few times to ask questions for clarification.  Mostly, I listened.  Everything was fine until the patient reached a point in her story that involved being conscious for a medical procedure in which she lost massive amounts of blood. 

I started becoming dizzy.  Suddenly I felt hot and I began sweating profusely.  (It was literally dripping off of me; when it was all said and done, I noticed that my clothes were wet).  I was lighthead and the room looked like it was spinning.  My patient was still talking but she sounded far away, or maybe muffled. 

It occured to me that I've experienced this sort of thing before.  You see, I have a strong aversion to needles.  For years I used to faint everytime I had to give blood.  Eventually, I discovered that I could prevent myself from passing out if I took deep breaths during the procedure and avoided looking at the needle or the blood.  Still, even now I get anxious whenever I'm faced with the prospect of getting stuck with a needle. 

So here I am in session with a patient and I think I might pass out from hearing her story.  I didn't want to ask her to stop -- what kind of message would that send?  On the other hand, how would she feel if I passed out right there?  To make matters worse, the room was still spinning and I couldn't think clearly. 

Finally, I lifted my hand and said, "Hold on a minute." I tried to recompose myself but it was so hot and I felt so lightheaded. 

"Was it the blood?" my patient asked.

"Yeah," I said.  "Just give me a minute.  I am so sorry."

Eventually, I excused myself.  A coworker's door was open and I slipped into her office.  "Are you okay?" she asked, alarmed.  "Your face is green!  Why are you all wet?  What's wrong?" 

Fortunately, the temperature in my coworker's office was much cooler than that of my own.  The blast of cool air did the trick.  Within a few minutes, I was feeling better.  I ended up going back to talk to the patient.  I apologized and told her we'd meet again next week (if she still wanted to, of course).

I felt like I needed to share this because I didn't want to allow myself to become embarrassed (anymore than I was at the time) about it.  In my opinion, the sooner I can look back on something and laugh, the better.  I've also been mentally rehearsing my patient's story so that I'm ready to hear it when the time comes for her to tell it again.

Sunday, September 9, 2012


It is impossible to go through life without ever experiencing regret, even when we intentionally avoid doing things we'll later wish we hadn't (or intentionally seek to do things we know we'll regret not doing).  We are human; we make mistakes.  Our mistakes beget unpleasant outcomes.  In the midst of coping with the consequences of our bad decisions, it is only natural to wish we'd made different choices.  This is regret: to feel a sense of personal responsibility for the way things turned out and to imagine that things would be better if we'd only decided differently. 

Regret is a natural consequence of being free to make choices.  Studies have shown that the very act of choosing almost immediately leads to regret and causes the unchosen option or options to appear more attractive.  Because there is regret associated with each unchosen option, more options leads to more regret.  Researchers have found that we anticipate this regret and take it into account everytime we make a decision.  When tasked with choosing from a large number of options, the amount of regret we anticipate can seem a bit daunting.  This is consistent with evidence suggesting that the more options we have, the less likely we are to make any choice. 

Of course, deciding not to choose is also a choice.  We opt out of making a decision so we won't have to face the regret associated with the options we did not select.   And so we are spared, at least in the short term.  We have not, however, successfully avoided our regret; we've merely postponed it.  Here I borrow a quote from Gilovich and Medvec: "As troubling as regrettable actions might be initially, when people look back on their lives, it seems to be their regrettable failures to act that stand out and cause greater grief." 

The research gives some credence to my own personal decision-making philosophy.  (Not that the "philosophy" itself was developed with this in mind.  Still, it's nice when there's actual evidence to support the quirky way I do things).    When faced with multiple options, I gather a small amount of basic information about each of them. (Notice the emphasis on small and basic). This allows me to rule out any options that clearly aren't a good fit.  At that point, I am typically left with several equally attractive alternatives. 

The way I see it, if all options are equally attractive then it really doesn't matter which one I choose.  It's unlikely that gathering more information will help.  You see, the more I learn about each option, the more attractive they will all seem.  This will make it more difficult for me to choose one over the others.  So I just pick one.  It doesn't matter how; maybe I'll write them all down on little slips of paper, put them in a bowl, mix them up, and pull one out.   Maybe I'll cut out pictures of them, lay them out in a circle around me, close my eyes, spin around, come to a stop, and point.  Whatever.  I just pick one.  And once I've made my choice, I fully commit to it.  I don't second guess myself.  I don't keep looking for other possible options "just to see" if I could've gotten a better deal.  I make my selection and commit to it; then I move on.

Have I managed to eliminate all traces of regret from my life?  Um, no.  I'm human, after all.  Like everyone else, I'm a work in progress...

Sunday, September 2, 2012

On being an introvert

Sometimes it's hard being an introvert.  It seems like extroverts have all the advantages, at least in today's world.  American society values the characteristics associated with extroversion: energetic, outgoing, enthusiastic, active, willing to take risks, objective, cheerful, expressive.  Extroverts are quick to engage with others.  Because they tend to be action-oriented, they enlist other people in doing things; this shared participation in a common activity provides the context for building interpersonal connections.  Thus, extroverts establish relationships quickly and easily.  People like extroverts and they like to be around them.

Whereas the extrovert is attuned to and energized by the external environment, introverts tend to focus their attention inward.  Introverts spend a lot of time thinking, interpreting, and analyzing.  They often enjoy abstract concepts and ideas.  They typically concentrate well and are not easily distracted.  The extrovert gains energy by spending time with others; the introvert gains energy by spending time alone.  Thus, introverts often withdraw from social situations. 

These are not the qualities that get a person noticed.  They are not the characteristics Americans tend to associate with success.  Americans admire and respect the type of people who can walk into a situation and take charge without batting an eyelash.  They look up to people who appear steady and confident.  In America, the qualities of the extrovert are seen as favorable and are therefore advantageous.

In addition, there is an abundant body of evidence suggesting that extroverts tend to be significantly happier than introverts.  So many studies, in fact, have demonstrated this effect that Lucas, Le, and Dyrenforth call the correlation between extroversion and positive emotion "one of the most robust findings in the study of personality and emotion."  There have even been studies showing that introverts can increase their positive emotion by acting like extroverts. 

And so being an introvert can be difficult.  We're systematically undervalued and frequently misunderstood.  Often, we're encouraged to become more extroverted, implying that there's something wrong with the way we are.  I've seen the impact this can have on people.  Over the years, I've had many introverted patients who came to me thinking there was something wrong with them.  Such is the plight of the introvert living in an extrovert's world.

I briefly saw a psychologist when I was in graduate school.  One of the first things he did was have me complete the Myers-Briggs (a personality assessment).  I remember when we went over the results together.  "So do you think you're an introvert or an extrovert?" he asked before revealing what the assessment showed.  "I don't know," I replied.  "I could see it going either way."  "Actually," he said, pausing.  "You're pretty strongly introverted."  "Really?" I asked, surprised.  I'd always thought of introverts as being shy, reserved, and quiet -- all things I definately am not.  (As it turns out, this is a common misconception). 

Discovering I'm an introvert shed new light on a light of things I didn't understand about myself.  Once I understood these things about myself I was able to embrace them.  I was also more sensitive to what I needed -- plenty of alone time to think and reflect as well as quiet time to regroup after socializing.  Whenever I have a patient who is clearly introverted, I set aside time to help them understand what this means.  I normalize their need for alone time; I explain that making time to be alone is an essential part of taking care of themselves. Hopefully, they will learn to embrace who they are...

Sunday, August 26, 2012


It's not unusual to feel certain emotions without knowing why.  Disappointment is not one of those emotions.  When we feel disappointed, we almost always know what caused it...

Disappointment stems from positive expectations that never materialize or from desires that are left unfulfilled.  We expect something to go a certain way and it doesn't; we feel disappointed.  We want something badly but aren't able to have it; we feel disappointed. 

Ideally and over time, we can learn to transcend disappointment.  To do this, we must let go of our attachment to ideas about how things "should" be.  When we stop clinging to our expectations, we are able to accept with equanimity whatever the present moment contains. 

Many people never realize this truth.  Even among those who strive to let go of expectations, there are few who will attain this ideal.   As a result, the great majority of us will continue to experience disappointment throughout our lives -- disappointment in ourselves, in our circumstances, in outcomes, and in others.  For us, the task becomes finding a way to work through disappointment so that we can move past it. 

Disappointment is one of those emotions that can become toxic if left unaddressed.  Long term, chronic disappointment in oneself leads to feelings of worthlessness and self-loathing.  Enduring disappointment in someone close to us causes anger and resentment towards that person.  Perpetual disappointment in life or its circumstances leads to feelings of hopelessness and despair.  These emotional states can quickly develop into habitual ways of relating to ourselves, other people, and the world. 

These are all things I know and can pass on to others without difficulty.  It is one thing to know; it is another to do...which is what I am struggling with now. 

I believe that acceptance is the antidote to disappointment.  To feel disappointed is to wish the present moment to be something other than it is.  Therefore, the first step in overcoming disappointment is to accept reality as it is.

Sometimes letting go of disappointment feels like giving up.  For example, if we give up on pushing our child to work hard and be responsible (because we've had so many arguments about it but nothing ever changes) are we giving up on our child?  It can certainly feel that way. 

But isn't the pushing just a way to avoid facing our disappointment?  Isn't it our attempt to get our child to do what is right so that we can be proud of him?  Nobody wants to say, "My son dropped out of school and refuses to get a job."  To have invested so much of our time, energy, and love into raising a child who then refuses to become a productive member of society is a great disappointment.  So we refuse to accept it.  We push our child to do what is right.  We will not allow our child to fail.  It is simply not acceptable. 

What happens when we do this for months and then years without success?  We've probably had so many fights with our kid about it that he's stopped coming to visit.  We worry about it constantly and think about what else we can do to change things.  We feel angry at and resentful towards our child for letting us down.  In short, we suffer.

This is when it becomes time to accept.  Sticking with my example, the time has come to accept that our child is a bit lazy and doesn't care much about becoming a productive member of society.  Yes, it's disappointing; but once we've stopped trying to change our child and have accepted him as he is, we can then grieve the loss of what we wanted him to become. 

Sunday, August 19, 2012

My (Blended) Family

My house feels eerily empty right now.  My stepdaughter spent nine weeks with me and my husband this summer.  This is almost twice as long as she was able to stay last summer and it's the longest we've had her at any one time.  She lives in South Carolina and we live in Virginia, so during the school year she stays with us every other weekend, alternate Thanksgivings, half of Christmas Break, and the week of Spring Break.  When she stays for a weekend, there's barely enough time to get used to her being here before it's time for her to go back to her mom's.  When she stays for extended periods of time we get comfortable.  We settle into a routine that's different from the one my husband and I follow when it's just the two of us.  Normally, I tend to like a lot of "me" time.  When my stepdaughter is here, it forces me outside of myself and into the world.  I consciously spend less time hiding out by myself and more time interacting with her.

It's not so bad when my stepdaughter goes back to her mother's after spending just a weekend with us.  Weekends are always set aside for spending time with family and friends anyway.  When my stepdaughter goes back to her mother's after staying with us the entire summer her absence is profound.  There's no one to tease about moving so slowly in the mornings.  There are no cute little outfits to lay out because there is no little person to wear them.  No one runs out to my car as I leave for work to wave goodbye.  No one needs me to answer random questions about how the world works.  No one asks me to pick them up by their feet so they can hang upside down.  There is no one to join in when I tease my husband.  No one needs me to braid their hair or to pick out a hair tie that matches their clothes.  There is no one watching the Disney Channel when I come home from the gym; I am greeted by a silent television and an empty room. 

So right now my house feels empty, although it is not.  My husband and I are there, doing what we always do.  I've always savored our quiet evenings together.  I'm sure I will come to enjoy them again.  Right now, though, the house is just a little too quiet...

Sunday, August 12, 2012


Everyone has something they're really good at, right?  Isn't that what we tell our children when they begin to cultivate interests and hobbies?  We encourage them to try their hand at a variety of extracurricular activities.  Some children immediately find something they do well.  Others try a little bit of everything but just can't seem to find their niche.  "Keep trying," we tell them.  "Everyone's good at something.  You just haven't found your talent yet."

A patient sat in my office not too long ago.  She was struggling with feelings of inadequacy and depression.  "I'm not good at anything," she lamented.  Like most of us, she'd been told since childhood that everyone has some sort of talent.  "Keep looking," people told her.  "Don't give up."  My patient, now in her late 20's, never "found" her talent.  As a result, she concluded that something must be wrong with her, that she was somehow lacking. 

I could empathize with this patient.  There was a point in my life -- shortly after I graduated college and started my first "real" job -- when I came to the same realization about myself: I'm not really good at anything.  I am, of course, better at some things than others; like everyone, I have strengths and weaknesses.  There are even a few areas in which my performance is probably above average.  I cannot, however, think of any one thing I can do so well that I stand out from the crowd. 

And I think that's true for about 95% of us.  Theoretically, most human abilities follow a normal distrubution.  This means that for any given skill, most of us will possess an (approximately) average aptitude.  About 68% of us will fall solidly within the "average" range (i.e., within one standard deviation from the mean).  Approximately 13.6% of us will fall within the "above average" range (i.e., within two standard deviations above the mean); another 13.6% will fall into the "below average" range (i.e., within two standard deviations below the mean).  Altogether, this accounts for 95% of all people.  Therefore, for any given talent, skill, or ability, only about 0.1% of people perform at the "exceptional" level (three or more standard deviations above the mean). 

The point is, there is only a very small minority of people who we can say truly excel at a given skill.  The rest of us tend to be average, slightly above average, or slightly below average. 

I wonder, then, if we aren't setting our children up for disappointment when we tell them that everyone has something at which they excel.  It might not be so bad for the 13.6% of kids who end up being "above average" at one thing or another, but what about the other 83+% who are just "average" or even "below average?"  Are we instilling in our children the belief that it's not okay to be "average?"  If we assure our children that they will find their place to shine but then they never do, are they going to end up feeling like they're somehow inadequate?

As a child, I remember thinking that I was meant to do great things.  I believed I was somehow "special" and that I was going to have a significant impact on the world.  Children are naturally egocentric so it's not unusual for them to feel special.  Ideally, they grow up to learn that while their wants and needs are important, they are no more important than the wants and needs of others.  Unfortunately, this doesn't always  happen, especially in today's world. 

People today tend to have far fewer children than did people who lived 100 years ago.  The parental energy and attention that at one time was divided among many children is now devoted to one or two.  Many parents put their children at the center of their world, often sacrificing more than a healthy share of their own wants and needs.  We tell our children that not only are they special to us, but that they are special in general.  We heap excessive amoutns of praise upon our children in an effort to build their self confidence.  We tell our children that they can do anything and that they should never allow anyone to stand in the way of their dreams. 

We mean well.  We want our children to grow into confident, successful adults.  We want them to reach for the stars and to lead happy and fulfilling lives.  But I wonder if we might have gone overboard. 

It wasn't until I became an adult that it hit me: I'm no more special than anyone else.  I began to realize that I will probably never create or achieve anything that will radically change the world I can, however, make a significant and meaningful contribution to society, even if it's nothing extraordinary.  I had to adjust my expectations, but I eventually reached the conclusion that it's okay to be ordinary.  I don't have to do anything great to live a meaningful life; I just have to be myself.

Sunday, August 5, 2012


Most would agree that human beings seem to be hardwired to seek happiness.  It appears to be an innate impulse (although in reality, it is impossible to say whether the first humans displayed this tendency).  Whether instinctual or acquired, the pursuit of happiness is practically universal among humans of the modern era.  In today's world, almost everything we do is in some way motivated by our desire to lead lives that are both happy and fulfilled.

Unfortunately, for many of us, happiness can be quite elusive.  This is especially true in Western cultures.  Modern Western societies tend to be obsessed with doing, achieving, and posessing.  We look for happiness in external activties, concrete achievements, and material posessions.  Unfortunately, evidence suggests that living this way does not make people happy.  Instead, it breeds malaise, discontent, and chronic feelings of restlessness.

Restlessness is propelled by a desire to be somewhere other than here, doing something other than the activity in which you are currently engaged.  It is a state characterized by unease and agitation. 

When people seek happiness from external sources, restlessness is the inevitable result.  When we believe happiness exists out there in the world then that is where we search for it.  We identify something we think will bring happiness and we set about trying to achieve or obtain it.  When we get it, we initially experience intense feelings of pride, satisfaction, and pleasure.  "Now," we say to ourselves.  "Now I can be happy." 

Unfortunately, our pleasure is always short-lived.  Once the novelty wears off, we realize that we feel no differently than we did before.  The thing we wanted so badly has not brought us happiness.  We feel restless, so we begin to search for something else we believe will make us happy.  The cycle continues. 

Restlessness is not a particularly comfortable feelilng, especially when it becomes a daily presence in our lives.  The natural reaction to something unpleasant is to try to get rid of it.  Restlessness is alleviated by movement.  We seek happiness, come up short, and move on to look for it somewhere else.  Perhaps we leave our spouse or begin a new romance.  Maybe we quit our job, sell our home, or move to a new city.  Or we might get a new haircut, buy a new wardrobe, and adopt a new look.  We're restless so we move, however we choose to do it. 

We look outside of ourselves for happiness; we will never find it there and so will always feel restless.  All humans have the drive to seek happiness; our restlessness spurs us to continue on this quest.

Our quest becomes much easier if we look in the right place.  Happiness comes from within...

Of course that's a bit cliche', is it not?  It's all well and good to say that happiness comes from within, but what does that mean exactly?

The first thing we have to do is stop moving.  In her article "Boredom - The Gateway to Peace," Joan Brooks explains that we must learn to do nothing.  Westerners tend to feel compelled to always be doing something.  If we remain idle for too long, we begin thinking about all the things we could, should, or would rather be doing.  There is no stillness because we don't pause long enough for our minds and our bodies to settle.  As soon as we feel bored or restless, we're on the go again.  Brooks suggests that instead of bolting into action when restlessness arises, we "need to slow down and find some peace and serenity."  This will undoubtedly be quite difficult to do, at least initially.  Over time, however, we learn to sit with our feelings, without trying to change them.  Eventually, we learn to let go, relax, and just be.

Sunday, July 29, 2012

Time poverty

When my husband and I first got engaged, I had an opportunity to get a second job.  It was a good opportunity -- the pay was good and we needed the money -- but I didn't really want to work two jobs.  I didn't like the idea of leaving one job at the end of the day and driving straight to another one.  My husband, however, thought I should do it.  "Think of all the extra money!" he said.  He made a compelling argument and I was eventually persuaded to his point of view. 

I was miserable as soon as I started the job.  I always felt rushed, like I never had time to do the things I wanted to do.  I was constantly stressed out and was often irritable.  I ended up quitting after about a month.

Did my second job really consume so much of my time that there was none leftover for me to do the things I felt were important?  I honestly don't know.  What's important is that I felt like I didn't have enough time to do the things that were important to me.  My perception was what mattered.

The mistake I made (i.e., taking a second job I knew I didn't want) is a common one: I bought into the belief that money is more valuable than time.  Ours is a fast-paced society.  We are always in a hurry and there is never enough time in the day to accomplish all the things that need to be done.  Studies in both the U.K. and the U.S. have found that while a typical adult has about five to seven more hours of leisure time compared to thirty years ago, people today  feel like they have less time to engage in meaningful activities than they did back then. 

If we have more free time than ever before, why do we still feel so rushed?

As it turns out, I'm not the first person to ask this question.  And there's actually a name for feeling like there's never enough time: it's called time poverty.  Time poverty is an inevitable outcome of living in a world that never slows down.  Some suggest that it's tied to the competitive nature of Western (and especially American) society.  Culturally, we have embraced the idea that success is measured by material wealth and tangible achievements.  For this reason, we attribute more significance to a prestigious job title than to the nature of our relationships with family and friends.  We want to be successful so we constantly strive to "get ahead."  (The irony is that no matter how far you get ahead it will never be far enough to make you happy.  True happiness doesn't come from getting ahead or even from being successful).  We fill our schedules with activities that reflect the value we place on material gain and personal achievement.  Unfortunately, these are typically not activities we find to be meaningful or personally fulfilling.  Still, they consume the bulk of our time, often at the expense of activities that we do find intrinsically rewarding.

So what can we do about it?  We can't exactly get off the boat while life sails past us at breakneck speed.  Dr. Stephan Rechtschaffen believes he has a solution.  He calls his strategy "timeshifting."  According to Dr. Rechtschaffen, the problem with living in a fast-paced world is that we never switch gears.  There are times, he acknowledges, when we need to move quickly.  At other times, however, we need to slow down and be present.

Sound familiar?  Dr. Rechtschaffen is basically telling us that the way to create balance in our lives is to incorporate periods of mindfulness.  He assures us that we don't have to take time out of our already hectic schedules to integrate mindfulness practice into our day.  All we need to do is pick a mundane task and make a conscious effort to bring our full attention to the activity.

Sunday, July 22, 2012

How do we spend our time?

I recently read an article about making the most of your weekends that really struck a nerve.  We're always complaining that the weekend is too short.  It certainly seems that way!  There never seems to be enough time to do the things we really want to do.  If, however, we are truly honest with ourselves, most of us would have to admit that we don't make the best use of the time we do have.  For example, we don't have to spend Friday night in front of the television.  Sure, we have plenty of legitimate excuses for doing just that -- we're tired from a long work week, we deserve a break from our constant commitments, we need some time to ourselves, etc.  All of these things are probably true and if you feel strongly about your Friday night television time then have it, by all means.  But if you decide to use your time this way, you are not in a position to later lament that you haven't seen your friends in months becaue you "haven't had the time."  Nor can you honestly say that the reason you haven't had a quiet night alone with your significant other in so long is because you're both "extremely busy."  Furthermore, you are being less than truthful when you tell your parents that the reason you haven't come to visit (or called) in so long is because you've been so busy with work and other responsibilities.

I'm as guilty as anyone of making excuses for not getting around to things I claim are important to me.  It's human nature.  Our behavior at a given point in time is strongly influenced by - among other things - how we feel at that particular moment.  That is why, despite our best intentions, so many of us never make it to the gym after work, put off projects until the last possible minute, or knowingly do something we're sure to regret later.  So while spending time with our friends and family is important to us, it is often overshadowed by our emotional impulses.  "I know I should spend some time with so-and-so," we tell ourselves.  "But I'm just so tired.  The only thing I feel like doing right now is sitting here on the couch."

Most of us know that time is a precious (and nonrenewable) resource.  Still, most of us squander our time as if it were of no value at all.  Ilona Boniwell conducted a study on how people use their time.  She discovered that while most people do not see watching television as a meaningful activity, they still spend a significant amount of time doing it, to the tune of about fourteen hours per week.  I imagine we'll begin to see similar studies about how much time we spend online. 

I've often pointed out that no one on their deathbed says, "I wish I'd spent more time at work" or "I wish I'd spent more time watching t.v."  I think about this whenever I'm tempted to turn down an invitation to get together with my friends or family.  Sure, I might be tired, but I can always go to bed early another night.  When I'm at the end of my life looking back, will I say, "I wish I'd gotten more sleep?"  Probably not.

Sunday, July 15, 2012


I used to work in a residential treatment center for teenage boys.  It wasn't all that uncommon for one of the boys to get angry at me or to become hostile.  There was one resident in particular who used to threaten to kill me everytime I did or said something to upset him.  Eventually, I learned what made him angry.  I avoided doing these things whenever possible but some things were unavoidable.  I didn't take it personally.  It was my job to give him bad news.  If it had been someone else's job, he would've threatened to kill them instead.  It was just his way of reacting to things he didn't want to hear.
I was pretty thick skinned back then.  I had to be in order to survive in that setting.  I worked there for three years.  After I left, I started working as an outpatient therapist.  One of the things I found most refreshing about outpatient therapy was how my patients treated me.  They were appreciative!  During the entire three years I worked as a residential therapist there were only two - two - boys who thanked me for helping them.  As an outpatient therapist, there were at least two patients who expressed appreciation to me in the first week.  The difference was that my therapy patients actually wanted my help; most of the boys I worked with before were only there because they had to be. 

Looking back, my years as a residential therapist were a valuable learning experience.  I not only grew as a clinician during that time; I grew as a person.  I learned to set limits, to be consistent, and to maintain clearly delineated boundaries.  I learned how to let go of wounded feelings out of necessity; I couldn't refuse to work with a resident just because he said or did something to me that was cruel or hurtful.  I left that job a better person than when I started.  I assumed these were permanent changes and that the things I learned there would stay with me forever.

But time can make you forget.  I've grown accustomed to patients treating me with kindness and respect.  That's not to say that my interactions with patients are always cheerful or pleasant; they're not.  Still, I rarely - if ever- encounter the level of hostility I used to get from some of the boys at the residential center.  I guess that's why I was a bit taken aback last week when a patient became hostile during a group therapy session. 

I really didn't know how to respond.  Group therapy has always been a struggle for me anyway; I intentionally avoided doing therapy groups for about three years because talking in front of a big group of people makes me feel self-conscious and uncomfortable.  On top of that, a couple of weeks ago my supervisor asked me to sit in on some of the groups run by other clinicians.  Our clinic asks therapy group members to complete anonymous feedback forms; it seems my groups haven't been getting rave reviews.  The hope is that by observing other clinicians' groups, maybe I'll learn something that will help me become a better therapist. 

Suffice it to say, group therapy is not my forte.  Then, out of the blue, one of the group members blows up on me.  I expected him to walk out when he was done yelling.  I was kind of disappointed when he didn't.  The entire group fell silent; no one said a word.  (I guess I wasn't the only one who didn't know how to respond).  After a long period of silence, I looked up at the clock.  "Well," I said pleasantly.  "It's a little early, but we'll go ahead and wrap it up for today.  Thanks everyone."  With that, I stood up and went back to my office.

It occurs to me as I write this that maybe it's not the hostility that upset me after all.  It is what I thought initially, but writing this has helped me to sort out my thoughts.  I think the incident felt sort of like a confirmation of how bad I am at group therapy.  It's sort of disheartening.  I'd resisted doing groups for a long time.  Still, when I couldn't get out of doing them anymore, it turns out that it wasn't as bad as I'd thought.  But perhaps I was wrong about that.

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