Pressure

"Works well under pressure."  This is a quality that a lot of employers look for in a potential employee.  They want someone who remains productive in a high stress environment.  Perhaps they are seeking someone who embodies the old adage, "When the going gets tough, the tough get going."  The fact that such an adage even exists suggests that our society values those who keep it together when things get difficult.

It's understandable that an employer would want to hire someone who "works well under pressure" if the environment in which the person will be working is a high stress one.  It's true that it is more effective to keep doing the best you can in the face of environmental stressors  as opposed to "falling apart."  I think most of us do this.  There are, however, those people who seem to thrive under pressure.  They put off doing things until the last minute because it's difficult for them to get motivated for action when there isn't a deadline looming just ahead to generate a little bit of tension.  If things aren't moving quickly enough then they get bored.  These are the people who "work well under pressure."  When you turn up the heat they spring into action.

I can see how people like this would be an asset to any company.  But is there anything wrong with people who prefer a low stress, low intensity environment?  Are those of us who perform best in a quiet, structured environment any less valuable?

Personally, I DO NOT work particularly well when I'm under a lot of stress.  No, I don't "fall apart" or "crumble" when things get difficult but I definitely don't churn out my best work under these conditions either.  The adage "when the going gets tough..." seems to imply that I am not, in fact, "tough."  I become overwhelmed when too many demands are placed on me.  I don't "get going" -- I actually tend to slow down.  This helps me to cope with feeling overwhelmed.  I also try to look forward to a time when things will be less difficult so that I can return to optimal functioning.

I find this to be true with many of my patients as well, particularly those who have a lot of anxiety.  Maybe it's because when you struggle with anxiety you essentially spend every day "under pressure."  You (ideally) develop ways to cope with daily life that help to alleviate your anxiety.  In contrast, most (non-anxious) people don't have to find ways to "cope" with daily life; they just live it.  They don't initiate their coping mechanisms until things begin to get stressful.  The coping skills of anxious people are pretty much ALWAYS activated.  This takes energy and conscious effort.  It can be difficult to find additional energy or to generate additional methods of coping in response to environmental stressors. 

I tell these patients the same thing I've learned to tell myself.  During periods of high stress you are GOING to experience a lot of anxiety.  You probably will always have a difficult time with change.  It's ok.  Feel the anxiety and go about your daily life the best that you can.  Take comfort in the knowledge that once life settles down a bit you will start to feel better.  Also, KNOW that high stress environments tend to make you feel anxious.  Be careful not to unnecessarily put yourself in these types of situations.  Don't take on too many projects.  Don't commit yourself to more than you think you can handle.  Deal with problems as they arise so that they don't accumulate.  Take care of yourself by managing your external demands.  You don't have to thrive under pressure -- you just have to get through it.

Grief

I've been thinking a lot about grief and loss over the past few months.  My grandmother died in 2003.  After her death many of us in the family wanted something of hers to keep as a reminder of sorts.  One of the things I chose was the body pillow she'd slept with in the months before she died.  For the next seven years I slept with that pillow.  It wasn't a fluffy pillow so I put another pillow on top of it to make it more comfortable. 

Last May, my boyfriend (who is now my husband) moved in with me.  My grandmother's pillow sat at the head of my bed, spanning the entire width.  As I said before, the pillow itself was not particularly comfortable; I remedied this by putting another pillow on top of it.  This didn't work for my husband.  He complained that the extra pillow tilted his head at an awkward angle and gave him painful neck cramps.  Thinking it was a simple request, he asked if we could take my grandmother's pillow off of the bed we now shared.

I absolutely did NOT want to do this.  "It was my grandmother's pillow," I protested.  He pointed out that he wasn't asking me to throw it away; he just didn't want it on our bed.  The logical part of me knew that his request was not unreasonable.  After all, it really is quite difficult to sleep if you're uncomfortable.  Still, the emotional part of me was having a difficult time.  Eventually I relented, but it was hard.  My husband thought the significance I'd attached to my grandmother's pillow was a little strange.

Over time he noticed other somewhat quirky ways I held on to my grandmother.  He pointed them out and asked me (with quite a bit of sensitivity, to his credit) if I thought I might be experiencing "grief issues."  I try to be open to feedback from the important people in my life so I gave this some serious consideration.  Ultimately, I concluded that no, I'm not suffering from "grief issues."  Actually, I decided, my behaviors were simply ways I'd developed over time to honor my grandmother's memory.

This experience led to a lot of thought about grief on my part.  The issue is relevant to everyone at some point in their lives.  I frequently work with patients who are struggling with bereavement.  In my opinion, losing a loved one is the single most difficult thing we as humans have to endure.

So what DO we do with our dead?  There are many cultures that provide an acceptable place for the dead.  In some cultures, the living look to their deceased ancestors for guidance and protection.  There is no rigid delineation between the realm of the living and that of the dead.

 American culture, unfortunately, does not deal well with death.  Many have asserted that ours is a death-denying society.  We see death as a failure and do any and everything possible to keep people alive, even in the absence of any quality of life (even in the absence of conscious awareness).  Many people die in hospitals as opposed to at home, in the presence of their loved ones.  When a person dies, we Americans typically look for someone to blame.  Someone must have caused the death; it certainly isn't a natural thing! (sarcasm intended).

There are, I would imagine, many ways this problem could be addressed.  For me, I will continue to make my grandmother a part of my life, just like she was when she was physically present.  I will keep talking to her out loud; I tel her all the time that I love her and miss her.  I will continue to share memories with my family and to listen when they share their memories with me.  I will keep her picture in its place on my nightstand.  I will continue to pray for our eventual reunification.  I will still see things in stores and say, "Oh, Grandma would've loved that!"  I will continue to embody the things that she taught me about loyalty and the value of family.  I will do these things proudly and without a trace of shame.  To me, just because my grandmother isn't physically here does not mean that she's gone.

Identity

Identity.  We all have one but we rarely think about what goes into it.  Identity is a term with many definitions, depending upon the context in which it is used.  For the purposes of our discussion, however, identity will refer to "the individual characteristics by which a thing or person is recognized or known."  A person's identity changes over time, yet there is also some intangible component that provides continuity.  If there was no consistency in an individual's identity we would not be able to say things like, "I used to be a trouble maker" or "she's not as shy as she used to be."  There is something about one's self that allows a person to refer to characteristics he once displayed but no longer possesses and yet still be referring to the same person (i.e., himself). 

The point is that a person can have many different identities over the course of a lifetime.  It is not problematic for a person's identity to change (and hopefully to grow) over time.  There are some things, however, that are problematic when it comes to identity:

1. Having no sense of identity.  This generally causes a person to feel lost, empty, and confused.

2. Being uncomfortable and/or unhappy with your identity.  In other words, the person doesn't like who he is.  This can lead to severe depression and self-loathing.

3.  Feeling like you cannot reveal your "real" self to others (because others would reject you).  This creates feelings of isolation, depression, and shame.

4. Neglecting things that are vital to your sense of identity.  This generally causes people to feel unfulfilled or like something is "missing."

A lot of emotional and psychological problems stem from disturbances in identity.  For people with diagnosable personality disorders the problem is a fragile or fragmented identity.  Depression is experienced by people who are unhappy with their identities, by people who feel they lack a sense of identity, or by people who are neglecting important parts of their identities.  Anxiety typically occurs in response to a real or perceived threat to a person's identity. 

I realize that identity is a very broad topic and could probably be the subject of it's own blog.  Still, I think it's something that is worth exploring, as who we are and how we define ourselves are factors that influence almost every aspect of our lives.  I am very open to ideas and/or suggestions about where to go with this topic.  Some things to think about: What kind of disturbances in identity cause the most problems?  Can a person have more than one identity at the same time?  What are the most important components of a person's identity?  How does identity shape our behaviors, our thoughts, and our choices?

Negativity

I made a decision a long time ago not to allow negative people to remain in my life.  I don't like "drama."  I try to stay away from people who always seem to stir up conflict or who somehow manage to manufacture crises on a regular basis.

As much as I prefer to avoid negativity there are times in life when it is not possible.  I think this is especially true during childhood.  When I was in sixth grade there were two kids in my class who used to tease me mercilessly.  They fed off of each other and would whisper cruel, derogatory things to me loudly enough for me to hear but quietly enough to avoid detection by the teacher.  I'm not sure why I never told the teacher.  Probably because "tattling" was not a socially sanctioned option among my sixth grade peers.  Switching to another class was not an option either.  I never responded to their comments, thinking that if I ignored them they would stop.  They didn't.  There were days when I'd go home, go to my room, shut the door, and cry about some of the things they'd said.  I remained sensitive about some of their specific criticisms for years afterward.  If I could have found a way to avoid these kids I would have done it without question.  Unfortunately, I couldn't.  I had no choice (at least as I saw it at the time) but to endure their teasing.

Really, these kids were just a couple of bullies.  While relatively common during childhood and adolescence, this kind of bullying seems to occur less frequently in the adult world.  Oh sure, there are negative people out there just waiting to put someone down.  In the adult world, however, we have a little more control over how much contact we have with this kind of people.  (This is not always the case, of course.  Sometimes we have no choice but do endure the obnoxious coworker in the cubicle next to ours.  We could, however, inquire about relocating to another cubicle).

It seems obvious.  If you want to live a happy, peaceful life then the best thing to do is to distance yourself from these "grown up" bullies.

An unpleasant experience I had last weekend made me start thinking about this subject.  My husband was previously married and he and his ex-wife have a child together.  We went to pick up his daughter for the weekend; this was the first time I'd met his ex-wife.  (We've only been married just under two months).  She saw me in the car when she pulled up.  She immediately jumped out of her car and started yelling.  She apparently did not like the fact that I was there.  I tried introducing myself and being cordial but with no success.  Instead, she responded by hurling insults at me.  She derided my appearance and told me that my husband only married me for money (not that she knows anything about our financial situation - the comment was just meant to be hateful).

I was really taken aback.  I cannot remember the last time I've seen someone act like that but I'm sure it was sometime before I graduated high school.  I wasn't even really angry at the time.  More than anything I was confused.  I saw no point in arguing with her so how was I supposed to respond?  WAS I supposed to respond?  I kept thinking to myself, "People just don't act like this..."

Do they?  Later I started thinking that maybe I am naive.  Maybe people really do act this way and I've just managed to shelter myself from it.  I ended up handling the situation ok but I was still rather unsettled.  It was almost like being in the sixth grade again.

Are there more negative people out there than I thought there were?  What do you think?  Are you able to keep your interactions with negative people to a minimum?  Or do you find yourself forced to deal with negative people on a regular basis?

Inertia

There is a lot of fluctuation in my daily workload.  Some days I have back-to-back appointments all day long and barely get a chance to breathe in between patients.  Other days are painfully slow.  I might have only a couple of appointments scheduled, patients might cancel at the last minute, or sometimes patients simply forget they have an appointment altogether.  I'm not sure why this inconsistency exists.  Perhaps it's the population, maybe it's the clinic location, or maybe (but I REALLY hope not) it's something I'm doing wrong.

Whatever the reason, I've noticed that there is a correlation between my daily workload and my levels of energy and motivation.  On my busy days I typically stay pretty motivated.  I'm sharper and more focused during sessions and when one patient leaves I'm ready for the next one.  It's like I start off busy and continue to gather momentum as the day goes on.  On slow days it's the exact opposite.  If  my early morning appointment slots are empty I find myself dreading my appointments later in the day.  I feel lethargic and unmotivated.  I find it difficult to focus during sessions.

I discovered that there is actually a name for this phenomenon.  It's called inertia.  The concept actually has its origins in physics.  It comes from Newton's First Law of Motion.  Inertia is defined as the resistance of any physical object to change in its state of motion or rest.  The law states that an object will continue to move at its current velocity unless some force causes its speed or direction to change.  An object that is not moving will remain at rest until some forces cause it to move.

Technically, the concept of inertia applies to objects.  It is, however, also commonly applied in reference to people and organizations.  It certainly seems to explain what happens to me at work.  When I am "in motion" - that is, when I'm working hard and staying busy - I can remain alert, focused, and ready to keep working.  When I am "at rest" - that is, when I am not busy and have few patients -- I feel lethargic and have difficulty motivating myself to work.  I am an "object" at rest that wants to remain at rest.

I'm really not sure how to change this except perhaps to find work to keep myself busy and engaged even when I don't have patients.  Perhaps I could take on a project.

Does anyone else have any ideas?

Feelings as Facts

A patient recently told me she felt unloved.  She blamed her husband for not doing enough to demonstrate his love for her and said she was having doubts about whether or not to stay in the marriage.  I asked her how long she'd been feeling this way.  "Not long," she told me.  "Maybe a week."  I asked her what had changed about her husband's behavior over the past week.  She was not able to identify a single thing her husband was doing differently than he'd been doing when she did feel loved.

The problem, I concluded, was that she was accepting her feelings as fact.  This is called emotional reasoning and it goes something like this: "I feel unloved; therefore, I must not be getting enough love from my husband."  Another example: "I feel anxious and worried; therefore, something must be wrong."  Yet another example: "I feel sad/depressed; therefore, something must be wrong with or missing in my life."

Now any of these statements might be true.  However, feeling a particular way is not enough evidence for us to draw any conclusions one way or another.  We need more information.

The point is this:  Feelings are not facts.  Emotions are a valuable source of information but they should never be the only source of information.  This is particularly true with those emotions that have been problematic for us in the past.

Here's a personal example.  I used to be very insecure and jealous in romantic relationships.  I became upset when my significant other talked to or even talked about other females.  It didn't take long before this caused problems for me.  I often over-reacted to benign situations.  My suspicions and accusations pushed those I cared about away.  I knew I had to make some changes.

I started to interpret feelings of jealousy as a sign (or a "red flag" of sorts) that I need to take a step back or remove myself from a situation for a few moments.  First, I would acknowledge my feelings of insecurity.  Then I would attempt to determine whether or not they had any basis in reality.  Sometimes that meant calling a trusted friend or family member to explain the situation and get their point of view.  If I determined that I was over-reacting (because of my own insecurities) I did what I needed to do to cope with my emotions without taking my feelings out on my significant other.  If I decided that my significant other had, in fact, done something to warrant my jealousy I worked to identify an appropriate way to address the issue with him.

This took a lot of practice but over time it became second nature.  Eventually I even started to feel more secure in my relationships.

Anyway, the moral of the story is that accepting feelings as facts can create a lot of problems.  To really make good decisions you need a good balance of reason and emotion.  In other words, when your head and your heart are in agreement you know you are on the right path.

Practicing What You Preach

I'm the kind of person who sort of jumps from interest to interest.  For a while I'll devote a lot of time and energy to something.  Then my interest sort of fades and I move on to something else.  It's the same way in my professional life.  I like to learn new modes of therapy.  For a while I become very interested in it.  I read everything I can get my hands on and I incorporate it into my sessions with as many patients as possible.  After a time, something else catches my interest and I move on. 

I don't think there is anything particularly wrong with that way of doing things per se.  However, I believe I would probably better serve my patients by maintaining my enthusiasm for learning new treatments while not completely abandoning the "old" ones. 

I started thinking about this the other day.  I had a patient who could really benefit from mindfulness training.  If you can teach someone to practice mindfulness you can help them learn to better tolerate their emotions, which leads to increased emotional stability.  I dusted off the file labeled "Mindfulness" and pulled out my outline.  (Yes, I'm a dork.  I create outlines so I make sure to cover all the important points).  I hate to admit that I've sort of slacked off in my daily mindfulness practice.  As a result I'd sort of forgotten why I'd been so enthusiastic about it before.  I explained the mindfulness skills to my patient but I was nowhere near as confident as I used to be.  Fortunately, the patient didn't seem to mind.  She was genuinely interested and expressed a willingness to practice mindfulness regularly. 

Explaining mindfulness to my patient reminded me of how much peace it has brought me in my own life.  I need to go back to it, if for no other reason than to be able to confidently share it with those patients who could surely benefit from it.  In other words, if I'm going to "preach" it then I need to practice it.

Toxic Relationships

I've often wondered why some are so reluctant to end their relationships with toxic people.  I've had friends who continued to let people back in their lives over and over again even after these people repeatedly turned their backs on them.  When it inevitably happened again they were genuinely surprised and hurt.  I never understood their surprise, as whatever the person had done this time around was completely consistent with his or her past behavior.

Now don't get me wrong.  I believe in giving second chances.  Everyone makes mistakes and in general people deserve to be forgiven.  For me the problem is when the same person repeatedly engages in behaviors that are hurtful to me in some way.  At what point do you say enough is enough?  At what point do you decide that you don't want this person in your life anymore?

Relationships and/or friendships with some people are simply toxic.  The longer you maintain the relationship the more toxicity you allow into your life.  Here are some of the qualities of a toxic relationship:

*Most of the conversations you have with this person end with you feeling unhappy, hurt, angry, put down, guilty, etc.  In other words, the person makes you feel bad more often than he or she makes you feel good.
*The person always seems to want something from you, be it money, a favor, a ride, to borrow something, etc.  Healthy relationships as a rule involve give and take.  In this relationship it's mostly about you giving and the other person taking.
*The person is rarely - if ever- there for you when you need something.
*The person is constantly criticizing you and putting you down.
*The person never expresses happiness for you when something good happens in your life.
*The person is frequently verbally or physically abusive to you.
*The person is always getting angry at you for reasons he or she refuses to share with you.  As a result, he or she often goes weeks without speaking to you because he or she is "mad."  Then, he or she tries to pick up the friendship or relationship right where it left off a few weeks later as if nothing happened.
*The person always seems to be in a crisis that he or she wants you to help fix.

These are just a few examples.  The point is, if you have a friend who resembles the descriptions I gave above you might want to ask yourself if it is healthy for you to maintain a friendship with this person.  There comes a point when the costs of maintaining certain friendships far outweigh the benefits.  When this happens it's probably time to think about ending the relationship.

Admitting You're Wrong

I've often wondered why it's so hard for human beings to admit when we're wrong and to accept constructive criticism from others.  I include myself in this.  I've had to work hard to learn to accept criticism without becoming defensive and still I catch myself wanting to explain it away when someone gives me negative feedback.  There's definitely ego involved.  There are times when we become so attached to our desire to be right that we don't even stop to listen to another person's point of view.  When insisting we are right or denying the validity of criticism we do it so vehemently that it almost seems as though we are fighting to protect our very identities.  And I think in some cases that's exactly what we are doing (or at least what we believe we are doing).

Identity is really only a collection of ideas each person has about him or herself.  Included in these ideas are beliefs about ourselves, beliefs about others, values that we believe we should adhere to, expectations we have of ourselves (and others) and our behaviors, etc.  Some people expect themselves not to make mistakes.  To admit to making a mistake is to admit that they aren't living up to their own expectations, i.e., that they are "not good enough."  Other people believe they should never show weakness to others.  They equate being wrong with being weak.  Thus, even if they know they are wrong they'd never admit it because to do so would make them seem weak and vulnerable.

The inability to accept criticism stems from self doubt.  Confident people accept themselves as they are.  They recognize that they have both strengths and limitations.  They accept that they are human.  Thus, when they are wrong they can admit it because they are, after all, only human.

The irony in this is that people who cannot accept constructive criticism are the very people who could benefit the most from it.  Criticism provides a person with important information about his or her personal weaknesses that he or she would probably not otherwise recognize.  This helps a person to identify areas for personal growth, which is, in my opinion, something we should all be striving for.

Gratitude

What does it mean to be grateful? Here are some thoughts:

*Gratitude means being thankful for what you have.
*Being grateful means not longing for more than what you have.
*To be grateful means not coveting what others have.
*Gratitude means saying thank you even for difficult experiences, as they generally have something to teach us.
*A grateful person is one who does not complain all of the time.
*Living a life of gratitude requires taking time on a regular basis to think about (or to write down) what you  have to be thankful for in your life.
*Practicing gratitude means recognizing that the good things in life are gifts that are bestowed upon you (rather than things that you earn or deserve). 
*A grateful person feels thankful for any opportunity to help others or to make the world a better place.
*To be grateful you must first let go of any and all sense of entitlement.
*Being grateful means not taking anything for granted.
*A grateful person is one who outwardly expresses his gratitude to others.
*Practicing gratitude means paying attention to all the "small" things we receive from others on a daily basis, such as service at the grocery store or post office, cooperation from coworkers, etc.

Just some things to think about...