Taking Small Steps

Sometimes the smallest of steps in a particular direction can begin, or further, movement toward a desirable outcome. Example: a client has for decades been struggling with feelings of shame, embarrassment, anger, fear, and self doubt, based on early traumatic experiences with his parents. His primary coping strategy through all of this time has been humor, or attempted minimization of the impact of these experiences. He says that he's "aware" of his real feelings, but hasn't been able to, or doesn't know how, to do his life differently. He continues, for the most part, to be sufficiently paralyzed by his feelings that his life - including his primary relationship - remains largely suffocating and unhappy, despite his "insights".

What do you think is a primary therapeutic theme here? What is this man not doing that needs to be done? What might you be doing similarly in your own life?

In spite of having some awareness of his real feelings, he continues to use very old "survival" strategies decades after the events in question. These strategies have in fact done their job - they enabled him to survive virtually impossible circumstances. Their job was done, though, decades ago, and their continued use serves to keep him trapped in a loop of feelings and behaviors that were no longer useful, or needed, 30 years ago. If he continues to use these same strategies, he'll continue to get the same results. Something has to change.

I ask him to find a way, or more than one way, to somehow give three dimensional form to his real feelings. I ask him to find ways to begin to honor and to respect not only his real feelings, but the real experiences he lived through. In effect, I ask him to begin to work with what is really going on for him, rather than to continue to "deflect" (his word) from this with his humor and minimization. Not until he can respect and accept his actual experience can he respect and accept himself. "How do I do this?" he asks.

Sometimes the smallest of steps in a particular direction can begin, or further, movement toward a desirable outcome. Begin right where you are. Pay attention to what you're actually feeling, be it shame, anger, grief, confusion, or anything else, and do something to acknowledge and honor that feeling. Draw it. Sing it. Write it. Speak it. Praise it. Thank it. Don't, of course, act it out in destructive ways. Whatever will allow you to begin to accept it rather than run from it. There's no one way. Each of us is capable of inventing ways that will work for us. And, importantly, have the right support for your taking these steps, even if they seem small.

Gratitude And Mental Health

Thanksgiving is my personal favorite holiday. This has nothing to do with what one friend of color called "the Pilgrim's Pillage" here in north America. It has everything to do with gratitude, feeling and giving thanks, appreciating the smallest as well as the largest of blessings in our lives, and coming together with those we care about to mark this occasion.

In the 12-Step model of recovery and wellbeing, the "attitude of gratitude" is promoted and lauded as a necessity for real health. There's other evidence from spirituality and mental health that this is true. Even in difficult circumstances, if you can remember and put some focus on whatever it might be that you have to be grateful for in your life, and certainly if you can actively cultivate a remembrance of and a practice of acknowledging the people, circumstances and things that you have to be grateful for, this goes a long way toward building and sustaining happiness and health.

Sometimes it's important to see the wisdom of being grateful even for difficulties. The Dalai Lama is well known for having said that his enemies are his greatest teachers, and the people in his life that he is most grateful for. Why would this be so? Because, he says, they provide him with the best opportunities to cultivate and practice patience, non-violence, compassion, and loving kindness. And it is these qualities that, from the Buddhhist view, lead most directly to happiness.

We can say that these qualities are clearly also important for mental health. And all of them are linked to gratitude. In this time of thanksgiving, let's try to remember the gifts in our lives, and make it a day to day practice to humbly give thanks for the true blessings that are ours.

Vulnerability And Change

Why is it difficult to make desirable changes in the ways we think, feel and behave? Of course there are going to be a number of reasons, but I want to focus for a minute on an area that seems to present particular challenges. That is, the capacity to allow the more vulnerable aspects of ourselves to come into focus. I don't know enough about the world's cultures to pronounce authoritatively about whether or not this is an issue around the globe (I believe it is clearly becoming more of an issue as much of the world becomes more Americanized), but I am willing to say that in American culture, vulnerability is discouraged in multiple ways.

Just one example: I recently attended a daylong conference on the needs of boys in our society. The keynote speaker, Luis Rodriquez, presented a moving account of some of his own history of gang involvement, drug addiction, violence, and despair. One of the stories he told was about how, when he was in prison, he was confronted by another man who was making it clear to Luis who was in charge. Threats were delivered. According to Luis, the only possible response to these threats was the stereotypical comeback of: well, if you're going to hurt me, you'd better be sure that I'm good and dead, because if I'm not, I'm going to come after you and kill you.

This is an extreme example of course, but it illustrates the truth for many people, even if the degree of intensity isn't the same, how vulnerability is undesirable. The risks, whether they be of physical violence, or emotional violence, are most often too high. We tend to choose power and control over vulnerability.

But what are the costs of always - or nearly always - choosing power and control? They are equally high, or even higher, if we include many spiritual teachings from different respected sources. From a psychological point of view, we lose our more genuine selves. We become hardened and defended. We lose the ability to experience intimacy and love. We damage our relationships, and become isolated, alienated and more and more alone. Of course, for some, this becomes some form of ultimate defense: the "I don't need anybody", "lone wolf", "self reliant" defense. This sort of thing has been idealized in American culture, with no reference to the price we pay for it.

So, for both men and women, vulnerability becomes an extremely important skill. For one thing, it's at least sometimes the actual case. If only we would admit it, we often do feel vulnerable, not so strong and in-charge, even tender. Directly related to the question of vulnerability is the question of safety, and how to create and develop that, both externally and internally, so that vulnerability is a real and authentic option in the right circumstances.

A Little About Sadness And Grief

It's sad to see how biased we are, as a culture, against sadness and grief. People are often afraid that sadness means depression, and that grief is dangerous and something to be gotten through as quickly as possible. We've all heard people say things like "You've just got to get over it and move on with your life". Of course, these people think they're being helpful, and we can probably assume that their motivations are good. They want the best for us. They want us to feel better. It's also almost a certainty that they are themselves seriously afraid of - and inexperienced with, in any healthy way - the experiences of grief and sadness.

The reality is that both sadness and grief are common, ordinary human experiences, and they occur just about daily for just about everyone. Most of the time we don't experience them though, because we've learned how to very skillfully deny them, and push them out of awareness. We carry on as though they didn't exist. We smile and let everyone know how happy we are. It's too bad really. As with other "unfelt" emotions, over time we develop habits and styles of being that prove to be detrimental, both for us as individuals, and in our relationships.

Learning to trust and to allow these so called "negative" emotions is an important part of psychological and relationship health. Learning how to creatively and appropriately work with these feelings is a key to personal freedom, wellbeing, strength and authenticity. Hopefully you'll take the time to learn more about sadness and grief, how to include them in your emotional repertoire, and how to let them enrich your life.

Relationship Discord Factors

What are some of the factors that contribute to relationship discord? Why don't couples get along, when they don't get along? It would be easy to say something glib, like, well, whenever there are two or more people, there's going to be conflict. And this is indeed true, if we understand "conflict" to mean anything from simple disagreement to hostile combat. But it's important to understand in more detail the specifics of conflict, so that we can imagine what might need to be done to create more harmony in relationships.

So let's list some of the most common contributors to relationship dis-harmony:
1) resentments 2) insecurities 3) unidentified and unmet needs 4) feeling disrespected
5) ineffective communication styles 6) assumptions 7) misinterpretations 8) fears that are unidentified and unspoken 9) sexual differences 10) money differences 11) value differences
12) parenting differences 13) feeling unheard 14) trying to control another 15) unspoken expectations.

These are some of the most common factors that lead, almost inevitably, to relationship problems. How could they not? All of them are important considerations in the dynamics of any relationship, and addressing them skillfully becomes an important aspect of healthy relationship interactions.

Taking Care of Oneself

Selfishness is a real paradox, especially as it applies to therapy. So many people are averse to the idea and the practices of taking care of themselves, because they believe it is selfish. And yet without taking care of yourself you become exhausted, or drained, or burned out, and then there's nothing left with which to give to others anyway, at least not in a healthy way; in a way that does not require becoming a martyr, and literally sacrificing yourself to illness or depression or resentment for example.

This is a very individualistic point of view of course, one which says in effect, be selfish enough to get your own needs met first, so that you will be strong enough and full enough to have surplus left for others. It's like the instructions on airplane flights where we're told to put our own oxygen masks on first in an emergency, and only then help our child or neighbor. At first this might sound selfish. Wouldn't a mother's first reaction be to save her child, for example? Perhaps it would, and the best way for her to realistically be able to do that in an emergency - to sustain that, we might say - would be to make certain that her survival needs are taken care of first. If she dies from lack of oxygen she won't be of any use to her child.

This may sound like an extreme example, and therefore not applicable to so-called everyday life. I would suggest however that it is not. Or, I might say that so-called everyday life often involves more extreme circumstances than we recognize. Most people operate at the extremes ordinarily, without even knowing it. The buzz words for this are things like, either/or; black and white; all or nothing. You can probably recognize some of the ways you do this in your life. It's really quite "normal", although it's not at all healthy.

Taking care of oneself therefore is about moderation rather than extremes; the grey's rather than the blacks and whites; the some for you and some for me rather than the all or nothing; the both/and's rather than the either/or's. True, it's not as dramatic, or possibly not as exciting - at least not at first, but it is a whole lot more sustainable and substantive, and satisfying.

Mindfulness And Psychotherapy

The term "mindfulness" in conjunction with therapy is quite popular in certain circles now. So what does this actually mean? And why is it being associated with psychotherapy?

In its simplest form, mindfulness means, simply, awareness. To be mindful. To be aware. This awareness applies to all aspects of our experience, both internal and external. This would include our thoughts, images, beliefs, desires (our "cognitive" self), our bodily sensations, our feeling states or emotional experience, and our spiritual condition. Body, speech and mind, to use the Buddhist formula: our physical behaviors, what we say out loud, and both our cognitive and spiritual conditions.

Psychotherapy is, in the final analysis, about change. It's about doing things differently, it's about thinking about things differently, and it's about feeling differently than we do at present. It is not about awareness only, or mindfulness only, yet these are considered to be essential before desireable changes can be made. If my behavior is causing distress for example, I'm not likely to be able to change it to something healthier unless and until I have an awareness of what I'm doing, and some idea of what I'd rather be doing. The same holds true for what I'm thinking and feeling, believing and imagining.

Since much of what we think and imagine and believe, and even much of what we do, is out of consciousness, developing new self-awareness - becoming more mindful - is a key to successful therapy. It isn't enough by itself, but it's an essential step.

To Stay Or Not To Stay?

Whether to stay together in a long term relationship which has involved much hurt for both people, is a challenging question. If there is a child, or children involved, the question becomes more challenging, since we can assume that bad energy between partners has already adversely affected the children, and is continuing to do so. How much hurt is too much? Where is the point of no return, beyond which reconciliation and repair are simply not possible, and quitting the relationship would be best for all, including, in the final analysis, the children?

I wish there was a pat answer to these questions. I don't know one if there is. I do know that there is a point beyond which it would not be advisable to stay together, if our interest is in the wellbeing of all concerned. This point is reached when there has been so much hurt that sticking around and trying to make it right would be more injurious than helpful. I believe that people can and should suffer only just so much injury in relationships. I'm not an advocate of the martyr approach, which might recommend endless patience, endless justifications, endless apologies and endless relapses into hurtful behavior.

If there are children, they are witnessing hurtful relationship dynamics, and are learning how they are very likely to relate with other people, especially with their future partners. They are also experiencing repeated injury themselves, through their own fear (or terror), confusion, chaos, anger, or self blame that is part and parcel of being exposed to repeated hostility and discord.

If both adults feel strongly that they are able, willing, and desirous of making significant cognitive and behavioral changes for the better (with professional help of course), then it would be well worth trying. If either of them are ambivalent, the outcome may be harder to foresee. In all cases, the safety and wellbeing of the children need to be a first consideration, and this is not always a straightforward assessment.

If you are experiencing significant relationship discord, please get professionanl help right away. There's no need or good reason to wait while things get worse.

The Importance of Grief Work in Being Free

I recently saw a client who, along with other issues, is struggling with "frozen grief", having to do with realities from childhood that were, indeed, deeply sad, shame inducing, security destroying, and chaotic. The tears, as the subject came up, were right behind the eyeballs, the pain of the memories was present and palpable, yet this client has learned to use humor as a way of coping with these feelings, instead of actually working toward some level of real resolution and integration. In other words, the client is stuck in the past as far as this issue goes, and is therefore handicapped in current life.

The major theme to emerge during the session had to do with "honoring" this grief, acknowledging it's real importance, respecting it, and somehow finding a way or ways to give explicit form to it. Why drag up old hurts, some would ask? Simply because the ways in which these hurts so obviously impact current life in negative, undermining, destructive, and ironically painful ways is unhealthy, that is, it causes unhappiness.

Pretending that old hurts are in the past is simply an illusion. The reality is that these hurts will and do affect our lives today. If they were left in the past with no adverse affect in the present, we could agree with the "why not leave them in the past" approach. But that's just not the way it works. We're structured in such a way psychologically that our experiences have lasting impact, and traumatic experiences have lasting traumatic impact, unless they can be resolved, integrated, healed.

The "get over it" view is unfortunate, not just because it is lacking in compassion, but because it's unrealistic, it's bad science. Like a garden, we are organic beings with particular kinds of needs if we are to flourish. We can survive even if these needs are never met, but we cannot "do well". Grief work is a natural process of healing the psyche from traumatic wounding.

Relationship Essentials

What makes for a good, healthy, viable, satisfying, loving relationship? Isn't this something we just know how to do?

To answer the second question first, "no". It might surprise you to know how little we actually "just know" about conducting good intimate relationships. Here are some of the mistakes people almost routinely make in their intimate relationships:
1) acting as if it is a sporting event, where there has to be a winner and there has to be a loser
2) insisting on being "right"
3) trying to tell your partner what they "have to" do in order to be acceptable
4) trying to control your partner's thinking or behavior
5) a lack of cooperative support toward a win-win dynamic
6) a failure to actually listen to your partner, and respect their differences and needs
7) making disagreements into a battle where conquest, rather than negotiation is the goal
8) dragging up issues from years ago when conflict arises

These are some of the obstacles to good relationship. So, to answer the first question above, the opposite of these things will make for good, healthy intimate relations:

1) learning to think about your relationship as a joint venture, rather than as a clash between enemies
2) learning to understand the necessity for flexibility, for give and take, for putting the relationship above your own need to be "right"
3) learning how to negotiate, rather than conquer
4) giving up the need to control, in favor of the rewards of real connection
5) understanding the benefits of compromise so that both parties come out winners
6) learning how to listen, to hear, and to pause long enough to take in and genuinely consider your partner's point of view, even if you don't agree
7) turning conflicts into opportunities to strengthen your relationship bond, rather than using them to prove how strong, or smart, or clever or important, or manipulative you are
8) learning how to work with feelings in the moment, instead of storing up grievances to be used as ammunition later on.

It's often hard work, but the rewards, if true intimacy and connection and loving are your goals, are worth it.

Is Contact With Nature Necessary For A Healthy Life?

I won't keep you in suspense. The answer is, "of course it is".

I know this might be considered a "bias" of mine, or simply a personal opinion. Well, OK.
The truth is though, it's not just my personal opinion. It's actually a view that's coming to be more and more recognized in all fields of health, not just mental health. I won't bore you with the long list of disciplines that are making this connection. You can easily read about it for yourself. Just choose an area of interest and start googling.

Mind-Body medicine. Respecting the ecology of the emotions and the psyche as well as that of the material (that is, "natural") world. Understanding that we are simply a part of this natural world, subject, as all of it is, to certain natural laws. For example, if we choose to live in a way that ignores the relationships between what and how we eat and resulting health effects, should we be surprised when poor diet leads to physical health problems? Or should we be surprised when a healthy diet contributes significantly to a healthy body? I don't think we should.

What about mental health? If we live in a way that isolates us from the natural world, or that believes that we are simply here to dominate the natural world, should we be surprised when we suffer with feelings of alienation, lack of meaning, anxiety, irritability, or spiritual emptiness? I don't think we should.

I'm not saying that everyone has to live in the forest, or out in the remote desert, or on a farm.
I'm saying that in some genuine ways, it's necessary to connect both physically/emotionally and spiritually with Nature, on a regular basis. By "connect" I mean also to learn to value, and to respect, and even to cherish, Nature, rather than relating to It as an enemy, or simply a "resource" to be exploited, or an inconvenience.

Yes, the health of the planet and the health of people are linked. This isn't esoteric lore, or New Age gobledeegook. It's simple intelligence and, really, common sense. If I drive drunk, my chances of having an accident are exponentially higher than if I'm sober. If I ignore my status as a product of the natural world, my chances of suffering some form of psychological dis-integration are exponentially higher than if I don't.

And now to the heart of the matter in terms of good therapy: connecting with the natural world includes, and often depends on, learning to connect more genuinely and more lovingly with oneself. Rejection and judgement of self, or attempting to live a false self, are forms of alienation from Nature. Hug a tree? Sure, and hug yourself, too.

Mindfulness Is Not A Drug

Yes, it's possible to use meditation as a means of escaping from oneself, rather than as a means of genuinely and beneficially connecting with oneself. Then you might end up feeling, as one client told me today, "stoned". You might feel high, or good, and this would be pretty much the equivalent of smoking pot, or drinking alcohol, or using other drugs or behaviors in order to self medicate against difficult or painful feelings.

I've known clients who have spent literally years doing this, imagining that they were somehow accomplishing something significant through their "meditation". A true mindfulness discipline on the other hand is a matter of connecting dispassionately, more objectively, with your own experience, whatever it might be, developing a non-judgemental attitude toward that experience, and an ability to observe it without acting on it.

One American Buddhist teacher whose writings I admire, Pema Chodron, speaks about fearlessness. I find her definition of "fearlessness" to be very accurate in terms of good mental health development: not turning away from your own direct experience. You notice that fearlessness here does not mean an absence of the experience of fear. Rather it's about connecting mindfully, more as an observer, courageously and compassionately with whatever your experience is, including the experience of fear., and not running or distracting from that.

The ability to do this is essential to growth, to healing, to recovery from addiction, to recovery from trauma, to good communication, to relationship skill, and on and on. It's essential, really, to happiness and wellbeing. Being "in the Now", a condition universally recognized as desireable and liberating, is only possible through mindfullness, through present awareness of one's moment to moment experience. Of course, this takes practice and development, and is not achieved all at once and forever.

Let's learn how to really pay attention.

A Veteran's Day Prayer

This being Veterans Day, it occurred to me to offer a prayer. Politics aside, the fact is that many men and women have participated in the horrors of combat, and many have suffered in both obvious and not so obvious ways as a result of this participation. I've had the privilege of working with some of these people as their therapist, helping them, along with others who have helped them, to overcome the traumas of war. Sometime decades after the fact. On the level of human wellbeing, there are truly no winners in war.

So I'd like to remember these folks today, and offer a prayer for their happiness and peace. For so many of them, the simple joys, satisfactions and pleasures of every day life that many of us take for granted, are distant and elusive. The burdens they carry, for any number of varying reasons, are at times heavy indeed. Whatever one's political views, I'd like to relate with these people as just people. Brothers and sisters, in need of a genuinely helping hand.

So to you veterans, especially, but by God's grace not only, on this day, may your burdens be light; may your spirits be lifted;, may your wounds be healed; may you experience the peace and the rest you deserve.

Let's Vote For Mental Health For All

We're in challenging times now, or maybe all times are challenging in their own ways. Maybe challenge is simply a part of the human condition.

It still amazes me that in 2008, 2500 years after the earthly presence of the Buddha, 2000 years after the earthly presence of the Christ, 2500 years after Aristotle wrote about psychology, a good hundred years only from the time of Freud, mental health is such a taboo topic for so many people in the United States. I don't know for certain, but I think this stigma may be less in many European countries.

It amazes me too, to tell the truth, that we in the US just elected an African American to the presidency. Six months ago I was saying that neither Hillary Clinton nor Barack Obama had a snowball's chance in Hell of being the Democratic party's nominee. I didn't think we as a country were ready for either a woman or a Black man. I'm delighted to admit that I was wrong.

Of course, after eight years of the tyranny of the Cheney, uh, I mean the Bush Dynasty, maybe it's not so surprising after all. Apparently we really are ready for some healthy change.

Which brings me back to mental health. Therapy is really all about healthy change.
I propose that we continue the momentum of the election and vote individually and collectively for more mental health. I'm prepared to be amazed again and again as more people say "Yes" to helping themselves and their loved ones along the lines of genuine happiness and well being. And remember,

If you give a man a fish, you feed him for today. If you teach him how to fish, you feed him for a lifetime.