As a psychologist, I listen carefully because it’s foolhardy to think I could know all about you without taking pains to understand the complexity of your circumstances, psyche, and history.
Unlike common advice, which gives you universal solutions to ordinary problems, therapy is tailor-made specifically for you. Every person has a story to tell about who she (or he) is and how she came to be, and more often than not her distress is woven into the broader narrative of her life. I don’t just listen with my ears; I use my eyes and heart, too. In the early part of therapy, my job is to make sure you feel understood.
But therapy is more than just careful listening; it’s also about giving input.
As human beings, we are bound by our own subjectivity. We have blind-spots. We may not grasp the big picture of our personalities because we are on inside of ourselves looking out. This is where a therapist can be especially valuable to you. Whether you’re trying to change something about yourself, or accept something (a vastly under-appreciated aspect of therapy), it’s always helpful to have someone who can help you discover themes, patterns, and biased views you have about yourself. Just as you need someone to understand you, you may also need someone to interpret, challenge, or confront a mindset that’s holding you back.
Of course, this sort of input needs to done with sensitivity and care. Therapy is never about passing judgment or requiring people to change. Rather, it’s about self-understanding, other-understanding, and sorting out the complexities of your emotional life. New information about the self often brings with it new possibilities for the self.
Emotional distress, symptoms, and vexing personal problems are your psyche’s way of informing you that something about your life isn’t working. In therapy, we tune into the message, puzzle over it, and figure out just what actions you might take to make your state of mind better.
But when the next session rolls around and you think, “Now what? What do I talk about?”
Here are some ideas to stimulate your thinking.
- When you reflect on the week, what were the key events, problematic areas, or stresses?
- What thoughts came to you since we last me? Did our prior session prompt any new reflections?
- Take a moment and go inside yourself. Let your “mud settle,” as a Taoist might say. What are aware of right now? What do you feel? What’s on the top of your mind? Dive deep into your immediate experience.
- What is the status of the problem that brought you here? Is it the same? Different? Better? Worse?
- Did you try anything different? Did you take an actions that might improve your life? What were they? Evaluate them. Think of them as mini-experiments in how to live. What steps might you take?
- If you took steps but they didn’t work, what got in the way? What blocked your progress?
- Did your psyche present you with any dreams?
- Likewise, are you a daydreamer? Where do your daydreams take you? Do you see any themes?
- What things in your life are you avoiding? Avoidance and anxiety go together like hand and glove. Where are your deepest anxieties?
- Relationships matter –– a lot. Relationships have the power to hurt us, help us, and heal us. Relationships also provide a context for learning something about ourselves. We discover who we are in relation to other people. How have your relationships influenced you?
These are just some ideas for getting started, for getting more deeply acquainted with your own psychology.
Don’t worry. I promise you, we’ll have something to talk about.
Consider an example. If you’re looking to make a career change, you can seek out “career counseling” (which I sometimes do, by the way), but no one would mistake this service for psychotherapy. It simply does not have the psychological depth that true psychotherapy does. “Counseling” is a broad term. (An attorney will give you legal “counsel,” for instance.)
Admittedly, the line between “personal” counseling and psychotherapy can be so thin as be appear invisible. Which is probably why these words have come to be used as synonyms for each other. But ideally, therapy should deal with your inner life, your relationships to self, others, and world, and your behavior patterns. “Personal” counseling is concerned with these same processes, though some practitioners shy away from using the counseling label because they think it does not imply the depth that the psychotherapy label does.
Unfortunately, all of this can be a little confusing if you are the person who is trying to get help. Psychotherapy is a pie that’s divided among psychiatrists, psychologists, social workers, and counselors. (There are also pastoral counselors and nurses with graduate degrees in mental health.) These days, most psychiatrists specialize in treating mental disorders with medications, leaving the other occupational groups to duke it out for a piece of the psychotherapy/counseling pie.
Unless you need medication, don’t get too caught up in the title or degree when you’re looking for a mental health practitioner. What you want is the right practitioner, one who has experience with your type of concern. You also want to feel comfortable with that person. As it turns out, the fit between client and therapist is a bit mysterious. It’s not always clear why one pair clicks and another doesn’t. What we do know, however, is that this bond or connection is crucial to establishing a good working relationship. Indeed, a good relationship is a much stronger predictor of therapeutic success than the title or degree held by the practitioner.
In sum: I don’t care if you call me a psychologist, psychotherapist, therapist, or counselor. Frankly, I am all of these things. What I do care about, however, is whether you and I can establish a productive relationship that is useful to you. The stakes of your emotional life are just too high for it to be otherwise.
Therapy is also about self-acceptance. Sometimes when you relax your defenses and openly explore your own mind, you’ll discover who you really are, what you really want, or who you really want to be.
Or maybe therapy will bring you into direct contact with your flaws, your limitations, and your past mistakes. We fix what we can, but often as not we must learn to have compassion for ourselves. We make peace the idea of being imperfect. Indeed, in many cases, we embrace it.
We change behaviors, habits, patterns –- especially when they hurt us. But we accept wants, wishes, needs, dreams, and temperaments.
Therapy is a balancing act. We chance what we can, we accept what we can’t. This sounds remarkably similar to the Serenity Prayer, does it not?
God, grant me the serenity to accept the things I can not change,
Courage to change the things I can,
And wisdom to know the difference.
Or, if you prefer, a Moose Goose rhyme...
For every ailment under the sun
There is a remedy, or there is none;
If there be one, try to find it;
If there be none, never mind it.
Therapy is never just about change. It’s also about getting to know who you really are, imperfections and all.
Take, for instance, the so-called “mid-life” crisis. What is this if it’s not a crisis of meaning? Questions that were once thought to be settled –- Who am I? What do I stand for? Where I am going? Why am I going? –- come flooding back. When that happens, the result is usually instability. Life keeps moving forward, but for a time, we try to make it go sideways.
(By the way, the mid-life crisis was once thought to universal. But researchers now believe this is no longer the case. Some people sail through mid-life without any stormy weather.)
Or what about the person who struggles to find a true vocation, a “right livelihood” as the buddhists might say. Good work –- meaningful work –- gives a sense of purpose. A job is one thing, but a job that employs our unique talents and strengths is a source of fulfillment, a reason to get up every day. It just feels “right.” But what if you fail to discover your vocation? Where do you fit in the world?
There are probably many different kinds of spiritual issues, but what they all have in common is a concern with the big questions in life. But when these questions go unanswered, or when the old answers have worn out, it’s not uncommon for people to feel distressed.
Therapy can help. Many people mistakenly believe that therapy is only for clinical problems like depression or anxiety or post-traumatic stress. But therapy can actually be quite helpful to the person who is struggling with spiritual issues. Therapy is about creating a narrative of your life, and it’s about finding or rediscovering your soul. In fact, these are the very things that therapy does best.
Frequently, we know what we need to do, or what's good for us. The rub is getting ourselves to do it. Oh, sometimes our intentions will carry us through. We brace ourselves, put our shoulders to the wheel, and push. Willpower is a wonderful thing when it works. But what about when it doesn't?
Usually it's a matter of having contradictory commitments. For instance, we can be committed to change even as we are committed to avoiding discomfort. And make no mistake, change produces discomfort. As we try on new behaviors, roles, identities, we feel unsettled, uncertain, perhaps even a bit anxious. Your psyche would very much like it if you remained self-consistent, thank you very much. Even when that consistency is hurting you.
If you're committed to a project of personal change, of feeling better, or making progress on your problems, you'll have unpack your inner life. You'll have to delve into thoughts, feelings, fears, wishes, dreams, and more, and you'll have become deeply acquainted with your truest, deepest self –- even the parts of yourself that defy logic or common sense.
But look on the bright side. Your psyche is delightfully complex. Were it not, you'd be uncreative, uninspired, unfeeling, uncaring, unoriginal, and unfun. You'd be boring. And who really wants that?
The aim of psychotherapy is to help you improve your life. It’s not enough just to feel better. We want you to actually get better. There is a difference.
When you feel better, you are less bothered by negative emotions, dark moods, and symptoms like anxiety and depression. Of course, we all want to feel good. No one wants to suffer needlessly. But getting better is more than just how you feel in the moment. It’s about identifying internal obstacles that are holding you back, pattern-breaking, and taking new action.
For some, getting better may mean restructuring the way they think, relate, or act. For others, it may mean calling old, dysfunctional beliefs out into the open and challenging their validity. For most, it will involve taking a close look at the ways they cope with stress, manage anxiety, or deal with internal conflict. If you really want to get better, and not just feel better, you’ll have to make a project of personal change.
Which is why psychotherapy isn’t for everybody. Many people just aren’t that interested in digging into their own psyche. It’s not that they don’t want solutions to their problems or concerns, it’s that they want a fast cure, a simple answer, or a solution that requires minimal effort. Therapy offers you none of these things.
Therapy requires hard work, collaboration, and willingness to endure feeling a bit unsettled while you’re in the process of sorting yourself out. Therapy isn’t just about talking, complaining, or venting, it’s about exploring new avenues for construction action.
Obviously you can take action on your own; you don’t need a therapist to make changes in your life. But there are advantages to working with a psychologist. We all have blindspots. Moreover, most of us do not see ourselves and our issues in the most objective light. A therapist can give you feedback, input, and insight that is tailored specifically to you and your situation. A therapist can also provide support, encouragement, and, if need be, the occasional well-placed nudge if you start to falter or backslide.
Sometimes people will make the mistake of leaving therapy as soon as they start to feel better. Their symptoms subside. They are no longer held hostage by a negative mood. Their hope has been restored. They'll leave a polite sounding message on my voicemail: "Thank you, but I think I'm going to postpone my next session." And then I won't here from them again. Fair enough. The client decides when enough is enough. But in these instances, I often feel as though it was a missed opportunity.
Ideally, therapy gets to the core. The core pain, the core issue, the hidden belief or feeling or motive. Real change –- change that endures –- takes time.
You can feel better with a few glasses of wine, a shopping spree, or an antidepressant regimen. But you can get better by stepping back, taking stock, and altering your behavior. This is what good therapy is about.
- What will he think of me? Will he think I'm crazy, bad, or stupid?
- She'll diagnose me
- He'll try to talk about things I don't want to talk about
- She'll push me to do things I'm not ready to do
- It won't work anyway, so why bother?
- He'll try to psychoanalyze me
- She'll try to blame everything on my mother or father
- He'll be too stuffy
- She'll be too loosey-goosey
- He'll be like one of the t.v. shrinks in sitcoms
- She won't understand me
But here's what your psychologist is really trying to do...
- Understand you. See things from your point of view
- Join forces with you. Collaborate
- Put your problems / concerns in a context that makes sense
- Communicate his / her understand back to you –- to make sure it's right
- Understand your goals
- Figure out what you need, what's best for you
- Be professional but human
- Help you understand yourself better
- Help you understand others better
- Help you
"Bad Days" are nothing to be ashamed of. If you were a machine, you would run, run, run until you broke, but as a human being you have emotions, moods, fluctuations in energy, distractions, limited control of reality, and of course, stress. The occasional bad day is to be expected.
But if your bad days turn into bad weeks, that may be a sign that something is wrong. It's one thing to be depressed for a couple of days. It's another thing to be depressed for more days than not over a two-week period. Depression is not something to take lightly. Depression costs you life.
If you've had one bad day too many, maybe it's time to talk to someone. Maybe something is going on with you, and maybe your bad days are a signal that your emotional health needs attention.
You can read books. Books are a terrific source of information, and the right information, at the right time, can be very helpful. The first step in the change process is almost always to increase your level of awareness about your problem, issue, or pattern, and books are one way to do that. Of course, books will also offer you solutions. (See my very special book list)
You can try talking to a friend, confidant, or clergy member. We all need a sympathetic ear from time-to-time. We need objective feedback, but also somebody who cares about us. Ideally, try to pick someone who does not have a stake in your problem (which is often the issue with family members who try to help us). A true connection with another, caring person will probably make more difference than any other self-help remedy you can try.
You can try expressive writing. That is, writing candidly about your emotions or problems. Believe it or not, research has found that expressive writing really does help. Interestingly enough, it helps our bodies, not just our psyches.
You can try exercise. Maybe you're sick of hearing about the benefits of exercise, but the truth is, it's a cheap form of therapy. Research has shown that exercise helps with both anxiety and depression. It just works.
You can try taking vacation from work. Any emotional problem is made worst by stress. And for many, work is stressful. A vacation won't solve your problems per se, but a little time away from work may allow you to rest a bit, or play, which in turn may result in a change of perspective about your real problems.
Learn to meditate. There are simple forms of meditative breathing practices that can help. There's a reason why meditation has long been a part of some of many religious traditions, and there's reason why holistic approaches to medicine have become so popular, and why, these days, the trend in mental health is towards "mindfulness." Meditation works. Meditation calms the body.
If these remedies don't work, well, maybe therapy is what you need.
People confuse advice with therapy, but they are very different things. When we give advice, we're passing on universal solutions for problems that are usually straightforward. Frankly, the right advice can be a godsend under the right conditions. And fortunately, many of life's problems and frustrations can be solved this way. Human beings can profit from the experience of their neighbors, friends, and resident experts.
But personal problems are usually complex. Moreover, part of what makes them so vexing is that they don't always yield to logic. But there's a reason for this. Personal problems may involve thought patterns, suppressed feelings, hidden motivations, self-limiting beliefs, defenses against conflict or emotional pain, and not-so-obvious payoffs for dysfunctional or unproductive behavior. If your problem is not solved by common advice –– that is to say, "one-size-fits-all" solutions –– it may very well be that your psyche is running at cross purposes with itself.
When someone gives you advice, they're giving you generalized information, a solution that should work for everybody who has this problem. But when a practitioner provides you with therapy, you're getting a process that is ultimately tailored to you and your unique situation. Therapy helps you understand the complexities of your own personality and psyche, but it also helps you understand the forces that keep you stuck.
In any case, you can imagine how much I dislike the advice question when it crops up, say, at a dinner party. Usually, I turn to the person and say, "Well, that depends..."
Are you dissatisfied or are you distressed? Coaches help people become more satisfied, happy, clear, or productive. Therapists help people feel better.
Coaches are fond of saying they ask the right questions to get you back on track. They focus on the here-and-now, not your personal past. They don't deal with your emotions. So if you've got a time management problem, or a procrastination problem, or you're trying to figure how to achieve your dreams, working with a coach may very well be exactly what you need.
But if you're struggling with some form of a emotional pain –- depression, anxiety, global distress, anger, relationship distress –- or you're struggling to function –- sleep, work, eat, play, relate –– don't call a coach, see a therapist.
- Therapy helps you feel better.
- Therapy helps you understand the nuanced dynamics of relationships.
- Therapy helps you understand yourself better (e.g., your true nature, motivations, strengths).
- Therapy helps you grow as a person.
- Therapy helps you alleviate symptoms (e.g., depression, anxiety).
- Therapy helps you function better.
- Therapy helps you cope with stressful experiences.
- Therapy helps you face your fears.
- Therapy helps you clarify your purpose in life, or your direction.
Therapy can help you do all of these things, or some of these things, depending on your goals and your willingness to commit to the process.
What therapy is not, however, is a passive experience. Therapy requires your full participation. Therapy requires you to join forces with another human being who just happens to be a trained professional.
The general idea of therapy looks like this: Therapy –––> insight into self –––> behavior change.
The above formula makes it looks so simple. But behavior change is anything but. Why? Because human beings resist change. Human beings seek self-consistency, even when that consistency produces unwanted results. The real value of a therapist is that he or she helps you work with, and through, resistance.
Seligman suggests that happiness is composed of five components: positive emotion, engagement, meaning, relationships, and accomplishment. And here's the surprising part: he says that positive emotion ranks at the bottom of the list.
When we are deeply engaged in a task –- think of an activity where you lose track of time because you're so absorbed by it –- Seligman says that people do not, in fact, report much feeling at all. They're too submersed in the activity. Deep engagement requires a focus on something other than the self, and it usually takes us right out to the very edge of our skill. In those moments, people are not cheerful, they're absorbed.
But it's not enough to be engaged by activities. We must have meaning in our lives, too. Human beings will tolerate a great deal of hardship for the sake of what something means to them. How people knock themselves out on a job they don't like because of what it means to their family?
And relationships, at least for most of us, are a primary source of meaning. If you doubt this, just count the number of people you see on their cell phones the next time you go out into the world. These devices feed our need for connection.
Are you happy? If not, which part of the puzzle is missing for you?
If you decide to improve you overall level of happiness you're likely to find it frustrating because "happiness" is simply too abstract to be useful. But if you focus on the components of happiness, as Seligman suggests, you'll have a much easier time of it. You can resolve to find tasks that engage you deeply. You can take a "meaning inventory" to determine what, if anything, needs changing. You can establish bonds with others. And you can arrange your life to maximize those accomplishments that would actually mean something to you.
This is what it means to flourish.
I don't think so. I think the opposite of happiness is boredom.
Let me take this a step further. There's so much talk, these days, about happiness. Thanks to a movement known as positive psychology, you can find scores of books on subject. Indeed, I've listed a few of them on this website under the Helpful Books page.
And yet, I'm not always so convinced that happiness is the brass ring that people are really grasping for. Joseph Campbell, the late mythologist, once said he wasn't looking for the meaning of life so much as THE EXPERIENCE OF BEING ALIVE.
That's what I think people really want. They want to feel alive, vibrant, or excited.
Mihaly Csikszentmihalyi studied the psychology of optimal experience, which, for shorthand's sake, he called FLOW. I think this is much closer to what most people really want. Think of some domain that requires skill. Brain surgery, psychotherapy, video games, tennis, whatever.
When there is a perfect match between your level of skill and the challenges presented activites within the domain, you're likely to experience flow –– that state of mind when you are completely absorbed by the activity itself. However, if the challenge is greater than your skill, you'll feel uncomfortable, possibly anxious. And if the challenge is significantly below your skill, you're feel bored.
Why are video games so compelling? Why do we play sports? We do people jump off bridges with a rope tied to their feet? Why do people climb mountains when they already know what's at the top? Why, despite the dangers, did extreme sports come into existence? Why do people travel to exotic lands?
It's difficult to seek happiness. It's just too elusive. It's much easier, however, to identify activities that produce flow –– jobs, hobbies, or relationships –- and then to arrange our lives so that we engage in these activities regularly.
Feeling fully alive –- isn't this what it really means to be rich?
Related blog entries: Flow and Savoring
When we feel guilty, we realize we have transgressed. We have committed an act that violates our moral and ethical ideals. But when we feel ashamed, we feel as though the entire self is bad, not just one sequence of behavior. We feel inadequate, unworthy, bad to the core.
In therapy, clients frequently have trouble distinguishing between these two emotional states, especially when they're trying to label what they feel. But one way we tell them apart is by the actions that each state engenders. We when feel guilty, we feel motivated to make amends –– to take action to repair the damage. But when we feel ashamed, we feel exposed, vulnerable, and we want to withdraw from others. In extreme moments of shame, we may even try to hide.
Shame is often at the core of many emotional problems. Shame is painful. As a result, our psyches have to find a way to help us deal with this emotion. So we avoid, withdraw from others, engage in various forms of self-attack (self-hate), or other attack (projecting our self-hate onto other people). We might use one or all of these forms of defense. Sometimes, dare I say often, the defense, which was originally designed by our psyche to help us cope, begins to look like a problem. Depression, disordered eating patterns, self-injurious behaviors –- these are just a few examples of problems that may be tied to an underlying self that feels inadequate, defective, inferior.
Whenever I discover a vault of shame in one of my therapy clients, I tread lightly. Too much press makes the person feel more vulnerable than they already feel. And yet, if therapy is to do the person any good, explore it we must. The vault must be opened if the heart, mind and soul are to be restored.
Writing expressively is a deep dive into the dark waters of your soul.
James Pennebaker and his colleagues have shown that when people write about a stressful life event for just 20 minutes a day for four consecutive days, they reduce the number of sick days they report, improve immune functioning, and decrease dysphoria (negative moods) and anxiety.
In other words, writing makes you feel better, but it also helps you physical body. (Is this not cool?)
Why? Writing is one way of helping you transform negative experiences. Writing about pain helps you find meaning in your experience, and place it in the broader context of your life story.
If you're going try expressive writing, make sure you write honestly, openly, and without filtering your emotions. You're more likely to write like this is you make an agreement with yourself that the output will be kept strictly private.
Unlike a diary, which is a record of the day's events, expressive writing requires you to plunge into your subjective experience. What you feel, think, want, need, wish for. And –– most importantly –- what hurts.
Don't worry about good grammer or being literary. What matters is that you dive deep into what you truly feel.
Skeptical? Fair enough. But maybe try refraining from passing judgment on it until you've tried it.
The aim of therapy is to help you work your way through distress. Of course, distress can take many forms. Maybe you’re struggling with a set of symptoms, like those associated with anxiety or depression, or maybe you're trying to get a handle on a key relationship. Or maybe life has sent you a curve ball––a divorce, a job loss, or an illness––and your head is spinning.
If human beings functioned strictly according to logic and reason, we’d seldom run at cross purposes with ourselves. But human beings are emotional beings. We feel pain, compassion, joy, anger, sadness, fear, shame, and guilt–-and these feelings are rarely more powerfully felt than when they occur in the context of attachments with other people.
Therapy helps you deepen your understanding of yourself and those around you. As we begin to examine the particular nature of your distress, we’ll discover patterns. These patterns may involve contradictory feelings, hidden motivations, or maladaptive beliefs that bias your perception of the world. The good news is, once these patterns are identified, they are changeable, especially if you are open to new possibilities.
It takes courage to seek therapy. Many people avoid it because they are afraid that being in therapy (read as: asking for help) makes them weak. But does it really make you a weak if you are willing face those aspects of your life that are not working? Or does it make you courageous?
Or maybe even smart.
Suppose I put it like this: If you were faced with the task of crossing a mountain range that you were unfamiliar with, would you rather go it alone or hire a guide?
A psychologist is a guide. He knows the territory of the human psyche. If you're trying to overcome an emotional issue, yes, you can go it alone. But a guide will help you reach your destination more quickly, especially if you’re prone to run in circles.
Give therapy a try. You might be surprised by how much it helps.
Have you made any resolutions? Many people do. Yet, if the research is to be believed, most people will give up on their resolutions after a month or two.
What can you do to increase the likelihood of success? I'd suggest, at the very least, three things.
1. Whatever the change is, make a list of the payoffs. A thorough, a detailed list. Give some serious thought to this one. Why? Because more benefits equals more motivation. Once you've completed the list, read it often.
2. Find some way to track your progress. These days, there are countless ways to track progress. Web-based tools, iPhone apps, Moleskine notebooks, spreadsheets, whatever. We manage what gets measured. Indeed, some studies suggest that self-monitoring itself is an "intervention" because it provides us with systematic (and hopefully detailed) feedback.
3. Find somebody who will support your efforts. The risk of telling someone about your project is that you'll have to face that person if you fail. But the benefit of support is that it increases your chances of sticking with something, especially if you're trying to do something that is emotionally difficult (i.e., causes you to move out of your comfort zone). We all need encouragement and praise. Good social support is worth its weight in gold.
Happy New Year.