Many have spoken about how one can win friends and influence people by actively listening to them and showing interest in what they say by asking follow-up questions. And to be sure, as a therapist, I am acutely aware that we all like to be listened to sometimes. But being a therapist also has taught me that listening is good for the listener in ways less mercenary than influencing others.
For one thing, when I am in session, I can tune out my endless inner dialogue about pressing tasks I need to accomplish. In this way, actively listening is a meditation.
It’s also a relief not to try to sound clever and witty all the time. When you listen, you don’t have to be interesting, yet will be remembered positively by others because you are interested in them.
In addition, other people invariably have something interesting to share - maybe it’s something unique about their life story, or maybe it’s simply that they do a job you know nothing about, so you get to learn something new about how the world works.
And even if you’re not a therapist, you can help someone through a bad day, simply by listening to them vent about their experience, putting yourself in their shoes and letting them know that you understand why they are frustrated.
Above all, it’s been instructive for me to acknowledge how little I do know about the lives of others. I want to be the person who knows a lot about as many topics as possible, but the only way I’ll ever get there is by shutting up and listening!
What martial arts taught be about CBT
As you may have read in my Bio, I have been practicing traditional martial arts for over fourteen years, and assistant-teaching for over four years. I originally got into martial arts out of curiosity, and because I wanted to get in shape. I have received so many benefits to my physical and mental well-being as a result of this training, but right now, I’d just like to focus on one of these benefits.
As one trains, one gets into increasingly demanding forms (sequences of movements.) They are demanding in terms of strength, endurance, balance and concentration. Fourteen years is a long time, but when I look back on what I have learned to do and how far I have come since I started, I am amazed. I never really thought I could get this far ever. I didn’t know I’d stick with it this long, but also, having not very much in the way of an athletic background, I didn’t think I could get this far even if I did stick it out.
I am currently taking an online course through the Beck Institute, and, in one of the course videos, there is an actor portraying an aspiring therapist, who is anxious about taking this same course. At one point, she says that she thinks there may be too much material to learn. One of the instructors suggests that one way to help the aspiring therapist alleviate her anxiety is to have her recall a past major accomplishment, and the steps she took to get there.
This immediately resonated with me and brought to mind this morning’s martial arts lesson. When I reflect on my unathletic past, I can barely believe what I was able to do today. Knowing I could get that far means that I can accomplish a great deal, if I just take one step at a time and recognize that it won’t happen all at once. Every new challenge I have in my career and in my personal life is a lot easier to face if I reflect on my accomplishments in martial arts.
What have you learned to do that you never thought you could handle? It doesn’t have to be athletic or academic – it can be being a good mother or playing a musical instrument or artfully sketching a landscape. As long as it took you time and continuing practice to get to that point, it’s a good example to remind you that you can handle life’s challenges.
The scaffolding of mental health
The Scaffolding of Mental Health
Often, especially when one is feeling down or depressed, one feels the need to rest, and to conserve energy, as one feels as if one has so little of it. And don’t we all need a lot of downtime to cope with all of the aforementioned responsibilities? Actually, the answer is often, no, we don’t.
Downtime actually saps our energy, especially considering that it is when we are idle that we “get in our heads” and think about how overwhelming life is. Being busy with activities that are meaningful and fulfilling to us gets us out of those negative head spaces and increases our energy level. Think of the way a ball rolling down a hill picks up speed and momentum. Our bodies work in much the same way.
Adding structured activities to our daily and weekly routine also makes us use what little time we have left more efficiently. It makes that downtime feel more valuable and well-earned, so if we want to spend it watching TV or playing video games, we’re less likely to feel guilty.
It also often surprises us what we can accomplish. Maybe you thought you didn’t have time to exercise every other day, or work on a creative pursuit, or volunteer, or apply to new jobs. But when you start to gradually add these activities, you’ll likely find that you have time for all of the above and more.
In CBT, we call this “behavior activation,” and it is the scaffolding of mental health. If we work together, you may discover that you don’t need to get better before you can accomplish more goals. Rather, you may find that accomplishing more goals IS what gets you better!
Riding the subway mindfully
As a New Yorker, I am often on the subway, and often for a lot more of my waking hours than I would prefer, (research shows that long commutes are correlated with mental and physical health problems.) I’ve learned to cope with the stress of commuting by reading, listening to music or listening to podcasts.
But sometimes the trains are delayed or skip my stop, causing me to be late to important appointments. This is always frustrating. My reaction to this used to be to think to myself “Great – once again, the transit system is screwing up my day. Why does this always happen on my subway line? Why does this always happen to me?” And so forth. When I would do this, I would get frustrated, and even irritable, often for hours after I got off the train.
One day, a few years back, I had a frustrating subway experience when the train skipped my stop, with no announcement that this was to happen until it was too late to get off the train and find a different route to my destination. Realizing that I was likely not the only person frustrated with this situation, I turned to a fellow commuter and said “You’d think they’d announce that they were skipping Spring Street before we left Astor Place,” and she immediately responded, “I know, right? It’s so annoying!” Before I knew it, several of the other passengers were commiserating with us.
The important takeaway was that none of us appeared that angry. We were mostly smiling and laughing. All of us were certainly still annoyed, but it didn’t feel so bad. I think the reason for this is that this was no longer something happening to me; it was happening to us. It wasn’t a black cloud following me around, raining on my parade and causing me, and me alone headaches and stress. It was something that my neighbors and I were experiencing together.
I’ve found that people often identify frustrating experiences as proof that they can’t get a break. But if we recognize that we’re not being singled out, but rather are sharing in a daily annoyance, it really seems like just that – an annoyance – and not yet another example of our bad luck. And the fact that it is shared means we are not so unlucky.
If you get set off by such things, the next time it happens, check in with someone in the same situation, and see how you feel afterwards.
The Reverse Golden Rule
How often do you “beat yourself up?” How often do you berate yourself mercilessly? Why do you do it? Is it because you hold yourself to a higher standard than you do others? Is it because that’s how you were raised?
As I said in a previous entry, it is helpful to be aware of your behaviors that you would like to change. But the language we use to talk to ourselves should also reflect that change for the better. Speaking abusively to oneself is not qualitatively different than speaking abusively to others. Moreover, it simply doesn’t “work.” Telling oneself one is somehow “defective,” a “failure,” a “loser,” or a “bad seed” is a kind of self-fulfilling prophecy. If I call myself “bad,” it would be illogical for me to act “good.”
The fact is that you will disappoint yourself from time to time, and maybe more often than that! You will act in a way that is not in accordance with your values. The twinge of discomfort you feel can be amplified or it can be filed away for future use as an example of how it feels bad when you act that way.
But forgiving yourself and treating yourself kindly is necessary. You don’t need punishment. The regret for not acting in accordance with your values is more than enough negative reinforcement. Always remember to ask yourself “would I treat my best friend / sibling / child this way if that person made a bad choice?” If he answer is no, why is it OK to treat yourself that way?
Do unto yourself as you do unto others.
On "projection"
I wrote in an earlier entry about being unwilling to dismiss entire schools of thought on psychotherapy just because I do not find them 100% to my liking. One specific artifact of an older school of psychotherapy, (the psychodynamic tradition,) that has been on my mind a lot recently is the idea of projection.
We’ve all heard the term used before, to the point where it’s practically a cliche. Basically, it refers to the idea of criticizing qualities in others because, subconsciously, they reflect qualities we dislike about ourselves.
Something related to this concept interesting happened to me recently. I was reading something about Buddhist philosophy - the book’s and author’s names escape me at the moment - that suggested that what is referred to as “right speech” in Buddhism essentially means “don’t talk s**t about people.” It rang true to me on an intuitive level, and so I’ve really tried to put it into practice, with some success.
What I’ve found is that not only does it make me feel better and lighter, but also, when I go back to the bad habit of speaking negatively about others, I feel the toxicity of it in my body. Moreover, it has become much easier for me to pinpoint the quality in myself that I’m “projecting” onto the other person.
It makes me reflect on that quality, and makes me want to try to make changes in myself. I would like to think it’s made me a slightly better person in the past few months in which I’ve tried this practice.
Try going a week or longer without speaking ill of others, and see if it changes you in a similar way. I would wager that you will be relieved to be unburdened of the toxicity.
On talking about ones upbringing
Many people like to come to therapy and talk about their childhood, week in, week out. It a cliche about psychotherapy that one simply perseverates about ones upbringing for years, hoping to arrive at a “eureka” moment. Many on the CBT side of psychotherapy dismiss the idea of reflecting on ones childhood entirely. However, at my first time at a workshop at the Beck Institute, Dr. Aaron Beck said to us, “We have something to learn from all approaches to psychotherapy.”
I think that what we have to learn, in particular, about our parents and their effect on our behavior is that, just as we learn to talk by imitating our parents, we also learn to emote by imitating them. That means that, had we grown up imitating entirely different parents, we would have entirely different emotional dispositions. That, in turn, means that our problems are not immutable; we can pick a new style of emoting, and gradually change. It’s not easy, but it is important to not get stuck in the idea that we are predestined to be a certain unhappy way because our parents were.
If you want to talk about your childhood, let’s use that to figure out how you can pivot away from it and live according to your own values.
What do you want to do?
What do you want out of life? What do you want to be doing for work? With whom do you want to spend your time? According to what values do you want to live?
If you’re able to answer those questions, a follow-up question is: Are you taking steps toward the life you just described? If the answer is no, you need to start doing that ASAP. That doesn’t means quit your job or move to a monastery tomorrow, (it doesn’t mean that you shouldn’t do that either!) It means, do something every week, and eventually, every day, that moves you in that direction.
Many times we apply for jobs we don’t want, stay in unhappy relationships and live in miserable places, out of habit. Consider that first one alone? How likely are you to land the job you didn’t really want in the first place? How successful will you be if you do get it?
It’s not always easy to get out of these situations, but if your gut is telling you to do so, then listen! Take small steps now and bigger ones later. You need an exit strategy. Sometimes having that is enough to get you through the days between now and then.
Just the way you are
Many of us grew up watching Mr. Rogers, and felt comforted by his message “I like you just the way you are.” Fred Rogers understood a lot about developmental psychology and the importance of young children hearing that they are “fine.” When we are that young, we don’t understand the nuance of having “strengths and weaknesses” and things we are good at and things we could be better at. We either think we are “good” or “bad.” And if we start thinking that we are “bad” at say, six years of age, it will be written into our personal narrative and will play itself out in all sorts of harmful ways.
The good news is that the damage is not irreversible. Learning to be ok with oneself, even to love oneself as an adult can help us lead happier lives and have healthier relationships.
Meanwhile, it might be worth going back and taking a moving look at Fred Rogers’ kind life in the great documentary Won’t You Be My Neighbor.
What do you work for?
Do you have a job that has an inconsistent and unpredictable schedule, where you never know when / how many hours you’re working, when your day off is, (if you even have a day off?)
We all have to work to make ends meet, and here in New York, we have to hustle a little more than people in many other areas. But how much is too much?
This job, this city and this lifestyle may not be worth the detriment to your health. It’s not a decision you should make lightly or hastily. But it’s an important one to consider. If you love your job or love the lifestyle or affords you, maybe you can tolerate the stress and the unpredictability. If you are getting no such benefits, perhaps there is a preferable alternative out there.
Why did you come to New York in the first place? Maybe that reason is no longer here, and it’s time to consider seeing what / where else is out there. It’s a big beautiful world. Don’t get stuck in a place with which you’ve fallen out of love - or even grown to dislike - because you once admired something about it. The place where you belong is with people you care about. That place may not be the hippest place on Earth, but it’s home.
Your compulsion isn’t going anywhere
There are many kinds of compulsive behavior - from alcohol and other mind-altering drugs to gambling to cutting to binging and purging to hair-pulling to staring at our mobile devices, (that’s one of my personal favorites these days.) But what these all do for us is always the same - they kick the can of negative emotions down the block to be dealt with at a later time.
We can force ourselves to stop the compulsive behavior, but then we inevitably have to face the emotions in the cold light of day, and if we don’t have the skills to bob and weave and roll with the punches, they often knock the wind out of us, which makes us want to return to the compulsive behavior that so effectively made them temporarily disappear.
How do we learn to cope without these “emergency ripcord” behaviors? The key is to have some tools in place before we try do without them.
It will start with you and I practicing mindfulness, acceptance and CBT skills together in session, plus homework so that you can continue practicing between sessions. But what my clients often find surprising is when I say this: “Know that, if all else fails, you always have the compulsive behavior to fall back on.” Why would I say such a thing?
I’ve found that the mere knowledge that the “ripcord” is there is enough to reduce anxiety. One client told me that if she has a Xanax in her pocket, it is often enough to remind her that even if she has a panic attack, it can be managed. She never ends up taking that little pill, and that’s the point; the opportunity to engage in these behaviors isn't going anywhere. You won’t wake up tomorrow and find that there’s no way to get high or pull out your hair or zone out on your device. Keeping that in mind may make it feel safer to try learning to cope with bad feelings. If it doesn’t work, you know you have something to fall back on.
But let’s give it a try and see if we can do something better than kicking that can down the street!
There’s no self-actualization if there’s no self
Where is your “self?” Is it behind your face, is it some gaseous apparition that floats through your body? We know what it is to be conscious and we know roughly where our thoughts are coming from. But this “self” we speak of is hard to pinpoint. It’s difficult, even, to prove it exists, outside of being an abstract concept like “justice.”
So when I hear people continuously referring to Maslow’s Hierarchy of Needs, with self-actualization at the top, I can’t help but be a bit skeptical. Yes, we exist, to some extent, as individual beings, but humans are not “lone wolves.” We are dependent on one another to survive. As such, we have the instinct to be with others hardwired into our DNA. The idea of going it alone is contradictory to what it is to be human. Infants fail to thrive without bonding with a primary caretaker, even if their physiological needs are met. Adults suffer from all sorts of physical and psychological maladies when isolated for extended periods of time.
So while it’s all well and good to foster the ideas that you come up with and the values that your unique experiences have shaped, the apex of your hierarchy should always be the kinds of relationships you have with friends, family, community and with all living beings you encounter. If your mission in life is to make these the best relationships possible, your life will most certainly be fulfilling.
What pets can teach us about mental health
Sometimes my cat wakes me up at night by knocking something over. He stares at me knowingly, almost seeming to mock the fact that I am annoyed at him.
But I can’t do anything about it. If I yell at him, he may be startled, but it won’t stop him from doing it again tomorrow night, (and it will likely wake up my wife if she hasn’t already awoken.) He wants my attention - either to play, to get fed or perhaps just because he misses me when I’m sleeping and wants to spend time with me.
If I stop thinking of how annoyed I am, I can take the time to appreciate my furry little friend. I can also probably get back to sleep more rapidly.
Maybe we can all learn from our relationships with pets and other animals. They can’t talk, so we must be patient and try to figure out what they are trying to tell us. It behooves us to try to show each other the same patience we show our animal friends, even when we act in seemingly incomprehensible ways.
Fight or Flight
We have evolved the ability to respond to a fight or flight situation not once or twice in a lifetime, but once or twice a day. And in the grand scheme of human history, not to mention the history of our primate ancestors and even earlier progenitors, that’s a millisecond. This comfort - the taking for granted of safety from predators and safety from starvation and many other kinds of life threatening deprivation - this is new, and our biology is old.
It’s no wonder we walk around panicking about banal, everyday situations. Whereas when we face real life-and-death crises, we often find that we can spring into action without thought, without angst. We are wired for it.
How do we learn to turn these ancient instincts off so that we don’t burn ourselves out? We start by becoming aware of these facts about our fight or flight instincts. The rest depends on the individual, but CBT is a powerful tool in talking ourselves down from panic.
But what if you’re anxious about real threats? What if you’re a young man of color worrying about being misidentified as a threat by a police officer, who, himself, is wired to avoid threats?
Let’s talk about your anxieties and figure out which ones are protecting you and which ones are killing you?
What’s in a diagnosis?
Many mental health providers whom I’ve met in recent years have expressed pretty negative feelings about the concept of diagnosis when it comes to our field. And to be sure, I have even been known to say “diagnoses are for billing.” I recognize the utility of being able to spot certain clusters of behavior, emotional states and thought patterns in order to formulate a plan on how to go about helping the person, but really, what is the value of the diagnosis?
People in treatment often get fixated on their diagnosis. Part of the reason seems to be that being able to name it, to identify it as a “disease” makes them feel less guilty about ways in which their lives are unhappy. But does one need a diagnosis for their unhappiness to be legitimate?
If you are unhappy, you don’t need a disease. It’s part of the human condition to be unhappy sometimes. Maybe we can fix the problem together. Otherwise, we can help you to learn to tolerate - perhaps even embrace - your unhappy times, so that life is more manageable.
What is PTSD?
Many people experience trauma. Some are able to process the event and move on with little impairment. Others - those who suffer from Post Traumatic Stress Disorder - experience debilitating symptoms - hypervigilance, nightmares, flashbacks, avoidance of any place that remotely reminds one of the event. What’s the difference between these two groups of people?
The research shows us that those who experience PTSD have more fragmented and disorganized memories of the traumatic event(s). A working theory is that PTSD results from a fear of a traumatic memory - an attempt to push it away.
But as is the case with so many other painful feelings, that doesn’t work. Feelings need to be felt. Just as we process grief when we lose a loved one, we must process grief over the loss inflicted on us by traumatic events. As with bereavement, the pain is, at first, immeasurable, filling every square inch of our emotional life. But, if we let ourselves feel this pain, it becomes more manageable over time, to the point where we ultimately make room for other feelings.
Perhaps you never let yourself grieve your trauma. Together we can face that pain and move through it so that you can make room for all life has to offer.
What’s the story Part 3: Shared stories
Humans have always had central stories we share - from oral tradition to the epic poem to the novel to movies. We share these stories to share common meaning - so that we’re all on the same page and so that we have an agreed-upon reality.
But if there is an ulterior motive to the stories we share, they may not serve our emotional lives very well.
Sometimes we forget just how much advertising we absorb each day. Moreover, most of us fail to see to what extent it informs our worldview; each of us thinks “I am too smart and too savvy to be influenced by ads.” Time after time, the research shows that the message we receive from advertising is “you’re inadequate without this product or service,” or, to be more succinct, simply “you’re inadequate.” How many times can you hear or see that message without internalizing it to some extent? What happens if you start internalizing it as a 12-year-old? As a 6-year-old? As a 3-year-old?
Becoming aware of the messages with which we are continuously bombarded is yet another way to determine what’s real and what’s just another story. It’s also a step toward a healthier outlook on life.
Who do you work for?
The question may seem easy to answer - “my boss, my company, ‘the man.’” But it’s a question worth asking yourself because, perhaps you are unhappy to be working for someone other than yourself. There is ample research that shows that as autonomy over ones work goes down, one’s mental and physical health gets worse.
Perhaps you, alone, don’t have the resources to start a small business. Maybe you and your colleagues can start a cooperative. Cooperatively owned businesses are owned by the people who work at them. For example, Cooperative Home Care Associates is a cooperative of home health aides in the Bronx. When I worked on inpatient units in hospitals, I sometimes had to connect patients with home health aide services. I remember being shocked by the number of layers of bureaucracy involved. Then I got to see how much Medicaid paid for home health aide service - it was around $35 per hour. Yet, the aides themselves were taking home as little as $9 per hour. What became of the other $26? The agencies, intermediary contractors and others all got a piece. The women of CHCA apparently grew tired of earning money for others, but little for themselves. So they worked cooperatively, something at which humans excel. I’m guessing they are some of the hardest working and conscientious home health aides out there too.
How much harder could you work, how much happier would your work day be, if you knew you were working for yourself?
What's the story, part 2: Stories About Yourself
We have all heard about the idea of the self-fulfilling prophecy - the idea that if you keep telling yourself sometimes will happen, you will somehow cause it to happen. This idea has a mystical quality to it, but it is really quite simple and logical: if I continuously tell myself I can’t succeed at something, it would be quite pointless and a waste of energy for me to put any real effort at trying.
Narratives of what we can’t accomplish are not the only kinds of self-fulfilling stories we tell ourselves about ourselves: “This always happens to me,” “Nothing ever works out,” “No one really cares about me,” “It’s hopeless,” “I’m unlovable.” If these stories are always running in the background, we will be hyper-aware of any information that conforms to the narrative and will dismiss any information that contradicts it.
Together, we can help you become more aware of the harmful stories – the stories that get in your way - and how you are ignoring information that contradicts them. This may help you to get out of your way, and write a new story in which you are the hero.
What’s the story?
Have you ever spent the day stewing about an interaction you had with a friend, family member, significant other or boss? Do you think about what you should have said, imagine what you will say at your next interaction and then imagine that person’s response? Do you imagine what they might be thinking, what selfish and insensitive motivations are influencing them? Are you angry at the person with those motivations, and at what you imagine that person’s response will be when you next speak to her or him?
These are stories. We tell ourselves stories all day long. Some of them may end up being relatively accurate. Some are wildly inaccurate. Regardless, how much sense does it make to work oneself into a miserable state over hypothetical interactions and hypothetical motivations in others?
A mindfulness practice, in conjunction with Cognitive Behavior Therapy (CBT,) will teach you to become aware of how often you are lost in thought, how often you are telling yourself stories.