Suffering, Acceptance, and Change

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Suffering, of one sort or another, often brings people into therapy.  It may be the ache of an unrequited love, the gnawing sense of dissatisfaction with a job, or the stabbing pain of a loved one’s death. It may be the relentless misery of chronic depression, the oppressiveness of an addiction, or the crippling panic that grips some people when they are obligated to speak in front of a roomful of strangers.

The first precept of Buddhist thought is that “life is suffering,” and the Buddha cited attachment and desire as the sources of our pain.  “I want a job whose perks include wealth and fame, not the daily grind I’m in now,” or “I can’t go on living without my spouse.”  “I hate everything and I wish it would all just go away,” or “I am so in love with my co-worker and he never gives me the time of day.”  “I need meth to function,” or “I wish I didn’t have to give that presentation in class.”  Suffering, in this view, can be seen as the distance between the way things are and the way we want things to be.

Acceptance – of the fact that my co-worker is already happily married, say, or of an obligation to earn a living, or of the reality of death – may be the most liberating way to bridge the gap between reality and desire.  But is that always true?  Should I just work on accepting the fact that I hate myself?  Do I need to resign myself to the fact that I just can’t make it through the day without getting wasted?  Should I just find a way to be okay with the fact that every time I have to give a presentation my heart will feel like it’s going to pound its way out of my chest, and then I’ll faint?

Sometimes it is within our power to change the way things are into the way we want them to be, and sometimes it is not.  The value of distinguishing between the two is nicely encapsulated in the Serenity Prayer common to 12-Step programs:  “Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”  Often, the work in psychotherapy involves identifying exactly what circumstances are causing pain, and then identifying and removing the obstacles to accepting them.  At other times, the work involves specifying changes that need to be made, and then identifying and removing the obstacles to bringing them about.

And sometimes, the work of therapy begins simply with sorting out what we have the power to change and what we do not.  Many people suffer needlessly because they cannot accept an immutable truth.  And many others suffer needlessly because they do not see, or can not access, their own power to effect meaningful changes in their lives.

Grief as a Normal and Healthy Process

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Western culture impresses upon many of us the need to exert personal control over the process of dying and grief in general, that is to say we must do everything we can to prevent the inevitable. In many cases, this futile individual effort continues even after a loved one has died. Meanwhile surviving family members and the structure that endures remain relatively unexamined or underappreciated. In the United States, the progression toward death most often occurs in hospitals where family members, doctors, nurses, social workers and/or other hospital staff become closely involved with family members in their charge of caring for their patient. Grief exposes us to deep attachments and reminds us of our innate social interdependence. Prevailing culture may be seen as turning a blind eye to the bereaved and, when people are in a period of great need they may be left to process their loss individually despite the collective loss (Shapiro, 1994).

The shared trauma of familial death exposes families and their ingredient structures to the same objective reality which immediately and profoundly informs the individual’s subjective reality. Families accustomed to open communication and sharing may move to narrower or more closed communication styles in an attempt to protect individual family members from debilitating emotional pain. The risks here are numerous; repression of sadness and the implication that family and friends are unable or unwilling to collectively grieve. More plainly, it is the strong desire to retreat from grief that implores us, if unconsciously, to essentially lean into the pain, to sit with and examine both objectively and subjectively what we have lost. Our larger goal is to integrate the loss into our lives.

Bereavement requires a thorough and sometimes painful exploration of who and what has been lost and what remains, including resources and stressors that may be relinquished and those which are created and built upon (Stroebe, Schut, & Stroebe, 2005). The range of loss may include health, livelihood, security and more that may move through families, businesses, communities, and even cultures for months or years (Neimeyer, 2002; Lin, Sandler, Ayers, Wolchik & Luecken, 2004).

Loss of intimate partners, family members or close friends may erode, on a foundational level, a person’s self-definition since no one any longer holds the unique relational stance toward them needed to call forth and validate the unique cache of shared memories that had sustained a person’s sense of who they had been (Neimeyer, 2002; Cait, 2005). Life crises and traumatic events, while nearly always involving painful emotions, may serve as an impetus for personal growth (Schaefer & Moos, 2001). It is not unusual for individuals and families to emerge from life crises with improved personal and social resources and new coping skills. The difficult truth is that any form of grief is inherently sad, difficult, and exhausting. While there may be any number of self-help books available, there is no ‘right way to grieve’, nor is there a timeline. Whether or not we believe in Kubler-Ross’s model of Denial, Anger, Bargaining, Depression, and Acceptance, we each navigate our grief at our own pace.

Shapiro, E., (1994). Grief as a Family Process. New York, NY: The Guilford Press.

Stroebe, M., Schut, H., & Stroebe, W. (2005). Attachment in Coping with Bereavement: A Theoretical Integration. Review of General Psychology, 9(1), 48-66

Neimeyer, R.A. (2002). Traumatic Loss and the Reconstruction of Meaning, Journal of Palliative Medicine 5(6), 935-942.

Schaefer, J.A. & Moos, R.H. (2001). Bereavement Experiences and Personal Growth. In Stroebe, Hansson, Stroebe, & Schut (Eds), Handbook of Bereavement Research: Consequences, Coping, and Care, (pp. 145-167). Washington, D.C.: American Psychological Association.

Avoiding Exercise Addiction: The Key is Awareness and Balance

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Okay, the holidays are over and it is the beginning of a New Year and you want to work on the new you. You have created an idea of how you want to move forward with your exercise plan and have bought a membership to your local gym or fitness studio. What could possibly go wrong? Well, a lot could go wrong if you are not aware of the imbalances in your life.

Many people start off by having the goal of attaining a certain fitness milestone and make the commitment to themselves that they will work hard at keeping that resolution. The imbalance occurs when the commitment to exercise crosses the line from the healthy use of exercise to dependence, thus leading to addictive behavior. Some people might respond, “exercise isn’t a drug so how can it be considered an addiction?” To answer that question, it’s important to understand a healthy and unhealthy perspective of change.

With a healthy perspective, a person may choose change because they feel that the equilibrium is off in their life. This desire for change could occur when either their work-life balance has shifted to the work side and life has taken the back seat; or, work is suffering from other pursuits, but balance hasn’t been attained. With an unhealthy perspective, a person chooses change because they fall victim to their internal voice stating that they shouldor must exercise in order to be functional. The internal voice is the key to understanding what you believe about yourself, the world, and your future.  When that voice is punitive and judgmental, an unhealthy perspective can begin to form.

When a person tells themselves that they must work out for whatever time or amount they have chosen, it is important to be flexible in their goals and plans. Below are some examples of when exercise could have crossed the line from a goal oriented health tool to a compulsive addiction:

  1. When there is no flexibility in your schedule; for instance, if something causes you to miss your lunch time run and you beat yourself up inside for missing it.
  2. You experience a loss of interest in doing anything other than exercising, such as working out three times a day while avoiding other aspects of who you are.
  3. You experience depression or anxiety for missing a workout. In more severe cases, a person with an exercise addiction may feel intense sadness, inappropriate guilt, difficulty concentrating, intense fear or even panic attacks if they are not working out.
  4. You experience a compulsion to work out even if you are injured or sick and could benefit greatly from resting your body.
  5. Multiple people have commented on your excessive exercise habits and state that they notice what they deem as excessive exercise behaviors.
  6. Exercising has got in the way of relationships, your job, sleep, or your health. An example of this is when a person arrives late for work, or calls in sick when they really plan on going to the gym multiple times that day; or if a person who suffers from exercise addiction avoids their family and friends altogether, yet has plenty of time and motivation for exercise.

Examining your internal voice and understanding your motives starts with awareness. Once you are aware of the imbalance, you then have a choice. When you are not aware of the imbalances in your life, you may fall victim to old patterns and negative thoughts that may lead to addictions and compulsions.

Tips for a healthy, balanced exercise regimen:

  • When starting a new exercise regimen, it is of course important to consult your physician to make sure that you are in good health so that you can physically do exercises and that you are not putting your body at risk if there are any pre-existing conditions.
  • Contact a registered dietitian who can educate and coach you on the most beneficial meal plan for what you are hoping to do.
  • Write a list of goals regarding your vision with exercise. Examine why you want change. Be honest in your assessment of what you can do and the timeline you need to accomplish it. What happens when you have to reschedule your workout? Will you be flexible and compassionate with yourself or will your negative thoughts flow with self-defeat? For example, if you tell yourself that you are worthless or won’t attain your goal because you have to reschedule, you may be out of balance.
  • If you have a propensity to “over do it” in situations, now is the time to establish clear guidelines and identify warning signs that might come up and decide how you will mitigate them.

Avoiding exercise addiction is about balance, awareness and compassion. Without those components, you could possibly play into patterns that lead to self-destructive and judgmental thoughts and then the behaviors may follow. Remember that you decided to start the workout regimen in the first place so that you may have a more balanced life.

Dealing with Difficult People

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Most people are regularly stressed and frustrated by the behaviors of co-workers, bosses, internal and external customers.  This article will help you understand and effectively cope with the “difficult people” you encounter.

            What is a “difficult person”?   The dictionary defines “difficult people” as “causing hardship”, “needing skill and effort to handle”, and “not easy to be around”.  Moreover, difficult people are considered a true source of stress in one’s life. 

            You can begin your strategizing with the simplest method of reducing the overall stress associated with “difficult people”. The answer lies with redefining and narrowing what we consider a “difficult person” to be.  Statistically less than 10% of the populace is truly difficult to work with. Indeed, most of the people we consider difficult are simply different in their personality, backgrounds, and appearances.  Just because someone is different from us doesn’t mean that they are “difficult to work with”.  Truly difficult people have recognizable, well-defined obstreperous characteristics. 

Paraphrasing Patricia M Hines, there are seven types of truly difficult people. 

·         Dominate/Aggressive types are known for bullying people and thrive on attacking the perceived weaknesses and indecisiveness of others.  They are seen as impatient, pushy and fault finding.  When frustrated they can explode into brief but scary tantrums and rants.  It is important to avoid feeling intimidated or overwhelmed by their aggressiveness.  Realize that their explosive behaviors are usually “tempests in teapots” and with patience can pass as quickly as they occur.  Avoid giving into or surrendering yourself to their aggressive, inappropriate wants and needs.  Conversely, do not fan the flames of their ire by attacking back.  Help them try to sublimate their aggressive tendencies while setting limits on their negative behaviors.

·         Indecisive types are opposite of Aggressive types.  They often are passive and non-committal.  They tend to equivocate and procrastinate regarding their decisions and actions.  They are motivated by a need to placate others for fear of upsetting someone.  They vie for time, hoping a pressing situation will “go away”.  It is helpful to validate and build on this person’s thinking.  Coach them toward clarifying and acting on their thoughts and plans.   

·         No types react to ideas with negative comments.  They strongly resist change and are a poison to morale.  It is important not be defeated by their initial dooms-daying.  Be particularly well prepared when you present to a Notype.  Speak clearly about your strategies and goals.  Anticipate their criticisms and negativity. Gain a consensus among the group whenever practical.   Involve the No person in the formation and evolution of an action plan. 

·         Super agreeable types are overly positive and supportive when an idea is first broached.  Later, when it comes time for responsible follow-through, they may be reticent and act passive aggressively.  Use the “SMART” rule when working with agreeables.  “S” stands for being specific.  “M” reflects measuring progress.  “A” stands for choosing achievable tasks.  “R” is for producing results.  “T” stands for setting specific timelines for ongoing actions.

·         Know it all types can display the bravado of super aggressive but are truly more about demonstrating their knowledge and intelligence.  They have a vested interest in displaying their expertise and have limited tolerance for correction and “one ups men ship”.  They are also noted for wanting the last word.   Know it all’s needs and habits are well ensconced and hard to change.  The critical factor is not letting yourself feel threatened or overly annoyed by their arrogance.  Let them have the lion’s share of the discussion, take what you wish from their knowledge base and move on.  Try to set limits on the amount of time dedicated to discussing their expertise and enjoy the positive parts of your relationship.

·         Complainers are constantly finding fault with life.  They believe they are helpless victims of an unfair world.  They catastrophize regarding the normal issues they face on an everyday basis.  They make simple problems into complex monsters.  Avoid trying to bring solutions to their posed problems.  Your attempted problem solving will only draw you deeper into the abyss.  Also, notice that the complainer will greet your ideas with an increasing number of “yes buts”.  Avoid getting into a detailed discussion of their situation.  Acknowledge their emotional concerns and move on to greener pastures.  Remember, if your suggestions fail you will be the next topic for complaint.

·         Clams virtually shut down during times of perceived stress and controversy.  It is difficult to know where you stand with them because they will not discuss their opinions, fears or thoughts.  You need to tolerate their silence and lack of overt actions.  Be warm and supportive but realize some issues will not have a typical degree of closure.    

I wish you good fortune in working with the more “difficult people” in your life.  Remember if all else fails you can fall back on five more straightforward options:

1.    Avoid the person.

2.    Ignore their behavior.

3.    Confront specific aspects of their behavior, and then move on.

4.    Alter your attitude by laughing off the situation.

5.    If the situation continues, consult with a Manager or arbitrator to resolve the problem.

*If emotional issues continue seek the assistance of a qualified therapist at New Day Psychotherapy Group.

The Value of Comprehensive Career Counseling

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The utilization of a comprehensive approach to career development is essential to the exploration and validation of who you are and can be as a person.  The direction and form your career takes is important.  Half of an adult’s working life involves work activity.  Additionally, it is estimated that 50% of a person’s happiness and sense of fulfillment can be attributed to satisfaction gained through work experiences.

Unfortunately, recent surveys have found that fewer than half of Americans are satisfied with their employment.  This is particularly true for the younger and/or less educated portion of the workforce.

Why such dissatisfaction?  There are literally thousands of different occupations to choose from and some 140 million work positions in this country.  Furthermore, career training opportunities abound in the U.S.  Educationally there are over 7,000 colleges and universities in America as well as more than a million high school, federal, state and county wide vocational training programs.

So again, the question begs, with so much at stake regarding one’s career satisfaction and given the multitude of job opportunities and training resources, why are so many dissatisfied with their career choices?

The answer lies in part with the paucity of comprehensive career counseling services available to younger and middle aged adults.  The career counseling offered to high school students is typically superficial and oriented toward college bound placement.  Vocational counseling in post-secondary programs vary in quality but rarely include the individualized attention necessary for longer term planning and decision making.  Sadly, for most, career decisions become more of a “crap shoot” than a series of informed, considered judgments.

What makes for effective career counseling?  Fundamentally there need to be an effective going between comprehensive career assessment and self-insight.  The assessment aspect should focus on the identification of an individual and their most significant life influences, work values, present and potential skills, work personality and life situation.  A skilled clinician can interpret test results a manner that is clear, precise and readily understandable.  More specifically the clinician needs to avoid using the “test and tell” system rather they need to provide meaning and insight for asset findings.

The ultimate goal is to help the individual develop and validate a personalized “vocational self-image” which they may use as an on-going compass in navigating their future career planning.  Emphasis also needs to be placed on increasing understanding of the world of work as associated with careers of interest.   Career clusters will be identified as well as specific occupations in which they might flourish.  Individuals can then be guided into researching their best career options via computerized programs, reading materials, vocational interviews, shadowing, trial classroom experiences and work experiences.  A written report summarizing findings and detailed short and long term action plans will serve as a compass.  It is important that the career counselor remain available to help with emotional and practical aspects during the sojourn.

As you may sense, comprehensive career counseling is both an art as well as a science.  With so much riding on your career why settle for less?

Four Questions to Healing

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img_inner_childWhen I was in grad school I took a particular interest in cross-cultural healing.  What I found was that many ancient and tribal cultures approached psychological issues with great concern for the creative, younger part of the individual.  If someone was unhappy, anxious, depressed or just feeling stuck in life, they would visit the village elders.  By way of assessment, the elders would first ask the following 4 questions:

1. When did you stop singing?

2. When did you stop dancing?

3. When did you lose interest in stories, particularly your own?

4. When did you become uncomfortable with silence?

I love these questions because they speak to something which brings many people into therapy – healing the inner child.  When you think about it, children are clearly passionate about each of these four topics – singing, dancing, stories (especially their own), and while they may make a lot of noise themselves, they are certainly not intensely uncomfortable with silence the way adults are.  We were all passionate about these things at one time.  And although we are now adults with busy schedules, we each still have an inner child who is in great need of care.

Between early childhood and adulthood something happens internally which causes us to lose touch with our inner child.  As we grow up we make all sorts of assumptions about ourselves and the world around us, which in turn, teaches us to close ourselves off from our feelings, from taking risks, and consequently, from experiencing true joy.  Think about those four questions again.  Each of those topics asks us to embrace an attitude of openness toward experiencing a full life, releasing ourselves from the rules and “should” statements we have created for ourselves.  Our inner child is longing to be set free, to help us relieve stress and adopt a more flexible way of viewing life.

Often times, however, facing those four questions involve facing our inner critic.  How many of you read the first question above and thought “Oh no, I can’t sing!”  That was your inner critic speaking.  If you look again, the question is not “When did you stop singing well?”   It does not matter one bit what you sound like.  The simple act of singing is what brings healing and growth to the soul.  Children understand this.  They have the freedom to sing simply because they love to.  The question of whether they can sing well or not doesn’t even cross their minds.

Many of us may have lost touch with that open, risking-taking, creative part of ourselves, but the good news is we can heal our inner child.  We may have learned faulty lessons when we were young that caused our inner child to become wounded, but we do not have to wait until we feel healed in order to embrace that child-like freedom.  In fact, it is exactly the opposite.  By choosing to sing, dance, tell our story, and sit in silence, before we ever feel totally comfortable doing so, we will find that healing of which we are in need.  New, healthier beliefs will replace the old, and our liberated inner child will transform each of us into a new person.

So for today, even if you don’t feel like it, what will you sing?  Where will you dance?  What story will you tell?  And when will you set aside some time for silence?

Guilt and Shame: How are they different?

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Every one of us – at least those of us who are not psychopaths – has experienced guilt and shame at some point in our lives.  Many people experience them on a daily basis.  Sometimes we think of guilt and shame as being one and the same, but they’re really not.  They serve two very different purposes.  Guilt can actually be useful and constructive, guiding our behavior and ensuring that society does not devolve into chaos; but shame can be quite destructive, and can manifest as countless forms of psychological distress.

Guilt and shame may feel physiologically similar, but the cognitions we associate with them are qualitatively different.  When we feel guilty, we are thinking, “I did a bad thing.”  When we feel shame, we are thinking, “I am a bad thing.”  Guilt says, “I know I did something I shouldn’t have done, something that was hurtful to others or to myself.”  Shame says, “There is something about me that is so fundamentally terrible and unacceptable that I need to keep myself hidden, or to compensate for it in a major way.”

If you do a bad thing – if you make a mistake – you can apologize and take steps to ensure that you don’t do it again; you can learn from the experience and do it differently next time.  If you are a bad thing – if you are a mistake – well, what’s to be done?  You’ll just have to make sure no one finds out how awful you truly are, you’ll have to work very hard to distract them from your essential horribleness, and you’ll have to act in self-destructive ways since you don’t really deserve to love and be loved.

Let’s say you ask your boss for a raise, and you’re denied.  You go home and act snippy with your spouse, or your kids, or your dog – you take out your frustration on someone who has nothing to do with what made you upset.  Later, you feel guilty about it.  You can say you’re sorry, and you can acknowledge the fact that you displaced your anger onto someone who didn’t deserve it.  You can resolve to increase your self-awareness to minimize the chances of doing it again in the future.

Or let’s say you’ve resolved to stop drinking, and so far you’ve been successful.  Then you have dinner with an old drinking companion who’s in town on business, and you end up having four cocktails.  You feel guilty.  You can spend some extra time on the treadmill at the gym the next day, and you can insist that your friend meet you at an alcohol-free restaurant the next time s/he comes to town, and you can seek professional help for your addiction.

But if you act snippy with your spouse or fall off the wagon and you tell yourself that you’re a worthless loser who always ruins everything, you’ll just spiral into depression, or start having panic attacks, or develop insomnia, or become a workaholic to prove to everyone that you’re not a worthless loser who always ruins everything.  And if you’re gay, or not Caucasian, or short, or tall, or obese, or transgender, or hairless, or Albino, or disabled, or anything other than some non-existent Norman Rockwell stereotype of what a human being is supposed to be, and you tell yourself that you don’t deserve love and respect, you will sabotage yourself in any number of ways.

Guilt can move us forward by motivating us to do better.  Shame is dead weight, and it only holds us back.

Differentiation

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One of the biggest myths perpetuated by classic children’s stories – and by Hollywood – is that, once they are married, couples live “happily ever after.”  The reality, as we’ve all heard by now, is that nearly half of marriages in the United States end in divorce.  Many obstacles factor into that dispiriting statistic, but one of the greatest challenges to a lasting relationship is an expectation that many people bring – consciously or otherwise – into a marriage:  “Now that I’ve found my soulmate, we will ride off into the sunset together and always be happy.  My spouse and I will value and desire the same things.  We will have sex as often (or not) as I want to.”  In short, “we two will become one.”

In a way, fairy tales like Cinderella and Hollywood romances like Pretty Woman do us all a great disservice, because nothing could be further from the truth.  Marriage is not a magical, alchemical transformation of two people into one being that automatically meets its own needs.  In fact, one of the biggest challenges in any marriage is figuring out how to stay true to yourself while remaining in relationship with someone else – another, different person who often does not think or behave the way you do, feel the same emotions you feel, or want the same things you want.

The ability to compromise is essential in any enduring relationship, but compromise can come from two very different places.  There is a world of difference between, on one hand, “I’ll go with my spouse to the Arnold Schwarzenegger movie – even though I’d really rather chew off my own leg – because I’m afraid that, if I don’t, s/he will leave me and I’ll fall apart” and, on the other hand, “I’ll go with my spouse to the Arnold Schwarzenegger movie because s/he really wants to share the experience with me, because it won’t exactly be like drinking battery acid, and because I would actually like to develop a taste for action movies – I’m getting a little bored with the biopics I usually watch.”  In the first scenario, the reluctant spouse fears that asserting her/his strong aversion to Schwarzenegger movies will lead to rejection and abandonment.  In the second scenario, the biopic aficionado chooses to step outside of her/his comfort zone in the interest of growing herself/himself.

Knowing who you are (what you think, what you feel, what you like, what you don’t like, how far you’re willing to go) and being able to communicate that information to your partner are crucial elements of a healthy relationship.  A strong marriage is about two, separate selves choosing to be with one another because they want to, helping each other to be the best they can be, willingly expanding their concepts of themselves.  It’s not about giving up values or behaviors that are deeply meaningful to you because you need to be with someone in order to function.

Finding the balance between individuation and interdependence is always a work in progress.  It’s one of our main tasks while we are here on this earth.  Rely only on yourself, and cater only to your own needs, and you’ll feel pretty isolated.  But always give yourself up, twist and contort yourself to be whatever you think someone wants you to be, and you’ll eventually feel resentful, angry, and as alone as if you lived on a desert island.  The key to a lasting relationship is in knowing yourself and knowing when to bend.