All the fixin's

photo: by comedy_nose

I have been hesitant to write this post because it seems like trite advice you can find in any relationship self-help book, but I'm going ahead because it keeps coming up in my office. 

A woman has just told me about something difficult in her life.

Me: "Have you told your boyfriend/husband/partner about this?"

Woman: "I tried, but he doesn't get it. He tries to tell me how to fix the situation, but it only makes me feel worse."

(Note: To keep the language simple, and because guys are more often fixers that girls, I am making the guy the fixer in this post. Please note that any gender can try to fix, and any gender can just want to be heard.)

Guys, when your woman is upset, your go-to move should be to listen. Not fix. Get her. Understand. Convey that you understand. If you don't understand ask questions until you do. Don't fix. At least not until she feels understood.

Here is how you do this:

1. Get out of your head. Your head will try to find a problem and offer a solution. Do this by concentrating on your breathing and by putting as much of your attention on her - her words and her body language - as possible. 

2. Listen closely to what she says and what her body language is telling you. Get the feeling behind it. Is she sad, angry, overwhelmed? 

3. Let her know you get what she is saying and more importantly how she is feeling. Do this with words, (ie, "That sounds like your co-worker was really mean to you. No wonder you feel so hurt.")

4. If you don't get it, either the content of the story or the feeling, ask. Just say, "wait, there is a part I don't understand..." Or, "how did you feel when that happened?"). It is also good to ask, "Is there more?" to offer her a chance to get it all out. Make sure your questions are without an agenda beyond understanding.

5. If it is not obvious she feels understood, ask if she feels like you are getting it. Be patient. People don't always communicate clearly when they are upset. Also remember it's most important that you get how she feels.

6. If you really can't understand where she is coming from - and this is most likely to happen if she is upset with you - then do your best to let her have her experience. Just accept that she is feeling something you don't get right now, and give her space to have her feelings. Let her know that you are ok with how she feels.

Note: It is much harder to do this when she is upset at you for something, but that is when this skill is most important.

Women, if your man is not good at listening and getting you and instead he tries to fix the problem (and you are not looking for fixing), you can coach your man. Tell him you don't want him to fix the problem. Tell him just to listen and to try to understand you and your feelings. 

Be patient. Most guys are fixers by nature, especially guys who are problem solvers in their professional life, and they haven't had any training in just listening. Cut them some slack if they relapse and try to fix. Reiterate as kindly as you can that you just want him to listen.

Gooooooaaaaalllll!

I want to point you to the Advanced Riskology blog which helped influenced me to quit my job at a big hospital and strike out on my own. I've been thinking about this blog recently, specifically the 1% list on the blog. The 1% list is a list of goals that the blog's author, Tyler, wants to complete.

He calls it a 1% list because he says less than 1% of the world's population will complete the goals. On it are things like mountain climbing, running a marathon on every continent, and selling a business for $1,000,000. These are big, lofty, exciting goals.

My goals are more humble, but perhaps not easier to accomplish. They have to do with creating a life that feels sane, meaningful, and fun. I am more concerned with the day-to-day fabric of my life than with accomplishing something big.

Why goals? I have traditionally had a little resistance to goals. As a Myers Briggs (free test!) perceiving type, I have a disinclination to having regular, scheduled time commitments necessary to accomplishing goals.

When I think about signing up for guitar lessons, for example, I think, "yeah but what if there is something I would rather do on Thursday at 3 pm?"

Having a free schedule feels relaxing to me, but I have learned over time, doesn't make me happy. I end up with too much time on my hands, and tend not to enjoy the unstructured time as much as I thought I would.

In his book Happier, Harvard professor Tal Ben-Shahar writes that having a goal allows us to relax. It is, he writes, like having a destination on a journey. If you know where you are going, it is easier to enjoy the sights along the way. Without a destination, humans tend to worry about where they are going.

So, I am embracing goals. Writing down goals, whatever their size, makes it more likely you will accomplish them. So does sharing them with others. With that in mind, I would like to take stock of goals I have accomplished and those I have not in the six months since I quit my hospital job.

Goals I have accomplished:

• started this blog
• began work at Affiliated Psychologists, a group practice of therapists in Cupertino, CA
• started a private practice in Oakland, CA
• got hired to teach two classes to psych students at Argosy University in the fall
• exercised regularly 3x per week at least - gym, yoga, running, boxing 

Goals I have yet to accomplish (with deadlines which increase likelihood of completion:

• start guitar lessons (August 1, 2011)
• Visit local meditation groups and choose one to go to 1x/week. (September 1, 2011)
• create a website for my private practice (August 1, 2011)

Goal I want to add:

• Go on ten new hikes in the Bay Area (October 1, 2011)

So, it looks like I have been on track professionally, but I could boost my hobby/personal development activity.

What goals, humble or grand, do you have? Remember, sharing makes it more likely you will accomplish them, so by all means, share.

Talkin' bout suicide

I used to work at a hospital program for people at risk of psychiatric hospitalization. I worked with a lot of people who were at risk of suicide or who had made an actual attempt. Part of this work involved talking with clients' family members and educating them about talking about suicide with the client.

Hopefully you never have to have this kind of conversation with someone you love, but with an estimated 750,000 suicide attempts in the US each year, this kind of talk is more common than you might think. Because it is a taboo subject, people often struggle talking about suicide. I pass on what I know here in the attempt to help with these conversations.

If you take one thing away from this post it is this: if you are concerned that someone you care about may be suicidal, urge them to seek care from a therapist or psychiatrist. It is beyond your role to be assessing someone's suicidality.

I am offering these guidelines because I know that in reality people who are thinking about suicide do talk to family members and friends. But as a friend or family member, your goal should be to urge the person you are worried about to get professional help.  

1. The best way to know if someone is suicidal is to ask. You can say something like, "I know you have been depressed for a while, and this may be a weird question, but have you been thinking of hurting yourself?" 
2. Sometimes friends or family are afraid to bring up the subject because they don't want to give someone an idea they have not already had. Don't worry about this; if someone is not thinking about suicide, your asking them will not make them suddenly think that killing themselves is a good idea. Bottom line: you do not increase someone's chance of suicide by asking them if they are thinking about suicide. 
3. Plans, means, and intent help determine risk. 
1. Plan: Has the person thought about how they would kill himself? A person with a plan is likely at greater risk than someone with no plan.
2. Means: Does the person have the means to carry out their plan? Someone who has the means to do so (i.e., "I would hang myself, and yes there is a rope in the garage") is likely at greater risk than someone who does not have the means, or has no plan to get the means. Note: If someone who is thinking about suicide has access to a gun, this greatly increases the chances that they will kill themselves.
3. Intent: Is the person actually planning on going through with it? When? Someone may have a plan and means but no intent: "If I killed myself, I would jump off the Golden Gate Bridge, but really I would never do this." Or they may be planning suicide but only if something they fear comes to pass "I will not kill myself unless my husband leaves." Obviously, someone who says they plan to kill himself in the near future is at extreme risk.
4. Certain risk factors can increase the chance someone will attempt suicide. Consider:
1. past attempt at suicide
2. people close to this person killed themselves or attempted suicide
3. drinking or drug problem
4. history of impulsive acts
5. hopelessness
6. history of abuse or trauma
7. isolation
5. Certain protective factors can decrease the chance someone will attempt suicide. Consider:
1. stated desire not to hurt friends and family by killing oneself
2. stated obligation to care for others (i.e., "I would like to kill myself, but I need to care for my children.") 
3. Religious beliefs against suicide
4. Person talks about future events they are looking forward to
5. Presence of family, friends, or mental health professionals who the person feels they can talk to and lean on
6. The phone number for the National Suicide Prevention Hotline is 800-273-8255. The hotline is open 24/7 Give this number to the person thinking about suicide. Call it yourself for support or advice if need be.
7. The emergency room or 911 is the right choice if someone is in immediate danger. If you are worried that someone is going to commit suicide in the near future take this person to the emergency room, or if they won't go, call 911. Having the police show up or going to the ER is a lot of drama, but far less than if someone kills herself. Err on the side of caution here. 
8. People who are suicidal are sometimes ambivalent about killing themselves. This can result in a person jumping from saying they are going to kill themselves to saying the reverse. The rule here is if the person you are talking to cannot convince you that they will be safe in the near future at least, take them to the ER or call 911.
9. People at risk of suicide need professional help. I am repeating myself here, but if someone is in a bad enough place to be thinking about suicide, they need to talk to a therapist or psychiatrist. Unless you are a mental health professional, you lack the training to be keeping this person safe. Urge them to get help. 

It's a process

I have this poster by the artist Nikki McClure in my office:

Despite its small size, clients comment on it more than any other piece of art in my office. To me, the word "process" has a dual meaning in the context of my office. One, people process or work through stuff in therapy. Two, therapy itself is a process.

The picture shows a process not unlike therapy. Pitting cherries, one cherry at a time. I imagine the hands belong to an old person who is patient and methodical.

It is a reminder to me that the work I do with clients and my own work in therapy is often this way. Big insights and dramatic breakthroughs do sometimes happen, but I find it is the change that comes bit by bit that often sticks.

For a long time, I looked for a cure for a part of my gut that gets tight. When I feel this way, it feels like the world is a scary place, and I would rather crawl back into bed. I have tried yoga, meditation, exercise, therapy, massage, and chiropractic to cure this problem. I imagined that I when I got rid of it, there would be no stopping me. I would be glowing with energy. I would be magnetic. I would accomplish twice what I normally do. 

What I realized was that hoping so hard this feeling would go away often makes it worse. It creates a split in me where one part of me hates another part.

I am learning to be more patient with my body. Now when I feel tight in my gut, I try to breathe with the sensation. I've found it important to breathe with the sensation - letting both my breath and the tightness be present - instead of breathing in an attempt to make it go away. I have also learned to expect ebbs and flows in my energy level. I would like to be high energy all the time, but that isn't how my life actually feels.

It has taken a number of years to learn to be more patient and gentle with myself. I have found that attitudes, especially attitudes about ourselves, change slowly. But it is this kind of change that actually makes a big difference in my life, actually makes me a happier person.

Do you agree? Have you found that change happens slowly or have you had more dramatic shifts that have stuck for you?

Breaking up is hard to do

I haven't written a post in a little while. I've tried, but I've either written diatribes against society or trite Buddhist wisdom.

It feels like I can only write with authenticity about one thing: the breakup of my long-term relationship. I haven't wanted to write about it because a. it is personal and b. I have qualms about talking about certain areas of my life given that clients may read this blog, but perhaps writing about it will help others who are going through something similar.

First, let me say that it sucks. It's just really painful and there does not seem to be any way around it.

And now for a closer analysis of this pain and how I am dealing with it:

Feeling: Self-blame

Every time I feel sad, there is a feeling that if I had done things differently then I would not be feeling sad right now. My general theory is that loss is inevitable, but we humans have an immensely hard time accepting this as part of life so we try to assign blame, hoping to feel more sense of control. 

Some people like to blame others. In keeping with my humble nature, I prefer to blame myself. I think about various points in the relationship where, if I had acted differently, we would still be together. I imagine going back in time and tapping myself on the shoulder and telling this version of me what I know now.  

Action: Stop it!

As much as I can, I try to short circuit this thinking. It is just not helpful and leaves me feeling worse. Also it is unrealistic: a. I can't go back in time. b. Even if I could, would this have saved things? I don't really know. It was a complicated situation and my fantasy of going back in time makes it much simpler than it actually was.

So, I just try to pull my mind out of this loop. Not always successfully. Sometimes I end up wallowing, but I try.

Feeling: Sadness

As I said, the self-blame tends to set in over a feeling of sadness. Sad because I miss her. I just do.

I think about times we had fun together or I think how it would be if she were with me in the moment. It's like I am reaching out with my mind and heart, but she is not there. Even though it hurts, there is something soft about this feeling, something tender.

Action: Feel it! 

When I actually let myself feel sad, and maybe cry it out a little, I usually feel better. This is often easier with another person - my therapist, my friend, my mom - than alone. I don't know why but it feels harder for me to get to a sad place when I am alone. 

For people who tend to spend a ton of time crying and feeling sad, I don't recommend staying in that place indefinitely. If this is you, you might need distraction. But if you are like me and getting to a sad spot can be hard, then I think it is good medicine to stay there for a little and let your heart be sad.

Feeling: Emptiness (depression)

This one sucks. It feels like there was a tube that supplied color to my life and now there is nothing on the end of that tube. My life feels like it is in black and white. 

I don't feel excited about anything, and there is the impulse to zone out, watch tv without really watching, even stare at the wall. My body feels heavy, and without energy.

For me, sadness has a feeling of movement to it, but this emptiness, this lack of feeling, feels heavy and stuck, like a stagnant pool of water.

Action: Keep doing my life!

I assume that time will heal things, and the color will return in time. I also find that when I actually do the things I am not excited about - exercise, hang out with friends, work - that I feel better at least during the activity. So, I continue to exercise, take walks, work, write (a little), meditate and see friends.

Action: Rest!

More than normal, I am allowing myself to spend time in bed, nap, and watch movies on my computer. I think you have to be careful with this one because too much bed time can exacerbate depression, but shit, I am going through something hard, and now and again, I let myself take it easy.

Feeling: Fear of suffocation

Ok, I know this may sound strange, but there have been several times when I have realized that a part of me is afraid I won't be able to breathe. It has happened during meditation and also when I wake up from a dream. It is like there is this fear that I will be stuck somewhere, somewhere I can't get out of, somewhere where I can't breathe but I don't die.

I have noticed that several times when I have woken up from a dream, I am a little afraid to go back to sleep for fear that I will get stuck in the dream world. I don't really know what this has to do with my break-up, but I think somewhere in me is the fear of dying and the sense that my relationship was a buffer against this fear. Like, ok here I am alone in the world and destined to one day die, but at least I have this loving person to hold onto, and now I am all alone.

Action: Be curious!

Even though this fear is terrifying, I am actually really curious about it because I sense there is something big here. So whenever it pops up, usually only briefly and on the edge of awareness, I actually try to feel into it more, so I can better understand what it is.

Action: Take a deep breath

Self-explanatory.

Feeling: Jealousy

"What is she doing right now? Is she with someone else? What is she doing with them?"

This one comes on fast and hard, the images of her with someone else flying through my mind and my stomach tightening into a knot. It's a burning feeling, like I have swallowed a red hot lead ball, and I don't know how to throw it up.

Then my thinking mind kicks in - in a bad way. "What day is it? Tuesday. Shit, she doesn't have her daughter on Tuesday. She could be on a date. With who? There is that guy she mentioned being friends with a few weeks ago..." And so on.

Action: Get to the bottom of it!

Some deep breaths help me calm the crazy-making thoughts and feelings. From this place I ask myself what is beneath this and I find fear first and then loss. 

The fear is like an alarm bell signaling grave danger: "Woman about to go with other man! Woman about to go with other man! Act now to prevent loss of woman!" 

But the truth is we've already broken up. I've already lost her. I do my best to tell the alarm bell to calm down, the thing I am afraid of happening has, in a way, already happened.

I am also afraid that her being with someone else means she doesn't love me anymore. I remind myself that just as I will always have a place in my heart for her, I believe she will always have a place in her heart for me. I find this comforting.

That's when I get to the loss that has already happened. She is gone. 

 

If, or should I say when she goes with someone else, it will mark another stage in this loss, making it more final. This is inevitable. When I can calm down about it, I realize I am more sad than anything else.(see sadness above).

So what feelings have you dealt with when you broke up with someone, and how did you get through it?

The comfort of the cage

The other day I was running around Lake Merritt in Oakland. It was sunny, the sky was, well, sky blue with no clouds. The light was glimmering off the waves and a cormorant flew low over the water. My Oakland peoples were out running and walking their dogs. It was Springtime and life was in the air.

But I didn't care. I was worried, and I kept thinking about whether she was going to call. I would only feel better if she called. Or should I call her? Should I be honest and upfront about my needs because that is who I am, honest and upfront? Or should I play it smart, let her come to me, knowing that this strategy is probably more effective?

All of a sudden, I got pulled out of this tizzy of thinking and I realized where I was. I saw the water shining, I heard the rhythm of my footsteps, I smiled at a guy running in the opposite direction. I felt a part of this day, connected to the lake and the sun and the other people. I felt alive!

And then I remembered I was worried, and just as suddenly, I was back in my anxious little head, worrying and strategizing. As unpleasant as it was, it was as if a part of me actually preferred the worried thinking to the freedom of letting go.

This part of me said, "hey, yeah I know you are digging on the scene and and the sun and the lake and just being and all, but you have a life to worry about, so get back to worrying, bitch". And like a good bitch, I obeyed, worrying my little head off the rest of the run.

This is what I call the comfort of the cage: when we actually choose a crappy state of mind over a more free state of mind because somehow feeling good is scary and feeling bad is safe.

In my experience, there are three reasons we do this:

1. We are scared to not think about our lives. We feel like something bad will happen if we are not worrying, planning, analyzing. "Can't let go into the moment, because then the house of cards might topple". This is what happened to me when I was running around the lake.

2. Feeling good is scary because we might lose it and feel bad again, so instead of dealing with this fear, we decide to just get it over with and feel bad again. This happens a lot with people who are starting to get better from depression. They are so scared of falling back into depression that they can't enjoy the new, good feelings and end up exactly where they don't want to be - depressed again. It's like flying feels really good, but shit, I might crash, so I better go ahead and just land the plane.

3. We find ourselves feeling really good, and then part of our brain wants to figure out exactly how we got here, so instead of just enjoying, we start thinking again, and dammit, the good feeling is gone. This one happens to me sometimes during meditation. It's hard for me to enjoy the new scenery, I want to go back and create a map.

In each of these instances there is the underlying sense that uncertainty is unbearable, and we actually prefer unpleasant states of mind that we are familiar with to the uncharted terrain of being more alive to the moment.

I don't know of any foolproof tricks to stay in the moment. I just keep reminding myself to let go, that it is ok to get out of my head and enjoy what life has to offer. Maybe one day, I will no longer be my mind's bitch.

What about you? How do you get out of your head and let yourself be in the moment?

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A Happy Relationship with Alcohol

Drinking too much will mess up your life. It will rot your liver, hurt your self esteem, get in the way of your relationship, destroy friendships, even cost you your job if the problem goes too far. 

Nothing new here.

Recently though, a friend told me a reason I never thought of for making sure I keep my relationship with alcohol healthy: If drinking becomes a problem, I may have to stop drinking. That would suck, because alcohol is fun and part of my sane lifestyle. Hell, I’m on a plane right now enjoying a Jack on the rocks. The alcohol makes my space invading neighbor’s elbows more tolerable and keeps the reality that a few inches below my feet is 37,000 feet of air pleasantly fuzzy.

As you can probably attest, alcohol has a great variety of uses including lowering inhibition, decreasing awkwardness, and increasing fun. It enhances meals, improves conversation, and makes cooking more enjoyable. Plus, mixing drinks can be a creative and tasty art.

But if you drink too much, you sacrifice all this. When you realize you have a problem, you will have to cut down. Then, you will no longer have license to get drunk. See, if your drinking is under control, every once in a while, in the right situation, with the right people, its fine to get a little ripped. But once you have a problem, you loose the right to get drunk. Now you probably shouldn’t have more than two, because well, you know what happens once you start down that road…

And if things get really bad, you will have to give up drinking all together, and forever. You will have to dance, go on first dates, attend weddings, reunions, and family functions completely sober. And then even if you have one drink, you will have relapsed. You will feel bad about yourself and have to go acknowledge what happened at a meeting.

You don’t want this. You want to be able to drink and have it be a good thing not a bad thing. So, keep it under control. Find other ways to cope with stress, so alcohol is not your go to stress reliever. Don’t drink every day. Make alcohol an addition to fun times, not the point of fun times. For college-aged readers: don’t funnel, shot gun, use a beer bong, or engage in drinking games – this is dumb. Only get drunk once in a while and then in circumstances where you are with people who won’t take advantage of you and where you don’t have to drive.

With a little maintenance, you can enjoy a lifetime of happy times with your good pal, booze.