Thursday, December 29, 2011

Day to day mindfulness

I wrote a guest post for pickthebrain.com, all about finding opportunities for mindfulness in ordinary moments of life. Since I've been so bad about updating lately (!!) I thought I could at least link the post here.

If you're new to the Doc Blog, please feel free to go browse back through some old entries, and rest assured that you'll see some more content soon. The holidays are wrapping up, my bus ticket project is slowing down, and I'll be around.

Anyone have some good new year's resolutions they'd like to just break now and get it over with? :)

Wednesday, December 21, 2011

One sure-fire way to soften the holiday blues

I'll disclose the secret right at the very beginning, and then we'll talk about it, okay? Are you ready? Here it is!

GIVE.

Pretty simple. I know that many are afflicted with holiday depression. For some, it's a continuation of an issue that they struggle with all year. For others, something about the holiday season triggers a case of the blues that makes this time of year just awful for them. What's worse is hearing "get over it, it's just a holiday," or "quit bringing everyone down." Rule one around here is that your emotions are the only truth you've got, really, and if you're bummed out about the holidays, or because of the holidays, then you're bummed out. No one in the world has a right to tell you how to feel. No one.

That being said, if we had a dime for every "beat the holiday blues" article on the internet, we'd be able to buy Christmas and Hanukkah, and have enough money left over to get Festivus poles for the masses. So, you can go read those, too. My list has one item.

GIVE.

There is so much need out there. Think of what you've got to give, and then share some. Money? Even five dollars helps. Talent? Go entertain someone who can't go out to see entertainment elsewhere. Writing skills? Write letters. Time? Oh, goodness, do people ever need that. A few hours volunteering locally will repay you endlessly with a bounty of thanks and good will.

I think this holiday blues-beating, though, is kind of a two-step process now that I think about it a little more. First step is accepting - just being okay with the fact that the holidays are hard for you. You have your reasons, and they're good enough. You don't have to prove anything to anyone. If you hurt, you hurt. And then second step is to push yourself forward just a little, despite the difficulty, and give. If you really want to be ambitious, give every day. Make a list of things you can do to help, to encourage, to praise, to love. Giving takes so many forms.

Give. Without expectation of return. Give. With the knowledge that all love put into the world ends up somewhere. Give. Without need for thanks. You'll get them regardless.

Most of all, just give to see that you've got it in you. Because you do.
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If you need some ideas for starters, here's a nice list from Uncle Internet to get you going.

Sunday, December 18, 2011

Three ways to make breaking up not as hard to do

I work at a college counseling center. Therefore, I work with college students. Therefore, at any given time, I work with people who are in the uncomfortable throes of a breakup. I have become something of a breakup expert at this point, whether I've wanted to or not, and I think that the least I could do with all of that knowledge is to pass a little bit of it along.

Everyone is different, of course, and when you combine two (or more) different people into an intimate relationship, the complexity increases exponentially. At the core of just about every breakup, however, there are a few basic forces at work. I hope that everyone reading this has nothing but perfect, intact relationships from here on out. Just in case, though, here are a few ideas that may help you get through that next breakup.

Let it hurt: As humans, we do everything we can to avoid pain. In my job, I see this in the form of complicated defense systems, and a roomful of denial. Because we are generally rewarded for "seeing the bright side," and often shunned when we appear hurt, we think that things will be better if we can somehow find the magic formula for stopping the pain. We think that if we say the right combination of words, find the right way to distract ourselves, that we'll make it through a breakup unscathed. The problem with this is that the hurt doesn't go away, it just hides from view and finds ways to pop up at the most inopportune moments. What psychologists call "complicated grief" is the end result of that unsuccessful avoidance of the pain. You can tolerate the feelings. Trust me on this one. And, letting that wave of grief wash over you will give you the deep knowledge that you are ready for what's next.

Your heart is a lover, not a lawyer: I had a conversation this morning with a friend who is suffering the aftermath of a painful divorce. The end of the relationship had caught him by surprise, and even after the papers have been signed he continues to learn of new transgressions. His sense of justice is offended. He has been done wrong, and he wants to straighten it out. The problem is that the breakup zone is not a court of law, and all the hard evidence in the world doesn't mean anything. That "sense of justice" thing often results in an ugly desire to hurt back when we've been hurt. I asked my friend whether he wanted to put more hate and pain in the world, or more love and forgiveness. The answer to that question is entirely up to him. And to you.

Shut things down for a while: When I was dating, back when you had to swerve to avoid dinosaurs on your way to the movies, there weren't that many ways to contact your ex after a breakup. If you were in pitiful mode, your heart would jump painfully when she drove by. That was it, though. There was no texting, no Facebook, no G-Chat. What was done, was done. It hurt more at the beginning, probably, but it was over. Now my clients tell me about extended late night chats and surreptitious wall-stalking sessions on Facebook. How do you grieve that? Are they gone? Do you still have a relationship? To grieve a loss, there needs to be a loss. Break the connection, at least for a while. I think those post-breakup chat sessions are often held by two people who are covertly helping each other avoid the painful truth. There's a reason that the truth hurts, and there's an equally important reason to feel that pain. I'm not real big on closure, as you may have read in the past, but I do think that there is something to be said for letting yourself know that it is truly over.

Coming to the end of anything, good or bad, means that it's time to deal with loss. The key words there are deal with it. Approach, rather than avoid, and in the long run you'll be readier for the healthier, happier relationship that awaits you.

Wednesday, December 14, 2011

Rumors of my demise

Hi all -

Yes, I miss the updates as much as you do. I've been very busy with the Holiday Fare Project, which is going swimmingly, but I know that the Doc Blog is hungry for some new stuff. I will return shortly. In the meantime, please do check out Holiday Fare. See you soon!

Tuesday, December 6, 2011

Why your last therapy session may be the best one of all

As you know if you've read this blog for any period of time, I work at a college counseling center. At this time of year, most students are bracing for finals, and for that trip home that some love, and some loathe. For some of my clients, though, it's time to graduate.

Graduation is a positive event for nearly everyone. All those years of attending classes, writing papers, taking tests... finally, it's time for a break. But as my clients get closer to the big day, they start to see the truth in one of the things I often say to the people with whom I work. For every loss, there are gains. And, for every gain, there are inevitably some losses. If we've been working together for a while, it can be hard for my client to accept that their graduation means that they'll have to stop seeing me for therapy.

In the therapy biz, this is called "termination." I've always disliked that term, as it conjures up images of Arnold Schwarzenegger dressed in black leather and smoking a rogue robot with a giant gun. Therapy termination is not as dramatic as that, but it can certainly feel just as final.

Termination happens in just about every therapy relationship, not just those at counseling centers. Eventually, therapy ends, whether through artificial means such as a graduation or someone moving out of town, or through organic means like the natural end of a successful therapy. And, for the client and the therapist, there are some ways to make sure that termination is a meaningful, mindful experience that can bring lasting benefits to both people.

Here are six ways that you and your therapist can make termination a positive, healthy experience.

1. Have a plan. A good therapist will pace the overall course of your therapy, just as he or she paces each individual session. Coming to the end of therapy is something that should be planned by you and your therapist. It's a good time to take a look at how your therapy has gone, what you've learned, and where you'd like to go from there. The last 2-3 sessions of therapy should look as though you are heading toward some kind of conclusion.

2. Stick to it. if you avoid things like this, tell your therapist so they can keep you on track. Therapists avoid goodbyes, too... they're human. Make sure they do their job, too. There should be an explicit conversation about how to tell when you (or your therapist) is avoiding doing the termination work, and about what to do if that happens.

3. Resist the urge to drop the bomb. Every therapist has a story or two about clients who save the last session for something earth-shattering. If there are things unresolved in your therapy, then maybe it's not time to terminate. If you're in an artificial termination (like graduation, or moving out of town), work with your therapist to set up the next step. Your therapist can offer a referral. Work with your therapist to plan your next step.

4. Let the emotions come. Work at acknowledging that this relationship is important, and give it the attention and emotion it deserves. Learning how to look someone in the eye and truly say goodbye is a lesson that many people never learn. It might help you as you say other goodbyes, which leads to number five...

5. Generalize your gains. Apply the lessons you've learned in mindful therapy termination to your other relationships. You will nearly always need to be the "grownup" out there in the real world, and take on the hard (but so satisfying) work of not letting yourself or others avoid goodbyes.

6. Remember that it's truly over. When a therapy relationship is over, it's OVER. While we can take the sting out of some endings with a "see you around," your therapist won't be in contact with you again. It's not ethical for your therapist to start a friendship with you after therapy is done, no matter how comfortable or natural that might seem. So, at the end of therapy, it's important to realize that the two of you won't be seeing each other again. This is the case in many goodbyes, but with this one, there's no question.

As a therapist, I think that learning how to terminate with clients is one of the lessons I've learned that has the most application to my "outside" life. It's just not something that anyone shows us how to do. It's also one of the places that some therapists bumble, and let their clients down. By being aware of how the process works, and willing to work with your therapist to do it right, you can use your therapy termination to make important gains right up until the very last moment.

Sunday, December 4, 2011

One Minute to Ground Yourself

When you were a kid, being grounded was not such a great thing - it meant that you'd done something wrong (at least as far as your mom was concerned) and you were forced to stay home, instead of going out and maybe getting in more trouble.

Now, as a grown-up, grounding means something entirely different. Well, maybe not entirely different - after all, when we think of grounding ourselves, we are usually thinking of finding ways to find a little peace, a "center" from which we can then move on with our days. So, maybe the concept of being grounded and staying home is not so far off.

The object of grounding is not to bring a halt to your day, or to find ultimate peace (wouldn't that be nice?). The object, really, is to just take a moment to make sure everything is in balance and ready for whatever is coming next. You know those "exploded view" drawings, the ones that show every part of a piece of equipment as though it had exploded straight out from the center? The purpose of grounding exercises is to un-explode - to bring all those parts of yourself back together. If you can get good at grounding yourself in just a minute or two, you can take on the challenges of your day in a more mindful, peaceful way.

Ready to try? Here are a couple of ways to start.

One of my favorite ways to quickly ground myself is with visualization. Try this one: Close your eyes, breathe deeply, and envision a gorgeous crystal blue beam of light emanating from the sky above you and shining right into you. From below, see a dark green beam of light, bringing you the peace and power of the earth, again shining right into you. As you breathe, visualize those two beams of light intertwining, combining to give you all the power, grace and energy of the earth and the sky. You are filled with the eternal, centered power of the world around you.

Another way to quickly center yourself is with a simple physical act. I like to slip my shoes off when I'm at my desk, close my eyes, breathe and just let the soles of my feet slide against the carpet. I feel the contact of my feet with the solid floor, and I give thanks to the floor for supporting me and to my feet for carrying me through my day. Wiggle your toes, flex your feet, and focus on the physical sensation, all the while continuing to take in deep, cleansing breaths. Add a word like peace, or love, or joy to each inhale, and soon you'll be grounded and ready to move on with your day.

Experiment with what works for you. Your exact technique isn't as important as just giving yourself that moment to bring all those exploded parts back to the center. All it takes is a minute, and you'll have a better day for your efforts.

Saturday, November 26, 2011

Is the myth of closure keeping you from moving on?

My friend Dr. Internet tells me that closure is "necessary," and "important," and "essential to moving on after a relationship ends." You know closure - it's that amazing thing that happens after you have that conversation like they have in the movies, and you both realize that you're better off, and that you've made the right decision. The movies say that this happens just prior to a big plot shift, like finding happiness in your life or maybe fighting a bunch of ninjas.

Unlike Dr. Internet, Dr. Jeff thinks that, for the most part, closure is a LIE.

I've written about grief before, and about the things people do to try and cheer you up. For the most part, "this is for the best" is friend-code for "I don't really want to face your grief." Closure is what we do to ourselves to try and avoid the grieving.

So many people go through life thinking that if they can pick their way through the minefield in exactly the right way, nothing will ever explode. We enter relationships with people who we don't really match, and then we spend all of our time trying to say and do the things that will somehow change that person. We manage our outward appearance and massage our social impressions just so, in the hope that everyone we ever encounter will like us. And, we try and find just the right thing to say to "finish up" a relationship.

The truth is that we are the sum of all of our experiences. Just because someone has died, or moved on, doesn't mean that they are no longer a part of who we are. We try and reach closure so we don't have to just sit with the knowledge that something sad has happened. We try and mask the loss by telling ourselves that the loose ends are all wrapped up now and we never will think of that person again, that we will never have to grieve the fact that they're gone.

Here's a thought: What if we just keep them all with us, forever? They don't have to be in the front of the line. We don't have to store them on that shelf at eye-level. But, what if we accept that in our complex minds, there's room for everyone? Sit with the loss. Accept some of the blame. Forgive the other person, over time. Feel love and gratitude for what they've brought to your life. Then, carefully place them somewhere within yourself where they're no longer as important, but still just as big a part of you as every other experience. Let a favorite song take you back, and make you cry, and then move to the next moment in your life.

Take the energy you've spent fighting off the existence of your grief, and put that energy into creating more love to put into the world. You'd be surprised at how easy that gets when you practice.

Monday, November 21, 2011

The Doc's Holiday Gift Guide

What to get everyone this holiday season: Genuine gratitude, heartfelt love, and patient acceptance. Not available in stores.

Really.

Stay tuned for a "Holiday stress" post. It will probably be the only one on the internet. :)

Saturday, November 19, 2011

You've probably seen this already...

... on Twitter, Facebook, my other blog, etc. But, here's a story about yours truly, and my holiday bus ticket drive.

Back with psych stuff SOON!

Wednesday, November 16, 2011

Is self-judgment getting in your way?

One of the things I do with clients (that both drives them crazy and helps them change!) is to point out their self-judging statements. So often, someone is simply talking about their week, and they'll say things like "I know this was silly, but it made me feel bad that..." or "it's stupid, I know, but I..."

We all do this. Everyone I've ever talked to EVER does, anyway. The problem is that these self judgments just reinforce our beliefs about not being good enough. Judgment is our way of comparing ourselves to an idea self. "Someone more in control wouldn't have silly emotions." "If I was smarter, I wouldn't have..." We're building a less-than-helpful kind of learning when we constantly utter self-judging remarks.

I think that many of us entertain the belief that as soon as we change something, everything is going to be fine. The thing is, though, that what we've got right now, at this moment, is what we are. This is what we have to work with. And accepting that, truly loving that, builds a base for real change.

Here's something to try, just for today. Catch yourself in self-judgment. Listen for statements like "I know this is dumb," or "It's silly, but..." and just forgive yourself for them. Just listen, observe, and then let them go. Judging our judgments just digs the hole deeper. Enlist a friend if you'd like. But, see about starting down that path of less judgment. Other good things will follow.

The beauty is in the work. You're doing the best you can!

Sunday, November 13, 2011

Five ways Google calendar can improve your mental health

Google calendar, specifically Google calendar reminders, can be an incredibly helpful tool. I often recommend text reminders to clients. If you don't have a Gmail account, go get one - it takes about two minutes to sign up - and start experiencing the benefits of regular reminders, delivered right to your phone or your email.

Setting up reminders is as easy as clicking on a date and time, then entering the words you'd like to see in the "what" field. After that, click the "repeat" box and "daily." Then click "add a reminder," and choose an email or text reminder. Then, just save your reminder. Text reminders work great if you're like me and you carry your phone everywhere with you. Repeat as needed during the day if you want to be reminded more than once.

Here are five ways that reminders can work to bolster your happiness and balance every day.

1. As a reminder to BREATHE. This one is the simplest, and the most often-needed, not to mention the most often-ignored. Deep, cleansing breaths can help tame the worst of days and the scariest of crises. Set up a text reminder that will have you inhaling deeply a few times a day. Really easy, really helpful.

2. As a source of centering tips. Set up a few reminders that will have you doing easy grounding exercises - "Take your shoes off and feel your feet on the floor." "Do a five-minute walking meditation." Schedule these reminders for when you know you'll have a few minutes, and follow them daily.

3. For affirmations. Affirmations are much-maligned, often-ridiculed ("gosh darnit, people like me!") and consistently helpful. Who doesn't want to see "You are beautiful" or "Stay strong" every day? Affirmations are a way of re-wiring your brain, and repetition is an important part of this learning process.

4. As one-time booster shots. Sometimes you've got something in your day that is going to take everything you've got to get through. Set up a reminder that will arrive partway through, encouraging you to keep going, relax and get it done.

5. As a reminder that things get better. Sometimes when I have a client who struggles with recurring depression I'll have them write a letter from their "happier" self to their depressed self. As silly as it sounds, simply remembering that you've felt better can help you stay on the path until things get better again. A recurring note from that part of yourself might help if you're susceptible to down days.

That should be enough to get you started. I'd love to hear other ideas - let me know what you plan on doing with your reminders!

Thursday, November 10, 2011

One minute to tricking yourself into a better mood

This little "mood hack" has been the subject of ongoing research, and it has supporters and detractors just like many other theories. The idea is this: if you're feeling a little down, putting a smile on your face will trick your mind into thinking that you're happier. As a result, you'll feel happier, and eventually that smile will be more genuine.

Research on this idea has been conducted in several ways. One of the most notable studies had people clasp a pencil in their teeth, forcing their mouth into a smile. Try it! Just as shallow breathing sends a panic message (something must be wrong! I'm breathing rapidly!), a smile sends a message of improved mood. The most damning research in opposition is pretty weak stuff, mostly saying "we don't think it works all that great."

So, let's try this: either put a half-smile on your face and keep it there for a minute, or better yet, hold a pencil in your mouth, using your molars to clamp down on it. Your mouth will be pulled back into a smile, your brow will change, and you'll FEEL the smile on your face. Hold it for a minute or two, and see what happens. At worst, you'll just have the taste of pencil in your mouth for a while.

At best, though, you'll have a learned a ridiculously easy way to get a little mood boost.

An interesting offshoot of this facial feedback research is the mounting evidence that botox treatments can actually impact mood and cognition due to LACK of feedback. But that's another story for another day.

For now... smile!

Today's Assignment?

Doc Blog readers are hereby notified that Today's Assignment is likely to become This Week's Assignment. Your humble Doc Blogger needs more time for OTHER posts.

Stay tuned.

Wednesday, November 9, 2011

Today's Assignment 11/9/11

Here's something to try: admit that you were wrong. Just own it. No defenses, no excuses... Just own up, apologize, and move on.

Have a great day!

Tuesday, November 8, 2011

Today's Assignment 11/8/11

This one is easy: consider the other side. No need to change your mind - just open it a little. As you make decisions today, put aside your certainty and just take a second to think about what the alternative might be.

Happy Tuesday!

Monday, November 7, 2011

Today's Assignment 11/7/11

I commute to work each day via mass transit - first a walk to the transit center, then a light rail ride, then a transfer to the bus. All told, it takes just under two hours. For the most part, I love my commute, and use it to ease into my day, and back out of it. But, that's a long time to be sitting in one spot, in recirculated air, with no possibility of opening a window or making a stop.

When I got to the transit center this morning, I was feeling a little disconnected. There was time to take a breath before the bus arrived, so I walked half a block to a small patch of grass. I stood on the grass, took a few deep breaths, and looked up to see a huge flock of geese flapping their way across the gray morning sky. I was recharged, and I felt reconnected to my world. And, of course, I thought "hey, there's today's assignment!"

For today: take five minutes at some point in your day, and find a little piece of nature somewhere. Even if it's a flower box on a downtown building, touch the planet for a few minutes. Take a few deep breaths, breathing out the artificial, taking in the organic. Reconnect. Repeat as necessary.

We are a part of this earth, and the earth is a part of us. Stay in touch.

Sunday, November 6, 2011

Today's Assignment 11/6/11

Think of something that's been bugging you - something that somebody did to wrong you, maybe, or just something that didn't strike you just right.

Think of this thing - and then try to forgive. Notice the word "try." Forgiveness is a difficult path, one that takes practice. For today, just accept the effort.

If you need a little reminder about how to forgive, here's one.

The beauty of forgiveness is in the trying. See what happens when you make the attempt.

Saturday, November 5, 2011

Today's Assignment 11/5/11

Today's Assignment sounds like the easiest thing to do, but may very well be the toughest.

Don't try to change a thing today. You are perfectly imperfect as is. No extra help for others, no improvements in yourself... just take a breath and be who you are today.

No destination today, just path. No finish line, just track. Today, the beauty is in the attempt.

Love yourself, first.

Friday, November 4, 2011

For college students: Five ways to survive that trip home.

I write a column for the school newspaper where I work. Thought I'd share this one here!

Even though it seems like the semester has just started, take a look outside. See that dark gray? Feel that cold drizzle that hits you as you walk across campus? That can only mean one thing - time is whizzing by and it's almost time for Thanksgiving break. And Thanksgiving break inevitably leads to finals, and Winter break. And all of those things, for many students, leads to time at home with the parents.

For some, family time is as joyous as one of those old holiday movies, with much festive fellowship and big steaming piles of delicious food. For others, though, things aren't as joyous at home - and those steaming piles are something different entirely. There are as many family styles as there are families - there's no way to give advice that fits everyone. There are a few things to keep in mind, though, that might make the trip home a little easier this year.

Expect changes. Many a wayfaring college student has been dismayed to find that their bedroom has been switched to a sewing room or a giant storage closet. Relax. What can feel like a loud-and-clear "glad they're gone" message can often be your parents' way of saying "we miss you, and it's too hard to look at your room the way it was."

Let them parent you a little. Even after a few years away, visits home can quickly devolve into a power struggle. It can feel pretty weird having mom check on your whereabouts at 2 AM after you've been keeping your own schedule for the last 2-3 years. If you'd really like to ensure domestic tranquility, let mom and dad give you some advice about car maintenance. Acquiesce when they tell you to pick up those damp towels. Your late-night freedom may depend on it.

Really listen. This is is interesting time for you and for your parents (and siblings!). Being treated like an adult happens more naturally if you treat others how you'd like to be treated. It's true - that golden rule that they hammered into you kindergarten still holds up after all these years. Show some respect, and listed with an open heart. You'll be surprised what you might learn.

Decide on some boundaries, and stick to them. There are times when compromise is a good, relationship-enhancing skill. There are other times, though, when you need to let your parents and the other folks at home know that there are such things as deal-breakers. Give in on the little stuff, but stay true to yourself when it comes to your values. Maybe it's time that uncle Roy's sexist humor faces some heartfelt resistance at the dinner table.

Remember that change takes time. Your relationship with your parents, and your siblings, goes through significant changes during your college years. While it would be great if everyone "got it" from day one, that's just not how it works. Even in the closest of families, there are old hurts, difficult memories, and some pretty well-established roles to deal with. Take a deep breath, pass the green beans to your right, and open your heart to whatever is coming next.

Today's Assignment 11/4/11

Today's assignment is about peace and quiet. Find a spot in the middle of your busy day, wherever you are, and carve out five minutes of beautiful silence.

For some of you this might mean leaving the house, or the office, or maybe ducking into an unused room. The object isn't to do anything WITH your moments of quiet... it's all about just having some quiet moments in the middle of your day.

Find a little island of peace and quiet today, even just for a few minutes. Happy Friday!

Thursday, November 3, 2011

Today's Assignment 11/3/11

This one is easy - give out five genuine, unexpected smiles. Some people will return them, some will wonder what you're up to, and if you're lucky at least one person will pass your smile along to someone else.

A genuine smile comes from deep within you - find that center of gratitude and joy, and just project it into the world. Even on a bad day, a smile can help turn things around.

Look people in the eye, flash a genuine smile, and move on with your day.

Wednesday, November 2, 2011

How do you know what your values are?

One of the fun things I get to do from time to time is speak to groups. Today, I'm giving a talk to a group of Social Workers. The talk is about the Social Work Ethics Code, and about the values that we bring to our work.

What struck me as I put my notes together was the realization that our values color everything we do, every day. And, for many of us, we're not really even that aware that the process is taking place. We make our decisions, have our conversations, and interact with the world without really taking stock of why we are doing what we're doing. Our values are deep-rooted, and in many cases they make an appearance in our lives without us even knowing.

We get our values from a number of different sources. As always, parental influence and developmental learning play a huge role. Think for a moment about the "truths" you hold dear. For some, the idea that people should be rewarded for what they do is a closely-held value. For these folks, life can feel really unfair when they give and give, and feel that they never get anything back. For other people, the idea of autonomy rules supreme. Anything that impairs their right of self-rule can be seen as the enemy. For many people, these strongly-held beliefs have been around for as long as they can remember. And they impact every decision that those people make.

Doing a values exercise can be an eye-opening experience. They're easy to find, and to complete. It can be as easy as making a list of your "truths," and prioritizing them. For example, my list would include the value that all people should be treated with equal respect, and that the act of giving love and support should be done without expectation of return. Yours might include the value of hard work done for its own sake, or the idea that public service should be a priority. Whatever your values, try taking a minute to write them down, and then take a few more minutes and sort them into priority order. It's really likely that what you've got at the top is a short list of things you use to make all the decisions you face on a day-to-day basis.

Conflicting values can cause a great deal of stress. If you value autonomy at the same time you value following the letter of the law, you're set up for ongoing value conflict and a lot of stress. If you believe that all good deeds should be rewarded, but also think that people should never blow their own horn, you've got another conflict. Simply identifying these value conflicts can help you understand what's bothering you.

Rigidly-held values can act as a guide for living. At the same time, they can set up ongoing internal conflicts that operate below your level of conscious thought and so are very difficult to resolve. Making your values known to yourself is the first step in learning how to accept those conflicts and make decisions in a more conscious and balanced way.

And, hey, if you ever want to book me to give a talk to your community group or workplace, you know where to reach me! :)

Today's assignment 11/2/11

We all have those little things we want to change about ourselves... We want to exercise more, change our diet, find a better job, get our teeth fixed... The list can feel endless.

The problem with those lists lies in what they do to how we feel about ourselves right now. Fix-it lists present us with an impossibly perfect future standard of ourselves against which our current selves can be measured. They stand in the way of accepting ourselves in the moment.

Today's assignment is to look at that fix-it list, see what's at the top, and just DROP IT. For today, assume that thing will never change. You are good just how you are. Take the pressure off that comparison, don't worry about it, and love yourself today. As-is.

You are beautiful just as you stand. Have a great day!

Tuesday, November 1, 2011

Things are cookin'!

It's becoming apparent that the Doc Blog is picking up some momentum. Page views are up, Twitter mentions are increasing, Facebook "likes" are on the upswing.

Yay!

If you're new here, welcome. If you're not, I'm glad you're still here! I'm doing my best to keep things updated, and I'm always available at drjeff@gmail.com for suggestions, questions, kudos and gripes.

If you'd like to be notified of new posts, you can follow the Doc Blog on Twitter - @DrjeffBlog. You can "like" Doc Blog on Facebook. And, if you look to your right and scroll down a bit, you'll see the box where you can get notifications via email.

Also on your right is a donate button. This is a labor of love, but if you'd like to buy me a beer or help pay the internet bill, there's your chance!

Again, please do feel free to contact me with questions or ideas. The best posts here have come from reader ideas and questions... and I have no reason to think that things will change in that regard.

Enjoy reading. I'm happy that you're here!
-jeff

Today's Assignment 11/1/11

Today's Assignment takes its inspiration from today's date. It's another one of those deceptively easy ones - just sit for one minute, and write down eleven things you like about yourself.

That should be easy, right?

If you get stuck, and some of you will, think about what a miracle it is to just be able to read, or to walk, or even to breathe. Stop to consider how amazing it is that we can love each other, or drive a car, or knit or sew or draw.

This exercise is meant to remind you that, even though we all have things we'd like to change, our everyday existence is made possible by US. Take a minute, write down some appreciation for yourself, and then live the rest of your day in gratitude for YOU.

Eleven things. That shouldn't take long at all!

Monday, October 31, 2011

And, a little bit more transit writing

I mean, what good is a psychology blog without some mass transit, right? This one's a Field Guide to Transit Operators. Enjoy!

Ask the Doc: How do I talk to my therapist about suicidal thoughts?

Sometimes I think it would be better for everyone if I wasn't around. I don't think I'd ever kill myself, but I'm worried that if I tell my therapist about it she'll have me committed to the hospital. Can she do that?

First, I'm sorry to hear that you're feeling that way. You'd probably be surprised at how many people share that feeling with you on any given day. One of the things that I've learned in my work as a therapist is that it is nowhere near uncommon to have suicidal thoughts once in a while. According to the American Foundation for Suicide Prevention, nearly a million people make a suicide attempt each year. For every one of those attempts, there are many more people in the situation you describe - not really wanting to die, but wondering how it would be to just not exist. We call this "abstract suicidal ideation" in psychology parlance, and it's a very uncomfortable thing to experience.

What you need to know is that your therapist is very willing to talk to you about what you're thinking, and unless you are unwilling to say that you'll keep yourself safe, she's not about to send you to the hospital. I've had clients who have had significant suicidal thoughts for months at a time, and the last thing I wanted to do was have them hospitalized. The fact is that, even though they were thinking about suicide and what it would mean, they were also continuing to function at work, at school, and in their relationships, and they were willing to keep themselves safe with a plan that we had worked on together.

Saying "I wonder what it would be like to kill myself" or "I've thought about suicide" are big flashing red warning signs for people around you, and I can certainly understand why you're keeping them to yourself around friends and family. Your therapist looks at things differently than your friends - that's why they're your therapist. Times like these are what we train for. We learn to ask questions about your level of intent, about whether you've got a specific plan, and about what you've got in your life that prevents you from acting on your thoughts. We learn to work with you to determine your level of risk, and to make a safety plan that fits your personality and your lifestyle.

If you truly don't feel as though you can keep yourself safe outside the hospital, that's another story. Don't keep that information from your therapist, because suicide is a permanent solution to what often turns out to be a set of temporary problems. But, if you know you're safe, and you need to pour your feelings out to someone without fear of overreaction, please talk to your therapist. Human life is a beautiful, valuable thing, and we're here to help you get the most out of it. To do so, we need to know what's going on with you. All of it.

One final note: if you're considering suicide, or just feel pretty awful, and you don't have a therapist, today is the day to start your search. As I said, life is beautiful. Consider this an opportunity to show yourself the love you'd show to a friend in the same situation, and get some help getting back on the path.

Best wishes, and thanks for reading!

*Thanks to reader Melinda F. for the suicide stat update!

Today's Assignment 10/31/11

Countless studies reveal the benefits of meditation. It's great for your physical and mental health and well-being. But, as with many things that are good for us, we often don't take the time.

Today's assignment is a quick and easy "walking meditation" that you can do at any point in your day. At some time today, when you're walking in your office, at the store, or at home, take a minute and change your mindset a little. Notice your breath... inhale and exhale with conscious intention. As you do this, as you breathe easily and deeply, focus on your feet and how they feel each time one strikes the ground. Feel the ground support you and help you on your way. Feel your feet working to keep you moving. Each step is a moment of conscious, centered gratitude to the universe.

I know that some of you have sore feet - the bane of modern, shoe-wearing existence. Take that moment to have some compassion and forgiveness for the pain, and some acceptance that your feet are doing the best they can for you.

Walking is a miraculous act. If you're lucky and abled enough to walk, give thanks. If you aren't someone who can walk, but can still get around, that's where to find the gratitude.

Happy Monday. Thanks for reading!

Sunday, October 30, 2011

Today's Assignment 10/30/11

When it comes to politics, my future father-in-law and I are on opposite sides of the spectrum. I delight in doing things like signing him up for emails from the Obama campaign. He returns the fire with an email volley of his own. Ours is a good-natured version of what has become an increasingly polarized political landscape. There's a difference, though. I think we learn a little from each other every once in a while.

It's easy to get swept away in rhetoric, and in defending "your side." When he writes me, I do my best to listen. I very much respect him as a person (his love for his children and his wife is abundant and clear), and I owe him the respect of listening to what he has to say. People express who they are through what they believe, and the world has shaped his opinions just as the world has shaped mine. In listening with an open mind and an open heart, I learn more about who he really is, and about what makes him tick.

Today's assignment might be tougher than it sounds. Take 5-10 minutes and listen, REALLY listen, to what the "other side" has to say. Drop your defensive stance and your exhaustive store of political facts, and just listen with compassion. Listen for THEM, not for YOU. Try this with politics, with religion, with "who was the best Dr. Who?," and you just might learn something you didn't know.

As always, I'd love to hear how it goes!

Saturday, October 29, 2011

Today's assignment 10/29/11

This one is all about appreciation and gratitude. We all have that mental list of people who create things that bring us joy - artists, musicians, writers, and others - and we often don't express that joy directly to them.

Today's assignment is to do just that - write a letter, make a post, drop an email to someone who has touched your life with their creativity. It might be a million-selling author, or maybe it's that woman who sells your favorite jewelry on Etsy. No matter who it is, open your heart and tell them why your world is better with them in it.

Don't expect a reply. This isn't about your need for contact. This about passing along your joy and gratitude.

Say something beautiful to someone who makes your world a better place through their creativity. That's your assignment for today!

Friday, October 28, 2011

Today's Assignment 10/28/11

Take five sticky notes. On each one, write "you're beautiful just as you are, and I love you." Put them in places where you'll see them every day - computer monitor, fridge, bathroom mirror.

People often resist these exercises for being "goofy." I often wonder if that's really where the resistance is.

Many of us have spent much of our lives learning less positive self messages. This is just a little tiny mind hack to start turning that around.

Happy Friday! Let me know how this goes!

Thursday, October 27, 2011

Today's assignment 10/27/11

Send a quick text or email to someone, telling them that you're glad they are in your life. Choose someone who wouldn't immediately expect that from you.

Wednesday, October 26, 2011

Today's Assignment 10/26/11

I've been doing a "Today's Assignment" for my friends on Facebook, and it dawned on me that it would be a lovely addition to the Doc Blog. So, let's go!

Today's Assignment: Listen patiently, with compassion. Don't worry about what it means for you. Think about what it means for them.

Monday, October 24, 2011

More transit stuff!

Even psychologists aren't thinking about mental health stuff all the time.

Well, okay, we are, but in other contexts from time to time. Yesterday I taped a podcast about my mass transit experiences, and today a new guest blog post appeared on a commuting site. Please feel free to check both out, and I'll be back with more Doc Blog Stuff soon!
-jeff

Saturday, October 22, 2011

Ask the Doc - Am I burning my therapist out?

Life has been a struggle for me lately. It seems like all I ever bring into my therapy sessions is an endless parade of bummers. Sometimes I worry that I'm too much for my therapist. Is that possible? Can too many bad events burn my therapist out?

The one thing I can tell you for sure is that you're not alone in your concern. It's easy to see your therapist as someone who is "paid to hear bad news." That feels pretty unbalanced. You certainly don't want a therapist who tells you all of their problems, but it can feel strange to just dump yours on someone.

I can't speak for every therapist, of course, but I've had conversations with plenty of clients who worry that they're bringing me down. Many colleagues deal with the same questions from clients, and we talk about what that means. Sometimes, concern about sharing things with your therapist can be a sophisticated defense against getting to what really bugs you. Sometimes you're just dealing with a social norm that doesn't apply to the therapy setting. Whatever the reason for it, undue concern for your therapist's well-being can definitely get in the way of getting your therapy work done.

I can honestly say that, while I think of my clients and their worries between sessions, I am infinitely more satisfied with the job I'm doing when a client "burdens" me than when they protect me. For many people, that act of "protecting" people is what has stood in the way of their ability to fully experience their emotions. And I firmly believe that until we can accept and experience our true emotions, we can't live a full and balanced life.

If you broke your finger, would you try and protect your physician's feelings by pretending that it didn't really hurt that much? Would you understate your pain so your doctor didn't go home and worry about you? Likely not. While it's okay to show physical pain in our culture, mental pain is a much more complicated subject. And as a therapist, it's my job to provide a comfortable and trusting environment with well-defined boundaries so you can fully experience your emotions without thinking that it's causing problems for me.

I'm much more tired after a day of trying to turn a casual conversation into something worth my clients' time than I am after a fully-connected, fully-disclosing session with someone who is really doing the therapy work. That's what I'm there to do. There's a lot of satisfaction that comes with feeling as though you have really helped someone by connecting with them.

This doesn't mean that your every visit to the therapist should include wailing, teeth-gnashing and the rending of garments. But, if you need to get there and you're worried that it will be too tough for your therapist, it's time to have an open and honest conversation about that very thing during your next session.

Thursday, October 20, 2011

Overcoming your fears

I was interviewed for a post on Lifehacker that ran this morning. Good information from several sources, including yours truly!

If you're here from that post, welcome! Please feel free to stick around for a while. I'm easy to find at drjeff@gmail.com if you've got any questions or comments.

Wednesday, October 19, 2011

Ask the Doc: How much should I email my therapist?

In this day and age, I use email for as much as I can. Sometimes I've got a question for my therapist in between appointments. Should I email her?

Therapists, like pack mules or carrier pigeons, sometimes have more trouble than most when it comes to grappling with modern accoutrements like computers and smartphones. I'm not sure why that is - with 4 teenagers around the house I have had to stay caught up or perish - but it seems like the psychology profession lags a little in this area.

That being said, your therapist should have a well-defined email policy, just like all of her other policies. For me, I draw the line at scheduling via email, and here's why. Email, as you know if you've ever used it (ha!) can be a very tricky medium when it comes to understanding emotional intent and emphasis. My work is all about emotion, and my concern is that one of us will misinterpret something that's said in a letter. Also, establishing an expectation that email will be returned sets up the potential for further misunderstanding. As I've said in the past, it is important to me that I treat all clients the same, and that all my clients understand my therapeutic "frame."

I have had clients express dismay that I won't engage in long email conversations between sessions, because their previous therapist was available 24/7 for them. They'd write, the therapist would respond. Some even continue the conversation after they are no longer a client. This is dangerous ground to tread, given the artificial immediacy of electronic communication, and sets the therapist up for possible ethical violations. Once someone is your therapist, that's their role. Converting clients to friends or confidantes via email is a very slippery slope.

So, in short, scheduling = yes. All other communication, especially therapeutic or just "saying hi," = no.

And, if you have any questions about this post, feel free to drop me an email, because I'm not your therapist. :)

Sunday, October 16, 2011

Real life gratitude practice

Yesterday, my 12-year-old daughter and I were in my car, leaving the grocery store parking lot. As I started turning left on the green light, I saw a white blur out of the corner of my eye. Seconds later, we were crunched by a big white Dodge RAM pickup.


I was glad I'd caught a glimpse of him as he swung around a slower car and tried to make the light. I was able to turn away from the main impact, and my daughter and I walked away, mostly unscathed. She's got no soreness, and doesn't even seem that affected by the wreck. I'm banged up a bit, most likely because I was able to see him coming and that tensed me up.

I write a lot about gratitude here, and I really like to practice what I preach. So, here's what I'm thankful for:

First and foremost, I'm thankful that no one was injured.

I'm thankful that the guy who hit us was covered by insurance.

I'm glad it wasn't my fault.

I'm thankful for the reminder that cars, for the most part, are big scary things. I'll bear that
in mind next time I feel like my light rail commute is taking too long.

I'm glad that I had my car as long as I did. I loved that car. It will be missed. I'm also
thankful for the reminder that things are just that - things. A car can be replaced. People can't.

And, I'm thankful that this unfortunate event has brought me back to my blog. I hope you've missed it as much as I have. Life's too short not to blog!

More soon!

Wednesday, September 28, 2011

Why we say goodbye forever

The date always sneaks up on me. You'd think I'd have it marked down on a calendar somewhere, circled in black maybe. But it sneaks up. This year I was listening Dreamboat Annie and thinking about going to my very first concert at Miles Field and it hit me - today marks 13 years since Greg's death.

I kind of like the word "death" in situations such as this one. I didn't "lose him," because I know right where he is, scattered on the hillside at Ostrich Peak with an excellent view of the Rogue Valley. We're going to go visit him next week, my friends and I. He's not "late," even though he was always late, infuriatingly, chronically late. He wasn't late for his own funeral, but only because as far as I know he had no control over that one.

He hasn't "passed on." He never passed on anything. That, as much as anything else, hastened his demise. For a while, I was there with him, keeping up. Racing with him, shot for shot. Gonzo. After a while I had to get up the next day and could no longer close the place down every night. After a while I drifted reluctantly into adulthood. He tried.

Before I wrote this, I took a walk so I could spend a moment fully feeling that weight in my chest that had started building. I walked out into a brilliant fall day, all crisp and full of promise, and I let the tears come. As I walked across an open field I watched my shadow, cast sharp and black in mid-day. I let my breath lead me through. I gave thanks that I'm still here.

Closure is a myth. I don't want closure. Closure is a word people use when they yearn to figure out how to shut the pain away. I think that the pain is now a part of me, giving some weight to my natural buoyancy, some shadow to the ball of light that sits inside me. We are an assemblage of every breath we've ever taken, every midnight clock-tick, every smile. My grief over Greg's death is a book, shelved and treasured. Today I take it down and hold it. I write. I shelve it again, back in the gap that was left when I pulled it down.

Sometimes now I'll have a client who is in the fresh clawing stages of grief, and I am graced with having been there. I'm made better by my knowledge of how it feels when someone is there one day, and gone the next. I know how it feels to try and make sense of it, and to finally realize that there is no sense, only that mixture of emptiness and eventual acceptance.

I'm grateful to know how that feels. Thank you, my brother. I'll see you soon, next week on the hillside. I'll tell you then, too.

Sunday, September 25, 2011

How much should my therapist talk about himself?

One of the joys of my job is helping to train new therapists. Every fall, our clinic hires doctoral students to work with us as trainees, and I have the pleasure of helping to supervise them. New therapists consistently ask questions about some of the things that we struggle with in our profession - "how do I deal with suicidal clients? "What do I do with a client who won't let me get a word in edgewise?" And, "how much should I tell my client about myself?"

We call this "self-disclosure" in therapist parlance, and it's an ongoing question for therapists. I've worked with clients who have told me of therapists they've had who couldn't shut up about themselves, griping about family issues, medical problems or just day-to-day crap. As you can imagine, their clients started to feel bad about bringing their problems to such "troubled" people.

A more common issue for trainees, and for all of us in the field, is whether to do any level of personal disclosure. As we hear about things our clients are experiencing, we're invariably reminded of our own lives. As we listen, we are weighing the costs and benefits of sharing that we've been through the same things. Will it help my client if I tell them that I, too, have lost a friend? Would they be dragged down or elevated by knowing that I've had similar problems?

For some therapists, depending on their theoretical orientation, self-disclosure is the antithesis of what they are in session to do. For some of my colleagues with a psychodynamic bent, their job is to remain enigmatic so their clients can project onto the therapist all the things in their subconscious (note: this is a drastically oversimplified depiction of a very complex process - work with me here!). And almost any therapist you see will limit what they say about themselves - it is, after all, your hour, not theirs.

When my trainees ask about self-disclosure, I start with my very simple rule of thumb - am I doing this for my client, or for myself? If my theoretical stance and my relationship with my client dictate that it would helpful for them to know that I've suffered similar tragedy, or that I have children, or whatever else, I'll carefully share. If I'm telling them that I saw their favorite band from front-row seats, does that do anything other than show them how cool I am? I'll hold that one back.

As I think about it, I apply that rule to everything I do in therapy. I filter my words based on whether they are about the client, or about me. One of our basic ethical principles is that of nonmaleficence, of doing no harm to the client. While it's a stretch to say that telling someone about my life while they are seeing me for therapy is harmful, it certainly isn't helpful. And, any time of theirs that I take to work out my own stuff is time that they could have spent working on theirs.

Next time your therapist makes a personal disclosure, think about that rule of thumb. If you find that you're working with someone who is disclosing to help themselves, maybe it's time to at least have a conversation about their habit. If that kind of self-disclosure persists, it may be time to move on.

Thursday, September 22, 2011

One minute to putting extra love into the universe

Over the course of a day spent seeing clients, no matter how much I try and remind myself to keep my mouth shut and listen, I invariably say a lot of things to a lot of people. Like all people everywhere, there are some things I say more than others. "It takes time" is one. "What do YOU want?" is another. And, "Put some extra love out into the universe, and you will get more in return."

I say this thing about extra love because I believe it. I've seen it work, over and over. I'm a dedicated believer that love and positivity, given freely without expectation, will come back to you in quantities greater than you could imagine. Naturally, some of my clients are skeptical, as they have a right to be. And many simply want to know HOW.

As with my post about one minute of gratitude, there will not be a test after this. There's no right or wrong to putting love out there. And as with anything worthwhile, it takes practice and perseverance. Practice is the fun part - you get to make people happy! Here's a little list of ideas to get you started.

Pay someone a genuine compliment. Compliments come in many forms. Obsequious, empty flattery usually feels as hollow to the receiver as it does to the sender. A genuine compliment, on the other hand, especially an unexpected one, can make someone's day.

Give a genuine smile. Try this sometime - pretend like you've been given 5 smiles that you have to give away in the next ten minutes. Take a walk downtown, or through the halls of your workplace, and give those smiles away while looking people right in the eye. This works best on people you don't know. I realize that there are places in which a random smile from a stranger might not be acceptable. Choose somewhere else, and give those smiles away.

Give someone a hand. Offer unsolicited help. If you see someone engaged in a mundane task, see if they could use some assistance. Carry something for someone. Open a door. Watch your neighbor's kid so they can get a peaceful cup of coffee (as a parent I will tell you that this is worth 4000 Karma Points).

Give thanks. Heartfelt gratitude is an amazing, contagious thing. If your boss makes your job a nice place to be, let her know. If your spouse does a routine, daily task, thank them.

Tell someone that you're glad they exist. I love this one, and practice it regularly. "I'm happy you're in my life" is something that people never grow tired of hearing. Call someone out of the blue, and tell them exactly that, for no reason other than the generation of extra love.

Let someone know that they're on your mind. "I thought of you today" is another lovely present to offer someone. As I've discovered in my work, people are often surprised to learn that you've been thinking of them.


Most of us have been raised to offer conditional gifts - "I gave you that, what are you getting me in return?" The act of giving without expectation does take practice, but it's the kind of practice that feels good, even if you stumble a bit. Fill your world with unconditional love, and watch it bloom into something life-sustaining.

Monday, September 19, 2011

Ask the Doc - Will my professors know I've been to the counseling center?

I just got this question in my email, and it's one of those basic questions that a lot of people ask. It's about a really important question that is at the heart of the therapist/client relationship - confidentiality.

Q. If a student goes to a counselor/psychologist ON STAFF at the college, does it get put into their academic file? I guess what I am asking is, can it be held against them? I think we have a counselor at my college and I've been thinking about it but what if my professors decided it meant I am not a good candidate to work in my chosen profession? I can't risk that.

A. The good news is that you don't HAVE to risk that. On your first visit to your counseling center (and to just about any other place you'll go for therapy) they'll take a few minutes to explain your rights of confidentiality. In short, they won't let anyone, even a family member, know anything about your time there - not even whether or not you've ever been seen. When someone calls my clinic and asks about a client, we say, "I'm sorry, I'm not allowed to confirm or deny whether that person is our client."

So, if your professor, your dean, or your mom calls the counseling center to ask about you, they won't get an answer unless you've signed a specific release that expressly permits the center to give out information about you. Those releases are very specific for a reason. It could be that you want your mother, but not your father to have information. Or it could be that you'd like it shared with a professor that you've attended counseling, but nothing beyond that.

As for your records, the same thing applies. Without your written permission, no one but counseling center staff can look at your file. At our counseling center, the medical staff isn't allowed to look at your records without a release of information. This varies from clinic to clinic, so be sure to ask. Your therapy records will never be combined with your academic records. In addition, colleges have FERPA rules that cover confidentiality of academic records. Ask your registrar about these rules.

There are exceptions to the confidentiality rules, and those will be explained to you as well. The short version is that if you are imminently at risk of suicide, or have identified someone you plan to hurt, confidentiality may be breached. In some cases, abuse of an elderly person or a minor may be reported as well.

It is important to note that just talking about suicidal thoughts will NOT trigger this breach of confidentiality. It is important to us as clinicians that you can be as honest as you need to be about how you are feeling. Only if we feel you may complete suicide if you walk out of your session will we break confidentiality. Even then, we do everything we can to stop short of that. Confidentiality is one of the most important things about our relationship with our clients, and we'll do everything in our power to maintain your privacy and security.

Saturday, September 17, 2011

Ask the Doc - What should I do when I see my therapist in public?

Q. - I was out for a drink the other night, and saw my therapist at a nearby table. Should I have said hello? Should she have waved? What are the rules for this kind of thing?


A. - I work at a small college. A walk across campus often puts me in the path of one of my clients. Sometimes they are alone, but more often they're with a group of friends. And even though I live in a city that has over a million people in the metropolitan area, I see clients out and around more often than you'd think.

This is one of the times that my usual social reactions aren't necessarily the best solution. While I am happy to say hi to a client, or stop and chat if they'd like, I'm aware that they might not want to answer their friends' questions about who I am (or more likely, "where do you know that old guy from?"). Some of my clients proudly tell their friends that they're in therapy; others feel that it's between them and their therapist.

With this in mind, I've got a simple rule of thumb - I just ask my clients to say hello first. We talk about this during our first session, as part of our "informed consent." That way, if they'd like to chat, they can let me know that in a comfortable way. If they'd like to keep our relationship on the down-low, they can do so just as comfortably.

As with everything in our therapeutic relationship, I want things to be about them, not about me. And my desire for social interaction is just that - MY desire. I want them to be able to choose. After that first public encounter, we'll talk about in our next session. My clients will often let me know that it's fine to say hello, and I'll do so next time. That should be YOUR call with your therapist, not theirs. No matter what your decision, it's important that you have the power to choose.

Thursday, September 15, 2011

Obligatory "holy crap haven't posted in a while" entry

Hi folks!

Have no fear, Doc Blog is up and going strong. I'll be back this weekend with some new posts, and then should likely be a little more frequent after that. Thanks for your patience!

-jeff

Thursday, September 8, 2011

One minute to let go of guilt

Hey, busy person! Have you got a minute? Forgo that last quick click over to Facebook, and let's spend that minute on something a little longer-lasting.

Step one in today's plan is to go read back over my post about one-minute forgiveness. Letting go of guilt is really about self-forgiveness and self-acceptance. I know, not an easy task, but let's at least get started practicing. It comes with time.

Again, we're going to find a comfortable spot, even if it's your office chair with the door closed and the lights dimmed. Give this the room and respect that it deserves. A minute of guilt reduction might make your day go by easier. I know for a fact that it won't hurt.

Breathe. So simple. Such a key to so many things that we do for ourselves. Your breathing helps to center you - it helps to bring you back to where you started from. Simple, slow breathing, the soft beating of your heart, the quiet... relax into this. Sometimes I visualize the aftermath of an explosion, or a fireworks display - watch as you inhale and all of those scattered bits come back to you, make you whole and centered again.

Letting go of guilt is an act of self acceptance. Guilt is rooted in our comparison of ourselves to a perfect ideal - we're punishing ourselves for doing something wrong. Guilt runs deep, and most of us are trained to do this from a very early age. Guilt is well-modeled in many families as a way to modify behavior. We internalize it and use it against ourselves.

Find that little point of guilt - let's start small! - and notice it. Observe it. Describe it. Look at it without judgment. "I see that I am guilty about yelling at my child when I dropped her off at school." Nothing beyond that. No "why did I do that?" No "that was shitty." Just the simple observation of the fact that you feel guilty.

Now the fun part. That act that you feel guilty about? It's over. It is now out of your control. If you want to, you can apologize for it some time in the future. You can resolve to never do it again (hey, you're human - in all likelihood, you'll do it again. Accept that!). But, in this moment, in this breath, you can forgive yourself. You can accept your humanity and your imperfection. And you can LET IT GO. Visualize, if you'd like. That guilt can be a stone that has been warmed too long in the sun, and it's burning your fingers. Put it down. Holding it tightly is not doing you any good. Put it down and let it cool. Accept it as it is. Flood it with love for its natural beauty. Direct that love at yourself. You're human. You're beautiful. And in this moment, you accept and forgive yourself, because in this moment that is your only task.

Forgiveness, you'll find, is often something more easily practiced on others than on oneself. This is the way we're built. Self-compassion is frowned upon in many ways. With a little practice, though, we can reveal that oppressive social training for what it is, and we can relieve ourselves of some of the unnecessary burdens we carry. Accepting responsibility can be a very positive thing. Punishing ourselves for doing something "wrong," long after the fact - not so much.

Try this, more than once. And, if you miss a day, try not to feel too guilty about it. :)

Monday, September 5, 2011

Is it a bad idea to cheer someone up?

I've written from time to time (including this post about memorializing him) about the death of my best friend, as it was one of the formative experiences of my life. I learned a lot from his demise, and carry many of the memories with me to this day - and I use a lot of those lessons in my job as a therapist.

One of the most important and long-lasting lessons I learned from that terrible time was that it's not always such a great idea to try and cheer someone up. I heard so many versions of "it's going to be okay!" and "he's in a better place!" and "it's all part of God's plan."

What I didn't hear, at least until his brother said it to me, was "Wow, you must really be hurting. You guys were so close." And that was exactly what I did need to hear. I figured out quickly enough that the people who were trying to cheer me up were doing it mostly for their benefit, not for mine. I'm a cheerful guy. Seeing me grieving threw them off. It made them feel weird, and they wanted me to cut it out. They weren't being malicious about it, or likely even making a conscious choice - but it was clear that it wasn't okay for me to just be there in my grief in front of them.

Going through that has changed what I do when someone is showing emotion. Greg's death came as I was training to be a therapist. Maybe that was his gift to me - his passing solidified and made real the lessons I had been learning in the classroom. No longer was I in a hurry to cheer someone up, and that holds true today both in the therapy room and out.

A simple "you sound sad" or "looks like things are tough for you right now" can really help someone just expand into that space where they're holding their feelings. No need to ask questions ("are you all right?" puts someone into their head as they try to figure out an answer - "you look sad" lets them stay in their heart). Simply let someone know you see them, and you are okay with what you see. This is another one of those easy "therapy tricks" that you can bring into your everyday life to help you strengthen relationships and open yourself to what's really going on with people.

Next time you feel the urge to cheer someone up, ask yourself whether you are doing that for them, or for you. And, make the conscious choice to let them feel what it is they need to feel. In the short run, it may be a little uncomfortable until you get used to it. In the long run, you'll find out how satisfying it can be to give people such a simple but powerful gift.

Friday, September 2, 2011

The Sad Faced Girl

My daily commute is a long one. I bring a book, I listen to music, I tweet and Facebook and blog and email and stumble upon things, but it's a long ride in what amounts to a moving tube full of interesting people. Like everyone else, I look around to see who my neighbors are. I'm a psychologist, and when you're a psychologist if you don't have a natural interest in people you're going to be a very bored psychologist in a very short time, and I'm anything but bored. I love studying people's faces and thinking about their stories. I don't "analyze" them, as people always seem to fear, but I like imagining what they're like and where they're going.

The first time I saw her, she was in the car ahead, obscured by dirty MAX windows and the vibration of a moving train. It was early, and I was just sort of glancing up from my book, and I saw her.

I saw the Sad Faced Girl.

When I was in grad school, learning to be a therapist, I had a classmate with a naturally sad appearance. This classmate was warm and witty and full of life and just cursed with a visage that evoked a feeling of moderate despair any time she looked at you. Not a great package for someone who gets paid to listen to bummed out people, and to this day I wonder if she ever made it in the psychology world. My guess was that she would eventually leave the profession and take up something more physically appropriate, like delivering funeral wreaths or telling people that they've been elected Speaker of the House.

The Sad Faced Girl makes my old classmate look like a smiley-face icon. She's so imbued with this classic, heavy sadness that I envision her face framed by the cold stonework of a medieval tower, her gaze longingly sweeping over the land from which she's been exiled. In my imagination, she has experienced a terrible loss, her heart heavy with it, her entire being slowed to a near crawl, her existence reduced to the experience of Olympic-quality mourning.

The next time I saw her, she was in the same car as me, facing forward, eyes closed. She was listening to music. I could only imagine the music - some dark minor-chord bereavement, bagpipes or maybe just a recorded voice intoning a list of victims of some horrible disaster. She looked tired, she looked downcast, she looked... sad.

A few weeks later, she boarded the train and sat right across from me. I understand the rules of commuting, and despite my urge to plumb the depths of her soul, I held my counsel and just cast a furtive glance once in a while. Her face was clear-skinned and pale, framed with wispy blond hair. Her eyes sparkled with intelligence. Her upper lip, though, was a genetic gift if one wanted to look permanently dysthymic, her Cupid's bow deeply indented, curling the rest of her mouth into a melancholy curve. Like my grad school classmate, she was destined to look sad no matter what she felt like on the inside.

The Sad Faced Girl's big secret was that she probably wasn't sad at all.

I tried once or twice to coax a smile from her as we rumbled through Orenco Station or the Beaverton Transit Center. Like all well-versed MAX riders, though, I knew better than to spend my time leering at her like a fixated schoolboy. Respect for personal space and for the eye-contact boundaries of others is one of the things that allows us to ride along, packed like slices of bread, and to pretend as though our arm isn't rubbing that of a stranger.

I see her now, every once in a while, and resist all attempts at diagnosis. Sadness, maybe not, but Sad-Faced? Severe. Chronic, with no inter-episode recovery. And she's fine just like that.

I wonder how I look to her.

Wednesday, August 31, 2011

One minute of forgiveness

In my line of work, I hear a lot of awful stories of transgressions that people have had visited upon them. Neglectful parents. Relationships ended by acts of betrayal. Friendships rendered apart by a moment of thoughtlessness.

As a therapist, I invest a lot of time "joining" my clients, walking in their world as much as I can. Just like them, when I hear about these terrible things my first response is a defensive, protective one. How dare those people do that! (Please bear in mind, this happens on the INSIDE. I don't tend to blurt these things out. That's another post for another time.)

When this happens, I usually realize that I need to take a step back and gain some balance. And when I gain that balance, and a little more clarity, it often becomes apparent that my client could benefit from an act of forgiveness.

Forgiveness is not something I foist easily upon someone. The act of forgiveness can be complicated endlessly by emotion, by habit, and by a lack of understanding the process. Before I lay that on someone's head, we make sure that forgiving isn't just a way of avoiding the emotions underpinning the situation.

No matter the complications, though, true forgiveness can be an amazingly powerful act. And, just like the one-minute reboot and the one minute of gratitude I posted about before, it can be a simple and energizing thing to do in your day. Here's how.

Find that spot you found for your one minute reboot. Get comfortable. Breathe. As before, observe what comes up for you, and then let the thought go. Worried you're doing it wrong? Observe that worry with kindness, and put it back into the stream. Soon, something will come up that you resent, or feel wounded about. Trust me on this one. If you can't find one, stop reading this blog. You're actualized! You made it!

Still reading? I thought so. Now, take that little grudge and let's hold on to it for a minute. If it's a huge one, a life-altering transgression, let it know that you'll be back after some practice, and let it go down the stream. We'll start small. Take the little grudge (that person who cut you off in traffic is a great start) and observe it. Observe the emotion that comes with it. And stop for a minute to consider that the act is OVER. It's in the past. You're in the now. That's a good place to be, sitting there in your comfortable spot. You're in the perfect place right now to just let it go. Just focus your compassion, not on the universe, not on your year or your month or your day - focus your loving compassion on that tiny act you hold in your mind. Say it - "I forgive." Say it again. Flood that act, that crappy driver, with all of your compassion. Don't worry, you'll make more.

And, just forgive. It's a radical act of acceptance, and when you practice it, it gets easier. Just like all the one-minute things in the world, they take some repetition. If your only act of forgiveness today is forgiving yourself for being crappy at forgiveness, so be it. You forgave something after all!

If you have to read this a couple of times to get it right, that's okay. I forgive you.

Monday, August 29, 2011

One minute of gratitude

I got so many nice responses to my one-minute reboot that I thought I might try to make a semi-regular thing out of one-minute ideas. Today: One-minute gratitude.

As you may have guessed, it's a pretty simple process. I'm of the opinion the simplest processes are the ones that have the most profound impact. Rather than complicate them with all that messy cognitive interference (aka "thinking!"), they touch something basic within us.

Here are the steps. There will not be a test at the end.

1. Find a quiet spot.
2. Breathe deeply.
3. Give thanks for something.
4. Breathe some more.
5. Reluctantly leave your quiet spot, but promise it that you will return!

See, I even gave you some exit instructions.

Gratitude is a process that we tend to muck up with our emotional reactions, our learned prejudices and assumptions, and all kinds of other stuff. Like the one-minute reboot, the trick is to let go of the judgment and just be simply thankful, without a reason or an explanation. If your shoes feel good, flood them with your loving gratitude. Good hair day? That works fine. Someone did something nice for you? Direct your uncomplicated flow of love and gratitude their way.

As the complications come in, be grateful for your mind's ability to produce such complicated loveliness and then let them GO. Return to that powerful stream of pure thankfulness. Let it wash over you. Pick a color. Is gratitude green and vibrant? Is it muted and smoky? Plaid? Your choice. Envision it touching the object of thanks, if you want. Let your pulsing blue river of gratitude flood over that guy who held the door open on the bus. See it however you'd like.

The point isn't to do it right. There is no point, really, other than being in that moment of thanks, touching it, letting it become a part of you.

One minute! That's all. No goal. No way to do it right. Just an opportunity to do it.

Let me know what you think!

Sunday, August 28, 2011

7 things to do during your first therapy appointment

I have a friend who is returning to therapy after a long time away. She's understandably a little nervous about the whole thing - one of the things I always try and remember is that even though therapy is a comfortable situation for me, a first visit is often anything BUT for my clients. She asked for some ideas about what to do, and what to expect, on a first visit. Being the accommodating type, here they are!

1. Spend a little time preparing. Sit down with some paper and a pen (whoa! Old-fashioned! Keyboard, tablet or phone works just fine, as well) and do a 5-minute free-write about what is on your mind, and about what your therapy goals are. Or, make a thought map by writing random words with your non-dominant hand. Free-associate. Make a spreadsheet. Bake a cake and pipe your goals onto the icing. The point is, rather than just walking into the therapy room and going "oh, uh, what now?" just invest some time in thinking about what you want out of this therapy thing. It is ABOUT YOU. Let's repeat this - therapy is ABOUT YOU. One of the things that makes people nervous about therapy is wondering how to do it right, or how to please the therapist. This will result in less progress and more frustration. Quiz time: Therapy is about ___. Right!

2. Realize that your therapist has some basics that need to be covered. We all do it a little differently, but we all have some things we have to take care of. You'll go through a process that we call "informed consent." This is an ethical obligation of ours. You'll be told about your rights of confidentiality, and about times that your therapist might need to break confidentiality (short version - life-threatening emergency, imminent suicidal risk, some court-related things that most likely won't happen to you). Your therapist will hopefully explain his or her policies about attendance, cancellation, etc. At some point, they'll do a risk assessment, in case one of the reasons you're in therapy is due to suicidal thoughts or intentions. At this point, if you have questions, ask them. It's always so refreshing when someone asks questions after the informed consent process!

3. Get a feel for the relationship. This one is a little tougher to explain in words. As I've said a few times around here, and will say a lot more, the relationship is critical to getting good therapy work done. If you are uncomfortable, don't feel safe, or just don't feel that connection, you're really going to have to force the work, and that's not what you're paying for. Sometimes it is immediately apparent that your therapist is not the one for you - in that case it's absolutely fine to simply say "I don't think I'm going to return" at the end of the session. "We just don't click" is not a bad thing for us to hear. I'd so much rather hear that than struggle through a few sessions with a client who is obviously not feeling the connection. If you're into humor, tell a joke or see if your therapist tries to. Some people want a concerned mortician to talk to. None of my clients are those people. It might not be a night at the comedy club, or a conversation with your best friend, but you'll know if it feels right. If it doesn't, then one and done is fine.

4. Go ahead and trot out that "one thing." Yeah, easy for me to say! I have this theory that everyone has at least one thing that they're sure nobody can accept, or they've been conditioned to think that it's bad or wrong. At least one. I've gone months with people before they've told me that they spend the majority of their time off going to swing clubs and being bound and gagged, or that they're Republicans, or, you know, whatever. And after they tell me, things shift. They've gotten That One Thing out on the table, I've accepted it, and we've moved on. You don't have to spend the entire session talking about the fact that you've lost your last three jobs due to your obsession with Papa Smurf, but maybe just drop a hint. Your therapist will be okay. If your therapist is not okay, and gasps disapprovingly, GET OUT NOW. Really, don't even wait until the end of the session. Therapy is where That One Thing is something that can be talked about. That One Thing is a part of you. A good therapist values all of your parts.

5, Set some goals, but realize that things change. Sometimes one of my clients will express amazement at my lack of whiteboard, or the fact that I haven't made a goal list and set deadlines. Here's the thing: So many times, a client will tell me what they want to work on, or what their goals are, and when I go back at the end of our work together, those goals have been left far behind, abandoned for whatever has become more important to them. Figuring out how to survive your crazy boss suddenly becomes a non-issue when your boss gets hit by a meteorite (okay, no personal experience with that one). Lives change. Minds change. Superficial goals are replaced by the ones that you find when you start to find yourself. This is one of the most beautiful things about therapy work. Come in with your list, but be prepared to burn it ceremonially, or maybe just chuck it in the shredder.

6. Make sure your therapist checks in. A good therapist will check at the end of the session, and throughout your work together, to make sure you are feeling comfortable (or at least aware of why you are uncomfortable) and safe in session. They will assess in an ongoing basis how you are doing on your goals, whether you are making progress, and how you feel about the therapeutic relationship. If you finish your first session, and your therapist doesn't at least ask if the match seems okay, then listen for it at the beginning of your next session. If they skip past this, then ask them why. Some therapists, believe it or not, have a tough time with some of the necessary work of building the therapy relationship. Make sure that your therapist isn't one of those.

7. End with some adjustments. Screw up your courage and make a suggestion or two. "I'd be more comfortable if we could spend more time chatting at the beginning." "I noticed you checking your watch and wonder if that's necessary." "I realized that I don't really want to talk about my mom yet." Whatever you've got. Hopefully your therapist will do number six above, and give you some time to just relax and reflect on that first session. If the two of you can do that together, you're on your way to good work.

There are plenty more suggestions all over the internet, if you'd like to do some more reading. That counts as preparation! The bottom line is this - you should feel respected, listened to, and be in an environment that feels safe and non-judgmental. You are by far the best judge of what works for you. Stay open, breathe a little, and take that first step on your journey.

Saturday, August 27, 2011

Is it really that easy to Just Do It?

Today's email brought news of another study about the impact of exercise on depression. This one was conducted by the University of Texas, seems very well-designed, and the upshot is that exercise works just as effectively as a second medication for folks with long-term depression. The trend among prescribers is to add something like Abilify to a current SSRI (Paxil, Prozac, etc.) for their patients who have depression that's not responding to just one med. This study shows that there is another way for many people to have the same result, without an extra med. Around half of the people who added regular exercise to their SSRI improved significantly.

So, you say, why don't I just tell all my clients to exercise?

The answer, as always, is that it's just not that simple. While I am keenly aware of the benefits of exercise, and try try try to add it into my lifestyle (No, really, I try!), it's not as easy as simply suggesting it to someone as though they've never heard that idea before. Can you imagine that there's someone left in the U.S. who hasn't dealt with a daily barrage of messages about their size, their laziness, their lack of motivation, their inability to look like people on TV? This is where my job gets complicated. Again.

The act of fostering change is one that we spend all our time in graduate school trying to figure out. And then we go into practice, and we learn a little more, and we keep trying. We get a dozen years of experience under our belts. And we are faced with a client who, for all we know, would make rapid improvement with exercise. And our years of experience sit there in our heads, mocking us.

While there are some who benefit from the boot camp approach, I'm guessing that many of them aren't overcoming serious depression, or a life of parental shaming, or a daily battle with body image. Screaming at my clients to "just do it" might benefit a couple of them, and damage my relationship with the rest. Mine is not really to urge, or cajole, but to join with my client in a process of discovery - how do I really feel when I resist exercise? What are some thoughts about my body that I might want to choose not to believe anymore? Is there a gentle experiment I can do, one without a failure component, that will let me try something new in a safe way?

Unlike the trainer at the gym, my job isn't to goad you into getting your workout done, no matter how positive the results may be. My job is to help you realize that no matter where you want to go, you've got to start just exactly where you are today. Judgment doesn't change that. Then I work with you to help you find about yourself, figure out what might be in the way, and to stand by and support you as you try out some new behaviors. If those behaviors don't "take," that's just as successful an experiment because we've learned more about the problem. I'm happy to help hold my clients accountable, if they want, by asking them to exercise, and I'm hoping that they'll have a few experiences that show them there's a better way.

There are therapists who will push, and goad, and you can find them by asking if they'll do that for you. In the long run, I've seen my way work more often than not. And, to me, that's reason enough to stick with it.

Thursday, August 25, 2011

And, in other news...

I actually write about things other than psychology from time to time. Here's a story of mine about commuting, at the most excellent Trimetdiaries.com.

Monday, August 22, 2011

Why won't my therapist give me longer appointments?

One of the things I do when I come into work in the morning is pick up the messages from people who have called during the hours we're closed. This morning, there was just one - a plaintive request from a client of one of my colleagues, asking for longer sessions. The client said that she felt she could do more with more time.

This is not an uncommon request. My clients will ask from time to time if we can meet for two hours instead of one, or go 15 minutes over, or any stretch of extra time, because they feel that we're ending while they still have something to say. I understand that, and I think there's all kinds of merit to the desire to do more work in therapy.

Here's the problem, though, from your therapist's perspective. If I do that for a client, should I do that for all my clients? If one of my clients finds out what another one is doing (and, in my job in a college counseling center, many of my clients know each other) how will they feel? Of course, I can't talk to any of my clients about what any of my other clients are doing - but they'll know. And they'll wonder why someone is getting special treatment when they're not. And this will color our work together, at least for a while, and maybe distract from the other good stuff that we're getting done in session.

Incidentally, one of the hallmarks of therapists that are sliding towards an ethical violation is doing special favors for one client above all others. Keeping later hours when they'd usually be headed home. Coming in on a weekend. Allowing that client privileges that no one else is getting.

I'm very sensitive to this, and I work hard to keep the "therapeutic frame," that container that helps our work together feel safe and consistent. If I find myself favoring someone, or feel like I'm NOT doing something for someone that I'd do for someone else, it's time for me to sit with that and figure out what's going on.

For your therapist, the work continues after the clients are gone. We need to make sure that we're centered, available, and doing everything we can to clear out those hidden prejudices and acts of favoritism. From the outside, it might just look like 15 extra minutes. From my perspective, it feels like a lot more than that.

Not all therapists are with me on this one, and I know of some folks I very much respect who give extra time to some folks. I've done it myself, when the clinical need was strong, once or twice. Those instances have been few and far between, and I've had a good conversation with myself, and then my client, about the reasons behind the shift. As will all things involved in being authentic and human, sometimes the little things mean a lot more than we think.

Sunday, August 21, 2011

Decision fatigue

Here's a great story in the New York Times Sunday Magazine about decision fatigue, stuffed full of fascinating research and anecdotes about the countless decisions we face each day. It's a real eye-opener, and the bottom line is that there are some basic brain functions that we should really pay heed to if we're making an important decision. The final quote says it all - “The best decision makers are the ones who know when not to trust themselves.”

Check it out if you get a minute, and see if it applies to you.

Five tips for finding a therapist, from a therapist

According to Google, this is online article number 1,630,001 about finding a therapist. Rather than be daunted by that challenge, I'm going to choose to ignore the other 1.6 million and give you some tips that I hope will help you wade through the mass of information.

1. Take a deep breath and start NOW. Therapy goals are often long-term goals, and we're not so good with those in terms of self-reward. Looking for a car means you get a new car. Hunting for the best vacation spot means you get to go somewhere soon. Get comfortable with the idea that you're putting effort into a long-term investment, and put at least as much effort into your search as you would into looking for the best price on a new computer. The benefits of good therapy last far longer than anything you can buy.

2. Like shopping for pants, comfort of fit is everything. We've all bought pants a size too small, just knowing that we'll soon be able to fit into them. Therapist-shopping is like that - many people cut the uncomfortable search process short as soon as they find someone they think they can live with. Some "how to find a therapist" articles warn AGAINST comfort of fit, saying that if you're too comfortable, all you'll have with your therapist are chit-chat sessions. My clients will likely tell you that I'm a pretty comfortable guy to hang out with, but when it comes time to do the work, we don't hold back. Without that welcoming safety net underneath, nobody wants to go up on the high wire. Most people will do more work, more quickly with someone they are comfortable being around.

3. Good therapists are good at recommending good therapists. Ask your friends if they know a good therapist, or if they know someone who does. Get the list of therapists from your insurance company. Then ask your friend's therapist if they know someone on the list. Or, if your friend's therapist is so great, go to them! I work in a college counseling center, and many of my clients know other clients of mine. It has no impact at all on our work. Confidentiality rules and general common sense forbid me from even acknowledging that I see your friend, much less say a single word about our work.

4. Don't let location make up your mind about who to see. The college I work for is in the sticks, location-wise. Many of my clients tell me that they value the drive (or bus ride) there, because it gives them time to think about what they'd like to talk about. And the ride home gives them time to process what just happened. A therapist five minutes from you is convenient, but if you land one of those build some time into your schedule to process your session, right after your session. Trust me on this one. You'll consolidate your gains and make more progress that way.

5. Know the difference in degrees and licenses, but don't let that make up your mind for you. In Oregon, psychiatrists and psychiatric mental health nurse practitioners prescribe meds and do some therapy. Psychologists do testing and therapy. Licensed professional counselors, marriage and family therapists, and other master's-level counselors do therapy. And there are a raft of other practitioners. If you have questions about someone's credentials, ask. I know people with a year of therapy experience that I'd recommend over others with a dozen years (if I could). Some have it and some don't. Experience helps, but it is definitely not the only thing to look for.

5a. See number 2. Relationship is everything. Look until you find someone with whom you can be comfortable and open.

Okay, add that one to the pile of 1.6 million other resources out there. Keep up the search - the rewards are great. And if you think you've found someone and you find you just don't fit, see my post on firing your therapist. It happens all the time!