O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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The Present Moment and Transformation

Mindfulness and transformation.Research reported in the respected journal Science, in an article titled “Just think: The challenges of the disengaged mind” by Timothy D. Wilson et al. (345, 75 [2014]), presented results summarizing 11 studies where participants were first given an electric shock; all participants admitted that the shock was unpleasant, and said they would pay to avoid it. Researchers then asked the subjects to sit in the empty room and entertain themselves with their thoughts without cellphones, iPads, or other distractions. There were only two rules: you can’t get out of your chair, and you can’t fall asleep. Participants did have the option to press a button and receive a shock again.

The mind is its own place, and in it self

Can make a Heav’n of Hell, a Hell of Heav’n.

 John Milton, Paradise Lost

 Very much to the researchers’ surprise, the study found that 70% of the men and 25% of the women chose to shock themselves instead of just sitting there with their thoughts—remember, for no more than 15 minutes.

Researchers ran the test in a lab with college students, but also with older subjects (recruited from churches, farmer’s markets, etc.) in their homes, and they tried to replicate the study with a wider sample of people minus the electric shock. They found that these folks also had difficulty sitting still for 15 minutes alone to entertain themselves with their thoughts. Over half the people admitted to cheating by using their phones. The majority said that hated the experience—it was boring.

What is going on here? Why is it so hard to entertain ourselves with our thoughts that people will actually resort to painfully shocking themselves just for something to do? Why not just stay in the moment and wait it out? Partly, reflecting back and looking ahead are just human nature, something our big brains allow us to do and a big reason for our evolutionary success. Because we can think ahead and formulate goals, or review the past and learn from it, we can accomplish stunning achievements like writing novels, building bridges, and curing diseases (not to mention more ordinary but still essential accomplishments like saving for retirement). But that’s not the whole story.

While being past- or future-minded can have benefits, it’s clear that mindfulness—staying in the present moment—offers essential benefits as well. The present moment is the only one that truly exists. It’s only in the present moment that we can feel peace, fulfillment, and harmony. And it’s only in the present that we’re free to choose. That’s why people meditate and why so many religious traditions include some kind of mindfulness exercise.

But researchers in the study found that even subjects who had experience with meditation and mindfulness found it only slightly easier to sit still without distraction. I’ve found this in my own practice. When I explain mindfulness to my psychotherapy clients, they understand the concept and its value on an intellectual level, and may even experience a sense of pleasurable release during some meditations. Even though my clients have come to me for help in dealing with life’s burdens, and even though they get good results from meditating, it’s still not easy for them to practice mindfulness regularly.

So, what comes up for people when they sit alone with their thoughts? We experience restlessness, discomfort, boredom, and irritation. Sitting in stillness, letting moments come and go and staying with the quiet space, gives room to encounter the self. We come face to face with our anger, our envy, our jealousy and our pride. Those feelings are unpleasant and it is easy to want to be quickly rid of them. Switching the channel in our mind to a diversion such as a show, a game, or a piece of chocolate cake takes us temporarily away from the difficult emotion. We don’t want to feel like a jealous person, for example, because that gives way to other feelings such as guilt—which makes us feel worse. Our self-concept takes a beating when we give it time in the quiet moments.

But if we are to enlarge our Self and be fully alive, we have to face the darker sides. As Goethe writes in “The Holy Longing”:

 And so long as you haven’t experienced this: to die and so to grow,

you are only a troubled guest on the dark earth.

To be at home on earth, learn to sit with yourself in the present moment.

 

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Marriage & Acceptance: Crooked Timbers

Perfectionism is a personality trait that can have positive results: perfectionists work hard to get things right and aren’t satisfied with anything less. But people can also make themselves miserable with unrealistic, unmeetable expectations, and this misery expands outward when perfectionist standards are applied to relationships.

David Brooks, a political and cultural commentator for the New York Times, had an interesting take on this concept recently (in response to a blog post by Lydia Netzer).

We are, to varying degrees, foolish, weak, and often just plain inexplicable — and always will be. As Kant put it: “Out of the crooked timber of humanity no straight thing was ever made.”

People with a crooked timber mentality tend to see life as full of ironies. . . . Marriage is ironic because you are trying to build a pure relationship out of people who are ramshackle and messy.

 It is Wiser to Work with the Flaws Than to Expect Perfection

Rather than beginning with the assumption that relationships (or the people in them) should be perfect, it’s wiser to accept that relationships are bound to be flawed, and work with the flaws you have. But what do you do, one of my clients might say when someone’s flaws really annoy you? Does this mean just gritting your teeth and putting up with it?

In a word, no. The key is to change negative perceptions by focusing on good aspects of the relationship and adopting a perspective of “we-ness.” As Brooks goes on to say:

People with a crooked timber mentality are anti-perfectionist. When two people are working together there are bound to be different views, and sometimes you can’t find a solution so you have to settle for an arrangement. You have to design structures that have a lot of give, for when people screw up.

For example, my clients Jay and Becca were fighting because Becca felt that the ideal family always had Sunday dinner together, while for Jay, Sundays meant all-day downtime, just like his father had always enjoyed. For each, Sundays were special, but in very different ways. Jay thought Becca was a nag who didn’t want him to relax, and Becca thought Jay was being selfish and denying their kids the great experience she’d had growing up.

Develop Your Partnership, Your We-ness

I asked them how they could cultivate an attitude of “we-ness” on this issue, instead of defending their positions as obviously right and sacred. What were some relationship-enhancing ways to think differently about the situation?

After some thought, Jay offered “I appreciate how Becca wants to build a strong family with good traditions.” In turn, Becca was able to say “I like how relaxed Jay is on his off Sundays; he has more fun playing with the kids and it’s good for us all.”

Eventually, Jay and Becca could agree on alternating Sundays for the big family dinner. Thanks to their new perspective on we-ness, neither one felt as if they were letting standards down, but rather, developing new ones as a family.

In relationships, don’t let the perfect be the enemy of the good.

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Happiness and Pleasure Born of Reverie and Reflection

Photo credit: Vicki DeLoach

When I was little and living in lush, sweaty Georgia, my mother would take me and my brother out to the lawn and we’d pick delicate white daisies, carefully connecting stems end to end to make a halo or a crown. Secluded from other cares, for me those afternoons before being called to dinner felt eternal, endless. We didn’t ask to watch TV, the only screen available back then. And if we were lucky, the day would turn dusky and bands of lightning bugs would appear, making their mystical dance around our heads, flying just low enough so we could catch a few in our glass jars. I always released mine after a few seconds, hoping they would remember me as kind and come back again the next evening.

Daisies don’t grow in the grass in California where I live now. Bugs do. They crawl up and down gigantic blades in a determined march to get to the other side of the lawn. When my twins were little, we’d get down on our forearms and elbows and watch their surprisingly fast journey. Then we’d roll onto our backs and look at the clouds, finding comical animals, monsters, and castles. Absorbed in our thoughts, time moved much slower than the clouds and bugs. When my husband called us to dinner, we strolled to the house, calm and happy.

Several years ago, we tore up the grass to save water. I don’t see the bugs up close now, but I see the honeybees and hear their sweet music, along with the birdsong.

Long before Gautama became enlightened while sitting under the Bodhi tree, he experienced a calm, peaceful reverie as a boy while sitting under a rose-apple tree in his father’s field. This Buddha-to-be watched the grass being churned in the fields and noticed the bugs being displaced by the plow, some dying and some surviving. Contemplating the transitoriness of life with calm awareness, he experienced the state Buddhists refer to as jhana—a rapture and pleasure born of seclusion from the usual demands of life. This glimpse was lost in memory for many years, until that day under the Bodhi tree when Gautama realized that life brings suffering, yet it also brings a way out.

Meditation is one of the paths that bring awareness, insight, and calm. These states of meditation where the mind is free from craving, aversion, sloth, agitation, and doubt, are experienced when we can be alone without demands of daily life pressing us toward the ever-present distractions that impinge daily. Watching clouds or bugs with nothing on your mind may bring about that first state of meditation, just as it did for Buddha. Taking time with no purpose, but to sit still, listening and observing, may bring surprise and joy.

 

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How Wisdom Emerges from Body-Scan Meditation

 

 In mindfulness practice we use the Body Scan as a way to develop attention and focus on the body without judgment.Mindfulness Meditation: Using the Body Scan as a Focus

Body-scan meditation focuses deliberate attention on the body without judgment or wanting anything to come from it. This isn’t a traditional relaxation method; people may feel peaceful, but they can also feel antsy, impatient, irritated, and hungry. That’s the point: You can experience these feelings, thoughts, and sensations without needing to take them further. Just notice, and then move on to the next part of the body.

With physical pain, for example, our thoughts might go something like this: “My back hurts, that muscle ache could be a spasm or what if it is bone cancer, maybe I should have an MRI, or maybe I need to go to a chiropractor, but that could mean I have to go three times a week, how will I get off work? My wife is going to be mad at me for spending the money, but then, damn that! If I’m hurting, then I need to get out of pain. She has no business keeping me out of the doctor’s office. I deserve to spend money on me sometimes. Just like when I was a kid, and my mother didn’t take seriously the pain in my arm, and it was broken! I went for weeks before she took me to the doctor… ”

The thoughts go on like that. Before you know it, you’re fuming; your body is more tense than when you began. You feel irritation not only at your wife, but your mother, the medical system, the ACA, and your insurance company. You probably feel sorry for yourself. All that strong emotion gets internalized into your pores, your muscles and sinews, and your heart. Your focus on your body ended ten minutes into the 45-minute practice: all you can think about is getting up and googling “back pain.”

A mindful alternative might go like this: “My back aches, oh, okay. It hurts now, that is how it is right now.” And then you rejoin your yourself, and think, “Noticing my right shoulder…noticing the feelings present there…I bring my attention to my right arm, noticing what is there to be felt…” At the end of the body scan, you open your eyes and realize that you have stayed with the practice for most of the 45 minutes. Your mind wandered, but you didn’t end up becoming angry with your partner, your mother, the medical system, and your poor luck.

Living with all our emotions can be difficult. It’s not uncommon for feelings to be transformed into physical sensations that can very possibly develop into an illness. You didn’t cause the illness, but being in prolonged or frequent physical and emotional turmoil puts the autonomic nervous system (ANS) into a constant state of over-arousal, a kind of hyper-drive that leads to difficulty sleeping, tense muscles, fretting, and worry.

In his poem fragment “Eternity,” William Blake wrote about the elusiveness of joy:

He who binds to himself a joy

Does the winged life destroy

He who kisses the joy as it flies

Lives in eternity’s sunrise.

Happiness studies show that no one is happy all the time. In the same way, wisdom is not always with us. We have moments where it all comes together, and then it disperses again. Focusing on the body with awareness is a way to allow wisdom to emerge without trying.

How does wisdom enter in? In the second, alternative, body scan you notice the pain in your back, move on, and finish the practice. You’re more rested because you didn’t get attached to any one thought. Then sometime later in the day, you do a kindness to yourself. You think, “I’m feeling some ache in my back; I’ll listen to my body over the next day and see if I should pursue it further. But for now, I’ll take care to not overdo the wedding, and to come inside and rest.”

That is wisdom. It’s not Socrates, or Jesus, or Buddha; it’s your own wisdom that emerges because of your kindness to yourself, and because you didn’t let yourself go down the rabbit hole of your thoughts.

Below is a thirty-minute Body Scan Mindfulness Meditation. It is one of the first meditations used in Dr. Kabat-Zinn’s Mindfulness-based Stress Reduction class (MBSR) and is also a core meditation used in Mindfulness-based Cognitive Therapy (MBCT). It is best done laying down, with your eyes closed.

Body Scan Mindfulness Meditation

 

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Post-traumatic Stress Disorder and Post-traumatic Stress Injury

 Responding to first responders and PTSD

Responding to First Responders:  PTSD and PTSI in First Responders

Psychologists sometimes treat first responders to an emergency. We may see police officers, firefighters, hospital staff, paramedics, and clergy who have suffered psychological trauma after responding to a natural disaster or critical incident. First responders may come to us to help them with post-traumatic stress disorder (PTSD), substance abuse, chronic pain, depression, and anxiety. Treatment for first responders and their families is further complicated by their access to firearms, which increases the risk of suicide.

The symptoms of PTSD, include hyper-vigilance, insomnia, flashbacks, and nightmares. Another “post-traumatic stress injury,” or PTSI. A traumatic injury implies that the reaction to a critical incident must not necessarily lead to a psychiatric disorder or become a chronic condition. Diagnosing a “disorder” may lead first responders to believe that their reactions are wrong and that they won’t get better. By using the word “injury,” we empower people to feel they have some control over how they recover from the event. In the words of Matthew J. Friedman, executive director of the Department of Veterans Affairs National Center for PTSD: “The concept of injury usually implies a discrete time period. At some point, the bleeding will stop. Sometimes the wound heals quickly, sometimes not. A disorder can stretch on for decades.”

An emergency can present first responders with a critical incident—that is, a sudden, unexpected, unusual event that includes the loss or threat of loss of life. First responders who perceive a threat or trauma can react in significant psychological and physiological ways. It’s important for the treating therapist to understand the meaning clients attribute to a critical incident, which affects how it is processed. Police officers at a violent scene might be excited, afraid, or just wonder about what’s for dinner that night.

Stress, left alone, is neither harmful nor toxic. Whether the stress becomes damaging is the result of a complex interaction between the outside world and our physiological capacity to manage it. – John J. Medina, Ph.D.

Our body’s reaction to stress is partly a matter of what stress we encounter, partly its duration, and partly what the responder brings to the event. Other life events can also play a role in reactions to critical incidents. At least 60% of adults in the United States have experienced at least one traumatic event in their life, such as child maltreatment, interpersonal violence, natural disaster or serious accident. Exposure to traumatic events is a risk factor for depression, substance abuse, and PTSD. When a parent or other significant adult has traumatized a child, scars are left that can re-emerge in adulthood. Depression is the most common effect of trauma. However, most who have experienced a critical incident don’t experience long-term consequences; in fact, only about 7% develop PTSD/PTSI, although the percentage is much higher in the military, at 20-30%.

Trauma response doesn’t come out of nowhere. Most people diagnosed with PTSD have had at least two traumatic events in their life. In a study by John Briere (2012) that attempts to predict PTSD, he found that psychological neglect in childhood accounts for the largest percentage of variance, rather than the threat of physical injury. In treating clients with PTSI, it is important to explore the particular incident to which your client’s reaction is tied.

Betrayal for first responders takes four forms: administrative, organizational, personal, and community. An example of betrayal is keeping the first responders locked in a debriefing room, away from press and victims while investigations proceeded—with no provisions made for food or water. This constitutes an institutional failure, or as psychologists would say an empathic failure, and compounds the trauma. In the aftermath of catastrophic events, sometimes the most obvious way to support a traumatized worker is to take care of their physical needs.

Another kind of institutional betrayal was failing to protect a first responder from the press—for example, allowing private observations to be publically recorded. Such inattentiveness and lapse of judgment serve to make the primary trauma much more complex by re-opening wounds from childhood that, when coupled with intense life-threatening trauma, can lead to PTSD or PTSI.

In treating trauma, it is important to:

1. Acknowledge it and move toward forgiveness
2. See the connection between the current critical incident and personal history
3. Help the responder understand why it is so powerful
4. Get peer validation for the first responder’s experience

“What separates people who develop PTSD from people who are merely temporarily distressed is that the people with PTSD start organizing their lives around the trauma.” Bessel A. Van Der Kolk

Treatment elements include cognitive restructuring, development of cohesive narrative, affect regulation and relapse prevention. The real work is ongoing support, through individual and group meetings. Couples and family therapy is also a major component of treatment. Peer support and 12-step programs designed to help first responders are important adjuncts to therapy.

Kamena, M., Kirshman, E., and Fay, Joel(2013). Counseling cops: What clinicians need to know. New York: Guilford Press.