O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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Psychotherapy: A Safe and Sheltered Space

Psychotherapy is a safe place to explore what is causing you pain and how to cope.One size does not fit all when it comes to finding a good therapist. Many variables influence the extent to which people get better, solve problems, and grow. While empirical support is important in choosing what treatment to provide, psychotherapists shouldn’t stick rigidly to what studies suggest; instead, they should work from the position of evidence-informed practice. This allows for treatments that respond to what clients bring to therapy—their unique histories, temperaments, and narratives. Sometimes what may be most helpful in the therapy is intangible and unmeasurable by any study. In research, these are referred to as non-specific effects. These are uncontrollable factors: the usually small, barely noticed interactions that create an unexpected effect in the subject. In other words, they are not a part of the research experiment.

In Irvin Yalom’s book Existential Psychotherapy, he describes how, during a cooking class, he wondered why the instructor’s meal always tasted better than any of the his attempts at the same recipe. He learned why after catching the teacher’s assistant throwing fistfuls of various spices in the dish before putting it in the oven. This story has stayed with me since reading it in the early years of graduate school. The crucial ingredients—the “throw-ins”— of good therapy may be unquantifiable, and untaught; even the therapist may be unaware of them.

In a previous post I wrote about love as part of the therapy. Love is a challenging factor to study because it is difficult to quantify and because love overlaps significantly with other emotional reactions such as respect, compassion and empathy, and curiosity.

What is the art of therapy? Sometimes it is as simple as being really present with clients during their pain. Being present means not interrupting, giving advice, or falling asleep, but instead staying tuned to a client’s process. As in meditation, a therapist who notices his or her mind wandering should first notice where it has gone (and if there is anything in that mental tangent that could provide meaning about the client’s situation) and second, return that attention to the client.

A safe and sheltered space

In ancient times a holy person who would descend into what was called an incubation chamber—a dark underground space—with someone in turmoil or grieving. They would remain together in the darkened underground space for three days. This practice illustrates how healing  comes through being present with feelings. When someone is suffering, the willingness to go into the dark with them as they express and move through their feelings is a large part of what we do as therapists. When suffering people can take what’s vague and private, locked inside their heads, and speak out loud the unspeakable, they can gain a depth of understanding and new self-compassion.

The popular 2015 Pixar film Inside Out shows how this works. Riley, the young protagonist must endure her family’s cross-country move, which takes her away from her friends, her home, and her beloved hockey team. Believing she must be perfectly mature, she suppresses her sadness. Five personified emotions–Joy, Sadness, Anger, Disgust, and Fear –live in her head and influence her actions and memories. The dominant voice is Joy, because being happy and not expressing our negative feelings is socially rewarded. But all emotions have a role to play in living well. When Riley tries to silence Sadness, she becomes numb to all feeling, including Joy, and pandemonium ensues. It’s only when Riley can fully acknowledge the sadness in her life that she can also remember the tender, loving moments. Therapy patients must similarly accept and not disown their most difficult feelings.

Good treatment isn’t always easily available. Many therapies lend themselves to apps and downloadable protocols, making these treatments more accessible for people who are unable to find (or afford) a good-fit therapist. Videoconferencing, mobile applications, g-chats, and web- or text-based therapy have a place, and can be powerful ways to change behavior and improve symptoms, especially for those who feel shy or stigmatized about talking to a therapist. But with something gained, sometimes something is also lost with techniques that avoid human interaction and relationship.

What’s missing are the powerful nonverbal communications that shed so much light on the intangibles of what might be contributing to a person’s issues. A blush, an eye-roll, a tear welling up; the fidgeting of someone with a secret, the nervous giggle or shy smile—these nuanced communications can speak in ways where texting is mute. Staying safely in front of a screen provides shelter, to be sure, but possibly also a place to hide.

To illustrate the importance of face-to-face therapy, there’s the example of my former client who returned to therapy after a seven-year break. He told me his physician kept increasing his antidepressant dosage, but he was getting worse, not better. After sitting with him for close to an hour, listening to the many stresses he described, I gently inquired about his subtle, yet noticeable twitching. His movements were suggestive of a genetic disorder and not merely anxious fidgeting. He immediately told me “My biological father [he was adopted at birth] was really strange before he died. He moved and twitched all the time—I haven’t thought about it in years but I know he had something wrong.”

At the conclusion of our session, he promised me that he would contact his cousin and find out the name of his father’s condition. I suspected it was Huntington’s disease, a rare genetic disorder. When he emailed me the confirmation, I was able to suggest genetic counseling and testing.

So what appeared to be depression and anxiety—and was being treated as such—was in fact a neurobiological condition. While the news was not good, he could be treated by the right physician for his condition and not keep taking medication that only made him feel worse.

The opportunity to look at your darkness with someone who respects you and your process can allow you to speak the unspeakable, giving room to the ineffable—those moments of awe that come only when we let the full range of who we are be seen and known.

Rumi stated it well in his mystical poem “A Garden Beyond Paradise”:

Everything you see has its roots in the unseen world.

The forms may change, yet the essence remains the same.

Every wonderful sight will vanish; every sweet word will fade,

But do not be disheartened,

The source they come from is eternal, growing,

Branching out, giving new life and new joy.

Why do you weep?

The source is within you

And this whole world is springing up from it.

 The joy of which he wrote cannot spring forth without awareness that it will also fade. Trust that the source of life is in sitting with and sharing the difficult parts of ourselves in a safe and sheltered space.

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Learning to Notice What is Already There: The Rose Itself

Being aware of pleasant events is an important skill in mindfulness and Mindfulness-based cognitive therapy.Behavior therapists have long used a technique to distract clients from their difficult thoughts. The client wears a rubber band around their wrist; when they have an upsetting thought, they snap the rubber band so that the sting wakes them up and interrupts the thought. This always seemed silly to me. And when I tried it myself, it didn’t work very well. The reasoning behind the rubber band is that distraction from a difficult thought will interrupt, not just the thought itself, but also the chain reaction that painful thoughts set in motion.

Distraction works for children quite well. If a child is crying about a lost toy, we show them another toy and they forget what they were crying about. But as we get older, emotions become more complex. The typical pattern is that when something difficult happens, we make a negative appraisal about it. Then we start thinking about the difficulty, which brings up negative feelings, sending us down the rabbit hole of rumination and worry. For example, a co-worker points out an error you made. Your thoughts might go, “Oh no, a mistake. I shouldn’t make mistakes. I’m a fraud and my co-worker knows it. I’m going to lose my job. Everything always goes wrong for me.” Our often-silent judgment triggers mental elaboration of what could have been simple awareness of a thought or feeling in the moment: “I made a mistake. It feels bad to get things wrong.”

We often go through the day thinking of what’s next. We plan dinner and dread the grocery store even as we’re walking around our home or office, long before we actually get to the store. Being 20 steps ahead of where we actually are misses opportunities that exist in the moment. But what if some of those moments aren’t very good? Wouldn’t avoiding them just make sense? The problem is that avoiding thoughts and feelings that evoke sadness or anxiety usually just postpones problems while they get bigger. There are endless ways to distract ourselves from even benign feelings such as boredom, or the effortful focus needed to complete a project. Constant phone checking may keep us from feeling bored or focusing on what we should be doing in the moment.

I did 6 Google searches for ‘North Coast silver cuff raven steals the light’ –to find information about a bracelet I purchased at a thrift store over the weekend. Do I feel better for putting off writing this post? No I don’t feel better after my  search, but I tell myself, “Ok, that wasn’t a great use of time, but now I am back to it.” I don’t need to chastise myself, but I don’t need to continue to distract myself either.

Being able to experience our thoughts and feelings without judging them opens up the possibility for experiencing the richness of the moment. It may be as simple as feeling engaged with what we are doing, or acknowledging our humanness and bringing forgiveness to the moment.

In practices like mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR), therapists have people keep track of pleasant and unpleasant moments in their day. This doesn’t have to be a tiresome homework assignment; it’s just jotting down, at the end of each day, something you noticed that was pleasant, or the opposite. By doing so, you can more easily increase awareness of the experiences when they are happening.

The most important component of mindfulness is attention to the moment. This awareness helps us notice what triggers ruminative thoughts. Rather than mechanically snapping a rubber band, we notice the thought and where our minds want to take it next. We don’t need to add to the thoughts, take them further, or elaborate on them. We also don’t need to classify or analyze them. Being attentive but nonjudgmental in this way helps us not only to let go of negative thoughts, but to notice pleasant things that may escape our awareness because we so often rush around, either literally or in our heads. As a result of paying attention to small bursts of pleasure, happiness grows.

In a commencement address to Colorado College, the poet Billy Collins described the power of mindfulness as being like an atom smasher:

Matter is composed of atoms and subatomic particles. Through the use of a particle accelerator it is possible to make these tiny bits collide which releases energy. Time, on the other hand, is composed of moments. And by arresting one of those moments, by concentrating fully on it, by smashing it under the intensity of your gaze, an energy will be released.

Poetry, Collins says, can help you slow down and pay attention, but you don’t need to be a poet. What do you notice right now? Are you aware of something pleasant—the shape and feel of your coffee cup and the color of your coffee, the song of a bird, or the light coming in the window?

In the same talk, Billy Collins says that gratitude “for simply being alive” goes along with mindfulness:

The taking of breath, the beating of the heart. Gratitude for the natural world around us—the massing clouds, the white ibis by the shore. In Barcelona a poetry competition is held every year. There are three prizes: The third prize is a rose made of silver, the second prize is a golden rose, and the first prize: a rose. A real rose. The flower itself.

Though we spend so much time worrying about the future or the past, it’s what’s real and present in the moment that is “the flower itself. “ To tell it another way, there’s an old Zen koan (teaching story) that illustrates these concepts.

 

Muddy Road

Tanzan and Ekido were once traveling together down a muddy road. A heavy rain was still falling. Coming around the bend, they met a lovely girl in a silk kimono and sash, unable to cross the intersection.

“Come on, girl,” said Tanzan at once. Lifting her in his arms, he carried her over the mud.

Ekido did not speak again until that night when they reached a lodging temple. Then he no longer could restrain himself. “We monks don’t go near females,” he told Tanzan, “especially not young and lovely ones. It is dangerous. Why did you do that?”

“I left the girl there,” said Tanzan. “Are you still carrying her?”

The whole way back to the temple, Ekido missed the birdsong, the breeze, and the fragrance of the cherry-blossom trees—and thereby deprived himself of the pleasure around him, just so he could fume and ruminate about what someone else did.

To increase mindfulness, try printing the chart below and filling it in each day. Make a point of remembering to notice just one thing each day that you find pleasant. If, like Ekido, you are still carrying unpleasant feelings, notice how far you take them, and see if you can find something in the moment that is even briefly pleasant.

Awareness of Pleasant Experiences

Instructions: For one week, be aware each day of one pleasant experience or occurrence while it is happening. At the end of the day, on this calendar or in your journal, record in detail what it was and your experience of it. (Click on image for a larger view.)

Keeping track of pleasant experiences during the day is a core component of MBCT and MBST.

 

 

 

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Maintaining Composure as a Parent and Householder

Parenting require finding balance and composureMaintaining a graceful composure when performing life’s demanding household and child-raising chores can take a toll, leaving us feeling depleted and out of balance. But practicing the postures and meditation of hatha yoga can restore that equilibrium. Yoga practice connects us to our bodies, and thus to our bodily wisdom if it is done mindfully.

Remember: If we don’t give to ourselves by taking care of our well-being, then we cannot take care of others.

One lovely pose (asana) to try is called lalitsana, the pose of royal ease. You can see this pose in statues of Yogini Hayagriva. Yogini translates as female practitioner of yoga. In Hinduism, the god Vishnu is one of three supreme deities, called the Preserver. One of his avatars (manifestations or incarnations) is the goddess Hayagriva, which means the “horse-necked one.” She is depicted sitting on an animal in a graceful posture, lalitasana, supporting her child with one arm. Both mother and child have horse’s heads. Hayagriva is considered to embody knowledge and wisdom. In this mythology, the horse pulls the sun’s cart into the sky every day, shedding light on the world. Symbolically, Hayagriva represents the triumph of pure knowledge, guided by God, over the forces of passion and darkness.

To assume the lalitasana pose, sit on a low stool, chair, bench, or firm ottoman with your left leg bent so that the sole of your left foot rests on your right inner thigh. Allow your right leg to extend, half bent, to the floor. You may notice a sense of ease and grace as your spine becomes aligned in this pose. This asana is similar to a half lotus pose, but sitting on a chair or bench allows the right leg and foot to drape down, without the strain that sitting in lotus pose can have on the knees.

Take this pose throughout the day when you feel restless and distracted. Even a few moments will help ground you so you can return to the tasks at hand with a bit more calmness. A few minutes of mindful breathing in this pose will enhance the experience. May all mothers and fathers feel this sense of comfort!

The horse head on the voluptuous human body reminds me that our being is composed of many aspects. Being a loving parent will look different at different times and stages of your life. Practicing yoga and meditation on a regular basis will help keep you limber and supple in mind, body, and spirit. We need this suppleness to stay open to the many ways life brings us into contact with our own darker natures.

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Parenting: Playing the Hand You’re Dealt

Parenting takes time and love.As parents, most of us make terrible fortune-tellers. When my daughter Eileen was a first-grader, she was sent to the principal’s office for fighting with her friend Eric. Apparently, he’d put a rock in the way of ants marching on the sidewalk, and Eileen felt bad for them “because they are so little it made it hard for them to do their work.” When Eric refused to move the rock, Eileen kicked him in the shins.

At the time, I interpreted Eileen’s motivations as tender-heartedness (toward the ants, anyway), but I never would have imagined that this foreshadowed an interest in workers’ rights. Today, Eileen researches and writes about working conditions in Latin America for a D.C. think tank.

We know from experience that we don’t know how our lives will unfold, and that we often see our own life events more clearly in retrospect. Looking back, we can see how seemingly random events make up the stones in our life’s pathway toward individuation. It’s all the more difficult, then, to look ahead and see how our children’s sense of identity is deepening, especially when that journey doesn’t match with what we’ve mapped out for them.

From Childcare to College: Joys,  Disappointments and Worries

As prospective parents, we tell ourselves stories about what our child will be like, entertaining idealized images of family life. As parents, we need to be respectful of the way our child’s life will coalesce—but staying out of it is tough. We want to help and to shape them; isn’t that our job? But for most parents, those idealized imaginings will be replaced with realistic understanding that comes from experience. From childcare to college, there will be joys, but also disappointments and worries.

The Haggadah (the book of readings for a Seder service) refers to four types of children who, viewing the Seder in different ways, ask different questions about Passover. One child is wise, one wicked, one simple, and one doesn’t know how to ask. Why four types? According to artist David Moss, “Every child is unique and the Torah embraces them all. . . . Diversity, how we deal with it, and how we can discover the blessing within it, is perhaps the theme of the midrash of the Four Children.” For good reason, Moss represents the four children as playing cards: “As in a game of chance, we have no control over the children dealt us. It is our task as parents, as educators, to play our hand based on the attributes of the children we are given.”

Many factors will play a role in who our child becomes. When we try too hard to control who our child becomes (social butterfly, academic striver, sports hero) we risk ignoring their own preferences and their ability to develop according to a rhythm of their own. That is not all we risk. As Carl Jung wrote, “Nothing exerts a stronger psychic effect upon the environment, and especially upon children, than the life which the parents have not lived.” (“Paracelsus,” 1929. The Spirit in Man, Art, and Literature, tr. R. F. C. Hull, 1966.) Pushing our child to be the best at something they don’t feel engaged with is too often our way to living our lives through our child, rather than allowing them to grow in ways they would choose.

Knowing When to Step In and When to Let Go

IMG_0014 - Version 2Kids have inborn abilities that we can support and encourage, respecting the differences between them, their siblings, and their peers. The way the Army and Air Force train bomb-sniffing dogs illustrates this concept. All dogs have olfactory acuity, but for a dog to do well in training, it must be willing to go to the target repeatedly without fetching (which would have disastrous results) and without losing interest, instead being motivated by the dog handler’s praise and rewards. So, even in such an important and dangerous job, the factors of individual traits (good nose, persistence), and environmental (the handler’s praise and rewards) play a role in which dogs will succeed at their job. Labs and German shepherds make great bomb sniffers, but my Tibetan terrier would never have been good at this job. If I throw a stick for her to fetch, she just stares at me. But she’s a great help in alerting me with her shrill bark (in the middle of the night) to the raccoons in the trees. The point is, I love her even if she’ll never be a good retriever; she’s a fantastic Tibetan terrier.

We don’t know who our children will become. There is no way to predict or to order up the perfect offspring. They are shaped by many factors. Our role as parents is to provide the best environment for their growth, knowing when to step in and when to let go.

 

 

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We Fear What We Cannot Control: Acknowledging Pain and Suffering

Learning to live with the things we have no control over.The German airplane crash by a suicidal pilot, the Florida shootings, the Boston bombings. Every week, we read about innocent people getting hurt or killed. We try to avoid pain and suffering; we teach children to look both ways before crossing the street, wash their hands after using the bathroom, and not to get into strangers’ cars. Even as we reassure our kids that no monsters live under their beds, we know that in the apartment down the street, there lives a convicted sex offender. How do we cope with life’s uncertainty and fear?

 

The Monster Under the Bed

We are saturated with information. Not long ago, we’d read a morning or evening newspaper and maybe watch the evening news; today, the news cycle is 24/7. And, because dramatically scary stories get our attention, the media makes sure to foreground them—not just what’s happening locally, but world-wide. We end up perceiving fearful threats all around us. The truth is, though, that we tend to overestimate certain kinds of risk while underestimating others. For example, as the Vancouver Sun notes, “We warn our kids not to talk to strangers even though 90 per cent of sexual abuse is committed by someone a child knows. And we freak out about plane crashes despite the fact driving is about 65 times more dangerous.” (“How much risk do you live with?”)

Studying how people evaluate threats, or “risk perception,” helps show why this is so. Psychologist Paul Slovic has studied the subject for many years; here, blogger Sara Gorman sums up his findings: “People tend to be intolerant of risks that they perceive as being uncontrollable, having catastrophic potential, having fatal consequences, or bearing an inequitable distribution of risks and benefits.” Plane crashes feel more uncontrollable than car crashes; strangers feel scarier than people we know. But control is an illusion. Life is full of uncontrollable things, people, and events, so how do we handle risk?

We cope by using reason and denial. Reasonably, we know that life always involves some risk and that we have a natural tendency to inflate threats. You can probably think of one thing you tend to worry about needlessly or unproductively. Can you really do anything about it? Needless worry robs us of a sense well-being; straining to control things beyond our reach only creates tension. But wait—denial? Isn’t that supposed to be a bad thing? Yes, denial is counterproductive when it keeps you from acknowledging harm that you’re doing to yourself or others, like smoking, cheating on a spouse, or abusing your child. But psychologists recognize that the use of denial can be advantageous in many situations. According to the Mayo Clinic, “A short period of denial can be helpful. Being in denial gives your mind the opportunity to unconsciously absorb shocking or distressing information . . . . For example, after a traumatic event, you might need several days or weeks to process what’s happened and come to grips with the challenges ahead.” Be patient and gentle with yourself in the wake of trauma.

We also must learn to balance risk against what we lose by being too careful. When we’re too sensitive to fearful possibilities, we become paralyzed. Not letting your daughter walk home from school with her friends because a car could run a red light, or a vicious dog might be on the loose, may seem protective. But overprotectiveness is harmful because it deprives children of practicing the mastery and independence they need to grow up successfully. And, more subtly and unintentionally, your anxiety seeps into her without either of you knowing the source.

 

What if the monster under the bed survives because your imagination feeds it every night?

 

Kids need to find their own strength by testing themselves in the world. That can start as early as learning to sleep alone, in their own beds. (While in some cultures sharing a family bed is the norm, children may be given other opportunities to practice self-soothing and frustration tolerance.) Kids and parents often resist the stage when they need to soothe themselves to sleep. When we know our child is distressed and may be fearful, we rush to give comfort. But allowing a child to sleep between her parents can come at the expense of intimacy in the marriage. By resisting letting a child sleep alone, parents deprive them of learning to calm themselves and tolerate frustration. For a fuller explanation of this problem and how to address it, see Dr. David O’Grady’s “Help Your Child Sleep Alone: The Snoozeeasy Program For Bedtime Fears. ”The important thing is that we convey trust that our child can manage the little and big things that come their way and feel they have the ability to self-regulate their emotional reactions.

Of course, being able to manage emotions doesn’t mean that bad things don’t happen. In mindfulness practices, we teach that suffering is an inevitable part of living. Sickness, accidents, money problems, frustrations, and worries: There is much in life that we have no control over, and as if worrying about the present isn’t enough, we tend to ruminate over past events or future possibilities.

Even spiritual people who actively practice mindfulness can’t escape suffering. In fact, “life is suffering” is the first Noble Truth of Buddhism. I remember listening to an audio interview with the Dalai Lama, the Tibetan Buddhist leader known for his calm serenity. He coughed and hacked his way through the interview, clearing his throat every few minutes. It was an unpleasant sound, but because I was on my treadmill, I didn’t want to stop and find another CD. I suffered along with the Dalai Lama. At the conclusion of the interview, he took questions from the audience. The question was asked; “Dalai Lama, do you suffer?” He answered, “Of course I suffer, I have been coughing this entire time and it is very uncomfortable.”

And as if present suffering isn’t enough, letting worry about the past or future take hold leads to more suffering. When we suffer from the fears we have about the dangerous, uncertain world we live in, we may think the answer is to run away somehow: shopping, clicking, using drugs or alcohol, or eating when we’re not hungry, for example. But pursuing pleasure doesn’t make our painful fears go away. Instead, our efforts backfire because we feel guilt, or dig ourselves deeper into debt, or become unhealthy—and the fear still exists.

Learning to look at our suffering and accept that it exists is a skill. Meditation or relaxation training can help us develop the skill of self-soothing, thereby enabling us to feel less afraid of both real and imagined monsters. As we do this, we also help those around us to be calmer and stronger.

 

How to Self-Soothe

 

Practice some form of deep relaxation, meditation, or yoga daily. This will change your psychophysiological baseline so that you are generally more resilient when worry or stress takes over.

  1. Accept that that suffering is part of life. We suffer, our children will suffer, and strangers we hear about in the news suffer. Acknowledging suffering helps because we are not pushing fears down, which paradoxically only makes them grow larger.
  2. Develop a spiritual practice. This helps us develop the strength to look deeply at our suffering; the insights gained about ourselves provide perspective and something to hold onto when our fears run amok.
  3. During difficult moments, use a short breathing practice (such as the Three-Minute Breathing Space or just silent focus on your breath) to stay calm during difficult moments. Being conscious of our breathing brings mindfulness to the present moment and helps pause the thought stream of rumination.
  4. Recognize your suffering without judgment. Some fears are truly awful, yet by staying in the present moment, we avoid getting trapped by our thinking. Look deeply at the source of your feelings, find their roots, and work on transforming the fears that need to be changed. This will allow space to nourish the feelings that bring peace and well-being.

This short relaxation exercise may help you to develop skills to relax in moments of anxiety and worry, as well as provide a foundation to help change the automatic, reflexive ways your mind and body respond to stress.  https://youtu.be/TCCA1kGSnB8