O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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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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Marriage and Parenting: Balancing everyone’s needs

Work-life Balance —  Making Time for Yourself

When I was born, my father’s colleagues congratulated him with the cartoon below.

Being a parent requires balancing personal needs with family and couple needs.

The proud new dad is wearing a halo and peering up at a trophy of me, his firstborn, hands on my hips. Behind him is a trash can filled with his favorite toys: skis, golf clubs, bowling ball. As this cartoon acknowledges, we all understand that when kids enter the marriage, parents have more work and less free time for previously enjoyed activities. When I ask couples during their initial therapy sessions about what they do for fun, they often look at each other, shrug, and say something like “Well, we sometimes watch TV together after the kids are in bed.”

One of the hardest things about having kids is the loss of identity. Parents often feel that they have to give up their recreational pursuits because children demand all their time. But is this necessary? In fact, parents today spend much more time with their kids than they did in previous generations. Fathers spend twice as much time in child-oriented activities than they did in 1965, and mothers spend an average of 20 percent more time with their kids. Where does this extra time come from, and what is sacrificed?

Generally, when both parents work outside the home, that extra time has come from mothers dropping some housework chores since 1965, and dads picking some up. But most of the additional child-oriented time has come at the expense of time spent with partner, friends, and on personal interests.

 

 The Venn Diagram of Marriage

 

Making time for yourself in marriage as well as time for your partner, and your children is important .Think of your relationship as a Venn diagram composed of two circles, one for each partner. The circles overlap for couple time—date night, activities together, time alone together. If you have children, add a third circle for kid-oriented or family time. Depending on the ages of your children, that circle will be larger at some times than others, but the important thing is to have your own circle, large enough to have time for individual pursuits not involving your partner or the kids.

This was what my dad threw away. He trashed all those fun activities to support his family. For him, as for so many men of his generation, ”support” did not mean participating in child-oriented time; it meant working. In my parents’ conventional marriage, he was the wage earner and provider: so much so that by the time his cancer was diagnosed, he had accrued three years of sick time. Which was just the exact amount of time he used before he died.

Don’t make that mistake. Give yourself permission to pursue your passions (within reason; maybe not 18 holes of golf every weekend, as this will surely cause conflict in the marriage) and reclaim the things you loved doing before kids or find new interests that nourish you.

What we know for sure:

  1. Don’t give up friendships. Friends are good for marriage because marriage doesn’t have to meet our every need. Friends also spread the load of stress so the marriage doesn’t have to bear it all.
  2. Express your needs for support and negotiate compromises. Fairness in distributing chores and caregiving tasks will reduce stress in your relationship. Read my post about the division of labor in marriage.
  3. Make time for fun together. Having enough fun strengthens your relationship and protects it during hard times. A good rule of thumb is to schedule two dates a week, where you get a sitter, a friend, relative, or neighbor to watch the kids and you go out for coffee, a walk, or dinner. Try to make it new and invent different activities to do together. In Gottman’s work, this would be called turning toward each other.
  4. Make time for yourself. Taking time for self-care is as important as caring for your family. Self-care includes a wide range of activities: taking a yoga class, doing formal meditation, exercising, skiing, painting, or gardening, (and bowling, golf, scouting.)

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Better Sex through Non-Sexual Touching

Sexual Intimacy isn't just about the sex.
Artwork by Peter Berkowitz

Two people rarely have the exact same sex drive. One person might be happy with daily sex, another with monthly. Besides differences in basic libido, life events (illness, job stress, childcare) can cause a desire discrepancy in couples. A large desire discrepancy will eventually cause conflict, likely eroding other aspects of the relationship as well.

 Why Non-sexual Touching is So Important for Sex

While couples don’t need to be conflict-free for happiness, we know that couples do need more positive interactions than negative ones. Dr. John Gottman’s research on this shows that the magic ratio is 5 to 1. That is, we need to have five times as much positive feeling and behavior with our partners as negative. Couples can increase positive interactions in many ways: by expressing fondness, appreciation, and admiration; regularly connecting by checking in with each other and staying in touch with your partner’s daily life events; and, of course, through physical intimacy.

For an amusing illustration of what goes wrong in many relationships, check out this performance by Flight of the Conchords. Miscommunication about sexual interest, lack of foreplay or after-sex cuddling, and showing little sensitivity to partner’s needs all leads to no sex or to perfunctory sex. And when couples rarely touch, embrace, or kiss except as a prelude to the bedroom, passion can dry up altogether.

But it’s important to remember that intimacy doesn’t necessarily mean sex. in fact, non-sexual touch is vitally important, both in itself and to improve sex lives. For each sexual encounter, it’s important that couples have at least five episodes of non-sexual touch. I use “five” loosely; a 15-1 ratio would be wise. Touching your partner several times a day allows closeness and intimacy to grow in a natural way.

Another reason to increase non-sexual touching is that many partners with a lower sex drive end up avoiding any touch for fear it’ll be interpreted as an invitation to sex. Sometimes partners are exhausted, sleepy, or just planning to go to bed with a book; they would enjoy physical closeness, but sex is the last thing on their minds. Sometimes the lower-drive partner pulls away, avoiding opportunities for physical closeness (cuddling on the sofa, kissing, or spooning in bed in the morning)—or even creates additional distance, for example by making critical comments. Over time, the higher drive partner will make fewer gestures of closeness out of frustration and feelings of rejection.

Another consideration is that partners must still be sensitive to appropriate moments for non-sexual touching. A common dynamic is when men come up behind a partner, often when she’s standing and working in the kitchen, and grab her from behind or grope her. This may be meant as playful (and can be just that); it’s also low-risk because a brush-off doesn’t mean as much if you’re “just messing around.” However, most women report that this gesture feels intrusive and disrespectful as if they’re property. It’s better to invite or ask for touch when a partner isn’t busy.

While the partner with a higher sex drive has a responsibility, so does the lower-libido partner. If partners with higher sex drives start feeling unappreciated, they may drift away and start getting sexual needs met outside of their relationships through online activities, finding sex in other venues, or beginning an affair, without having exactly intended to slide into infidelity.

Non-sexual but physically intimate ways to show your appreciation for a partner include:

  • Caressing your partner’s cheek
  • Cuddling with one another
  • Tickling the inside of your spouse’s arm
  • Walking with your arms around each other’s waist
  • Sitting close enough so that you are physically touching legs or arms
  • Holding hands
  • Briefly rubbing your partner’s back while watching TV or standing at the kitchen counter
  • Playing footsie with each other
  • Kissing or nibbling your partner’s ear

Intimacy doesn’t have to be through direct physical touch, either. Eye contact is also very important. Many couples will go for days without looking directly into each other’s eyes. I confess that when I was in the thick of raising our twins and working many hours a week, that I neglected to notice that my husband had shaved his mustache. He didn’t mention it, waiting to see how long it would take me to notice. That was a wake-up call for me. And we work in the same office!

Of course, while non-sexual touching is important to help create intimacy, so is sex! In my next post, I talk about romance and how to re-ignite it after years of neglect.

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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

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Psychotherapy, Love, and Healing

 

Psychotherapy takes place by holding the space for healing to occur.Nothing is more natural than the urge to be held and comforted by someone who understands our suffering. Whatever the painful situation (a relationship breakup, medical scare, financial disaster, the death of a loved one) we want to turn toward someone who will hold us and let us cry in loving arms.

Sometimes we need to seek that understanding from someone other than a lover, parent, or friend. These figures may be too close to your issues or otherwise unsuitable for receiving confidences and providing nurturance. Psychotherapy provides a safe, confidential, neutral relationship to explore what hurts.

Therapist and client sit together in a quiet space being present to whatever feelings come up. The noise of the outside world is put on hold for an hour: no ringing phones, text messages, TV, or other distractions. This environment invites opening up the parts of ourselves we keep shut down, secret, or tied up in knots. Tears are likely, but so is laughter and joy. Therapy is not only about pain but also learning to live well with the inevitable difficulties that life holds, and finding the laughter that lives alongside pain.

Good therapists with proper boundaries will not gossip about you, laugh at you, seduce you, or allow themselves to be seduced by you. At the same time, psychotherapy at its best gives room for love to be present. In fact, love is an important aspect of all good psychotherapy. In a letter to fellow psychoanalyst Carl Jung, Freud wrote that “Psychoanalysis is, in essence, a cure through love” (1906). In the client–therapist relationship, love, and gratitude are healthy human emotions just as they are in the world outside of the therapist’s office, although the client expresses his or her feelings while the therapist experiences them privately.

Many forms of love may be possible: that of a parent toward a child, of siblings, or adults with erotic feelings, or narcissistic self-love. Discussing such feelings is sometimes difficult—in part because love is fraught with vulnerability, in part because we have all been injured in our loving feelings. In therapy, it is helpful to both respect and be curious about this range of feelings for what it reveals. Much can be learned about how one loves, about how one contends with the fears and anxieties over love, about how one chooses a person to love, and about what it is that one loves (beauty, truth, kindness.)

Ultimately, the therapeutic process will lead to reclaiming the self that became lost, whether through years of living inauthentically, practicing unhealthy behavior or through emotions such as depression and fear that hold us back from living fully. Another way of putting it is that therapy is about putting life back together again based on a clearer understanding of ourselves.

Reconstructing identity is, as Plato wrote, a kind of remembering of what we’ve forgotten about ourselves; through therapeutic dialogue and listening to our intuition, we remember that self. Sometimes, for example, we lie about what our lives are because we need to create something to give us the comfort of that longed-for love.

When we live life that’s not in accordance with who we are, we are doomed to fall hard, cracking the veneer of the perfect life. If, like Humpty-Dumpty, we fall tumbling from perches too lofty (narcissistic) or too unstable (based on fantasy) all the king’s horses and all the king’s men will not be able to put us back together again.

A successful outcome of therapy is to find comfort in your aloneness because we are never truly alone if we know ourselves. The self, or soul, is with us all along, walking beside us. Throughout life, we are given glimpses of this companion self.

As Juan Ramon Jimenez wrote in his poem “I Am Not I”:

 

I am not I.

                  I am this one

walking beside me whom I do not see,

whom at times I manage to visit,

and whom at other times I forget;

who remains calm and silent while I talk,

and forgives, gently, when I hate,

who walks where I am not,

who will remain standing when I die.

 (Juan Ramón Jiménez, “‘I Am Not I’” from Lorca and Jiménez: Selected Poems. Translation copyright © 1973 by Robert Bly.)

Perhaps the therapist models this companion self for the client until the client can better become his/her own companion. The best psychotherapy creatively facilitates developing the disposition for happiness by encouraging self-transformation and self-integration. Ultimately, the therapeutic relationship ends and the client moves on in life with a strengthened sense of self that can better tolerate being alone with both good and painful feelings.