A schema is a cognitive structure that serves as a framework for one’s knowledge about people, places, objects, and events. Schemas help people organize their knowledge of the world and understand new information. While these mental shortcuts are useful in helping us make sense of the large amount of information we encounter on a daily basis, they can also narrow our thinking and result in stereotypes.
Key Takeaways: Schema
A schema is a mental representation that enables us to organize our knowledge into categories.
Our schemas help us simplify our interactions with the world. They are mental shortcuts that can both help us and hurt us.
We use our schemas to learn and think more quickly. However, some of our schemas may also be stereotypes that cause us to misinterpret or incorrectly recall information.
There are many types of schemas, including object, person, social, event, role, and self schemas.
Schemas are modified as we gain more information. This process can occur through assimilation or accommodation.
Schema: Definition and Origins
The term schema was first introduced in 1923 by developmental psychologist Jean Piaget. Piaget proposed a stage theory of cognitive development that utilized schemas as one of its key components. Piaget defined schemas as basic units of knowledge that related to all aspects of the world. He suggested that different schemas are mentally applied in appropriate situations to help people both comprehend and interpret information. To Piaget, cognitive development hinges on an individual acquiring more schemas and increasing the nuance and complexity of existing schemas.
The concept of schema was later described by psychologist Frederic Bartlett in 1932. Bartlett conducted experiments that tested how schemas factored into people’s memory of events. He said that people organize concepts into mental constructs he dubbed schemas. He suggested that schemas help people process and remember information. So when an individual is confronted with information that fits their existing schema, they will interpret it based on that cognitive framework. However, information that doesn’t fit into an existing schema will be forgotten.
Examples of Schemas
For example, when a child is young, they may develop a schema for a dog. They know a dog walks on four legs, is hairy, and has a tail. When the child goes to the zoo for the first time and sees a tiger, they may initially think the tiger is a dog as well. From the child’s perspective, the tiger fits their schema for a dog.
The child’s parents may explain that this is a tiger, a wild animal. It is not a dog because it doesn’t bark, it doesn’t live in people’s houses, and it hunts for its food. After learning the differences between a tiger and a dog, the child will modify their existing dog schema and create a new tiger schema.
As the child grows older and learns more about animals, they will develop more animal schemas. At the same time, their existing schemas for animals like dogs, birds, and cats will be modified to accommodate any new information they learn about animals. This is a process that continues into adulthood for all kinds of knowledge.
Types of Schemas
There are many kinds of schemas that assist us in understanding the world around us, the people we interact with, and even ourselves. Types of schemas include:
Object schemas, which help us understand and interpret inanimate objects, including what different objects are and how they work. For example, we have a schema for what a door is and how to use it. Our door schema may also include subcategories like sliding doors, screen doors, and revolving doors.
Person schemas, which are created to help us understand specific people. For instance, one’s schema for their significant other will include the way the individual looks, the way they act, what they like and don’t like, and their personality traits.
Social schemas, which help us understand how to behave in different social situations. For example, if an individual plans to see a movie, their movie schema provides them with a general understanding of the type of social situation to expect when they go to the movie theater.
Event schemas, also called scripts, which encompass the sequence of actions and behaviors one expects during a given event. For example, when an individual goes to see a movie, they anticipate going to the theater, buying their ticket, selecting a seat, silencing their mobile phone, watching the movie, and then exiting the theater.
Self-schemas, which help us understand ourselves. They focus on what we know about who we are now, who we were in the past, and who we could be in the future.
Role schemas, which encompass our expectations of how a person in a specific social role will behave. For example, we expect a waiter to be warm and welcoming. While not all waiters will act that way, our schema sets our expectations of each waiter we interact with.
Modification of Schema
As our example of the child changing their dog schema after encountering a tiger illustrates, schemas can be modified. Piaget suggested that we grow intellectually by adjusting our schemas when new information comes from the world around us. Schemas can be adjusted through:
Assimilation, the process of applying the schemas we already possess to understand something new.
Accommodation, the process of changing an existing schema or creating a new one because new information doesn’t fit the schemas one already has.
Impact on Learning and Memory
Schemas help us interact with the world efficiently. They help us categorize incoming information so we can learn and think more quickly. As a result, if we encounter new information that fits an existing schema, we can efficiently understand and interpret it with minimal cognitive effort.
However, schemas can also impact what we pay attention to and how we interpret new information. New information that fits an existing schema is more likely to attract an individual’s attention. In fact, people will occasionally change or distort new information so it will more comfortably fit into their existing schemas.
In addition, our schemas impact what we remember. Scholars William F. Brewer and James C. Treyens demonstrated this in a 1981 study. They individually brought 30 participants into a room and told them that the space was the office of the principal investigator. They waited in the office and after 35 seconds were taken to a different room. There, they were instructed to list everything they remembered about the room they had just been waiting in. Participants’ recall of the room was much better for objects that fit into their schema of an office, but they were less successful at remembering objects that didn’t fit their schema. For example, most participants remembered that the office had a desk and a chair, but only eight recalled the skull or bulletin board in the room. In addition, nine participants claimed that they saw books in the office when in reality there weren’t any there.
How Our Schemas Get Us Into Trouble
The study by Brewer and Trevens demonstrates that we notice and remember things that fit into our schemas but overlook and forget things that don’t. In addition, when we recall a memory that activates a certain schema, we may adjust that memory to better fit that schema.
So while schemas can help us efficiently learn and understand new information, at times they may also derail that process. For instance, schemas can lead to prejudice. Some of our schemas will be stereotypes, generalized ideas about whole groups of people. Whenever we encounter an individual from a certain group that we have a stereotype about, we will expect their behavior to fit into our schema. This can cause us to misinterpret the actions and intentions of others.
For example, we may believe anyone who is elderly is mentally compromised. If we meet an older individual who is sharp and perceptive and engage in an intellectually stimulating conversation with them, that would challenge our stereotype. However, instead of changing our schema, we might simply believe the individual was having a good day. Or we might recall the one time during our conversation that the individual seemed to have trouble remembering a fact and forget about the rest of the discussion when they were able to recall information perfectly. Our dependence on our schemas to simplify our interactions with the world may cause us to maintain incorrect and damaging stereotypes.
EMDR therapy is considered to be safe, with many fewer side effects than those of prescription medications. That said, there are some side effects that you may experience.
EMDR therapy causes a heightened awareness of thinking which does not end immediately when a session does. This can cause light-headedness. It can also cause vivid, realistic dreams.
It often takes several sessions to treat PTSD with EMDR therapy. This means that it doesn’t work overnight.
The beginning of therapy may be exceptionally triggering to people starting to deal with traumatic events, specifically because of the heightened focus. While the therapy will likely be effective in the long run, it may be emotionally stressful to move through the course of treatment.
Talk to your therapist about this when you start treatment so you’ll know how to cope if you experience these symptoms.
The bottom line
EMDR therapy has proven to be effective in treating trauma and PTSD. It may also be able to help treat other mental conditions like anxiety, depression, and panic disorders.
Some people may prefer this treatment to prescription medications, which can have unexpected side effects. Others may find that EMDR therapy strengthens the effectiveness of their medications.
If you think EMDR therapy is right for you, make an appointment with a licensed therapist.
Finding the right therapist is often likened to the dating process: It can be daunting, requires serious effort and is very fulfilling once you find the one.
And — just like in dating — knowing if, when and how to end or put that relationship on hold can be equally stressful. It’s nerve-wracking, confusing and can leave you wondering if you’re making the right decision.
The good news is: Therapists are trained to want you to stop.
“I think people get nervous their therapists are going to feel hurt that they’re leaving,” Lori Gottlieb, a psychotherapist and author of “Maybe You Should Talk To Someone,” explained to HuffPost. “Ours is the worst possible business model, because from day one our goal is how we can get you to be independent of us. We want you to be able to function without us.”
“Ours is the worst possible business model, because from day one our goal is how we can get you to be independent of us. We want you to be able to function without us.”
Growing out of your therapist can look many different ways, but there are concrete signs, and some of them exist outside the room, according to Meg Gitlin, psychotherapist and creator of the Instagram account City Therapist.
“I think it’s when the person starts internalizing your voice or is able to readily access the tools you have given them, when they come in and they say ‘oh, I was at my sister-in-law’s and I got into a tizzy about X,Y and Z but I was able to talk myself down and self-soothe,’” she said. “The things you practice and learn in therapy have no value unless you can take them outside of the room.”
Repeatedly struggling to come up with things to talk about in a session could also be a sign you’re ready to take a break, but Josephson warns against jumping the gun on that one.
“If you’re having a good week, it’s not a reason to cancel your therapy session,” she said. “Therapy is not a quick fix … But if you find yourself constantly coming up short of issues you really want to discuss I think it might be time to consider taking a pause.”
Taking a break or stopping altogether can feel scary, especially if you’ve been working with someone for a long time, but it can also be an opportunity to reflect on that work and see how it manifests in your daily life.
“There are many benefits of stopping or taking a break,” said Mark Aoyogi, director of sport and performance psychology at the University of Denver. “Reconnecting with your independence, practicing the skills you have developed, engaging in life with your deeper sense of self-awareness. It’s also a great opportunity for continued self-introspection on what has been learned, how to apply it and what works best” for you.
“If you are having apprehension about raising the topic of stopping with your therapist, that is probably an indication your therapist is not a good fit.”
As with anything, there are right and wrong ways to go about broaching the topic. The main one is: Don’t ghost someone who has committed time, care and effort into helping you. As Gottlieb puts it, it’s “a conversation.”
“We’re not going to keep you somewhere you don’t want to be,” she said. “At the same time, we’ll talk to you about where you think you’re at and what progress you’ve made and how you’re feeling. You can always leave and if something comes up you can come back ― our door is open. I think people need to feel really comfortable talking to their therapists about what they’re doing there and how long they’re going to be there.”
Importantly, Aoyogi said that if you’re seeing the right person, they will be supportive and understanding of your wishes.
“If you are having apprehension about raising the topic of stopping with your therapist, that is probably an indication your therapist is not a good fit,” he said. “I’m not sure therapy can be effective if you are feeling pressured to continue.”
The last time my father hit me was seven years ago. I was in my late twenties, living in Vancouver and visiting my family in Alberta. My dad was drinking a little bit, and my sister and I got into a pretty big fight about our extended family. I was upstairs and I could hear my dad telling my mom that he was annoyed with me. My sister ran out of the house after our fight—and then, I heard my dad coming upstairs so I hid in a closet. Eventually, he found me. When my dad was mad at me, he’d often tell me to go kill myself. That day, he told me that when I got back to Vancouver I should jump off a bridge because I’m someone who just causes problems. After repeating that for a good 15 minutes, he took a knife and put it in my hands.
That was it. I started screaming at the top of my lungs because I just couldn’t handle repeatedly being told to kill myself. When I start yelling, he hit me because he thought I was going to get him in trouble with his neighbours. After he punched me in the face three times, I stopped screaming. Then he sat next to me on the bed, petting my head. It was fucking uncomfortable. I wanted to get away from him but after he hit me, I wasn’t about to move. My mom was there too, sitting on the other side of me. She had tried to intervene, tried to pull him off of me when he was hitting me, but it didn’t make a difference.
Growing up, my dad was the person I was closest to in my family
After that episode, my dad didn’t talk to me for three months. I think it’s because he felt shame and guilt. I don’t think my dad’s a bad person. He just hasn’t been taught how to handle his anger.
My dad came from India to Canada when he was in his 20s, and then re-educated himself in computer science. Growing up, he was the person that I was closest to in my family. When I was a kid, he would drive me to school every day, listening to my opinions on what I was being taught or what was happening in the news. When I was older, I didn’t hide much from him. He’d be the one to pick me up at 1 a.m. from a party so I would have a safe ride home.
He didn’t abuse my mom or my younger sister physically (or emotionally, that I’m aware of). It was just me. My sister wasn’t any more obedient than me—she was just a better liar. She would tell my parents she was studying at school for hours instead of saying she was out with friends. She never understood why I told them the truth, especially since that’s what often landed me in trouble.
My parents were pretty liberal compared to my extended family and some of the larger Punjabi community in my hometown. But I still struggled to conform to their expectations of being Indian—being accomplished at school, things like that. And when I didn’t conform, it caused problems.
When I was in grade five, I showed up crying at school one day and said, “I got in trouble with my dad.” My teacher brought me to the school counselor and I really underplayed what had happened. I don’t even remember what the root of the conflict was on that particular day, it was just that the kinds of questions my teacher was asking me made it seem like my dad was bad. I didn’t think my dad was bad. In fact, I thought I was the bad one and blamed myself for the abuse.
I’m just not a good kid. I’m the one that challenged him. I knew that would make him mad. I would never think, He was wrong.
The abuse would happen when I questioned him, asking things like “Why can’t I take band?” or, “Why can’t I go hang out with my friends at the mall?” I was never a rebellious kid by Western standards—I didn’t drink, smoke or do drugs. I just wasn’t willing to listen to someone telling me what to do. I wanted to know why I couldn’t do that thing, because if there was no reasonable explanation, well, then I was going to do what I wanted to do. But questions like these sent my dad into a rage—his violence was an immediate reaction to them.
I only started thinking he was the one who was wrong as a teenager, but I still didn’t seek help, until that very last time he beat me up. I’ve gone to counsellors over the years, but I felt like I was just being talked to as a diagnosis, not a person. Then I tried a life coach and her approach was very different. She helped me discover answers on my own and make me reflect on my life and circumstances in a way that felt transformative. I work with one now who specializes in childhood trauma.
I’ve always kept in touch with my dad no matter what
I’ve been living away from home for ten years, but I’ve always kept in touch with my dad no matter what was going on in our relationship. I could cut myself off from him, but that would also mean cutting myself off from the rest of my family, my mom and my sister, because they are all so close. My mother has never really acknowledged the abuse, other than advising me that I have just move on and let it go. She never let me process it. It’s impacted our relationship—there’s no depth to it. And I never even thought about talking to my sister about what was going on. She’s four and half years younger, and growing up she just seemed like a baby to me. But two years ago, when she was pregnant with her first child, she told me she talked to my dad about it. She told him that if he had ever done what he did to me, they wouldn’t have a relationship. I was shocked. That night, I cried in bed because it was the first time someone in my family had even acknowledged what I had been through.
Even though my parents have hurt me, I don’t feel like their intention is to hurt me. I have a deep respect for them regardless of the shit that I’ve been through. It’s my responsibility to work on my shit, not for me to change them. And while the physical abuse has stopped, the emotional abuse hasn’t.
But my perspective has shifted. My work with my life coach has helped me realize I was living for my dad’s approval all the time. Now, if I don’t get it, I realize it doesn’t mean anything about me. I do my best and if I don’t receive his approval or acceptance, I can’t do anything about that. This has helped set a boundary with my father for the first time in my life.
I finally realized, No, this isn’t okay anymore
A few months ago, my dad and I were talking on the phone, and he was demeaning me about where my life is at—that I wasn’t far enough professionally, that I’m well into my thirties and not married. My initial reaction to that was to apologize, to say, “Yes, you’re right.” When we talked later that week, he blew up again. He said the problem with me is that I’m not the type of person who lets things go. Something clicked in me that day. Something that was just like, No, this is not okay. So I got off the phone, and I didn’t call him back right away to smooth things over as I would usually do.
Exactly a month later, he called me. After we talked for a while, I asked, “Hey, Dad. Did you want to talk about why I haven’t talked to you in a month?” He apprehensively agreed. Then I said, “I appreciate your concern for me, but maybe you could consider a different approach.” He told me to shut up and that he’ll never be sorry for being a concerned parent, but that he is sorry I’m unsuccessful in life, and then he hung up on me.
We didn’t speak for nearly four months—the longest I’ve gone not talking to my father. I didn’t really have the desire to call him. Before this, I would have just picked up the phone. This was the first time I ever called him out on his behaviour, and I was willing and open to talk about it. But he wasn’t. There wasn’t much else for me to do. Something changed in me during that conversation. Finally setting a boundary with my dad meant not actually standing up to him as much as it was standing up for myself. The decision to do this was a culmination of everything else that was going on in my life—my work stress was reaching a breaking point and I took a sick leave shortly after, and I was also having trouble with some key friendships. It was me finally realizing, No, this isn’t okay anymore. A parent can be worried about you, but they don’t have the right to verbally abuse you.
When he finally called me months later, he apologized. He acknowledged his behaviour, but still hasn’t acknowledged the physical abuse. He said, “I’m getting older and what will I do if I don’t have a relationship with my family?” I responded that that can’t be the only reason we have a relationship. We had a good conversation, but this time away has helped me reset how I interact with him. I’m being more cautious now—I don’t think someone changes after one conversation. I talked to him significantly less that I used to. Before this fight, I would call him out of habit. Now, I call him once every two or three weeks.
Looking back, my relationship with my dad has always been about trying to prove to him that I was valuable, that the warmth I bring to the world is meaningful even if I’m not achieving all the milestones he wants for me. I’ve done a lot of work on myself to know my worth—and now I know it doesn’t come from his approval.
Call 911 if you’re in immediate danger from abuse. If you’re in a abusive relationship—or want to help a friend who is—call the Assaulted Women’s Helpline at 1-866-863-0511 for support; crisis counselling is available 24 hours a day, 7 days a week. For additional, cross-Canada resources, check out this directory from the Ending Violence Association of Canada.
Have ADHD? Know someone with ADHD? Want to learn more? You’re in the right place! We post videos with tips, tricks and insights into the ADHD brain. This channel is my ADHD toolbox — a place to keep all the strategies I’ve learned about having and living with ADHD. It’s also grown into an amazing community of brains (and hearts!) who support and help each other. Anyone looking to learn more about ADHD is welcome here!
Here at HowToADHD we aim to provide a safe, respectful, and welcoming community that help each other out. Whether you are a Brain, a Heart, or simply someone curious about ADHD, don’t worry! Everyone is welcome!
Don’t know where to start? Try here!
Some things about ADHD:
ADHD is a common neuro-developmental disorder that is incurable, but highly treatable. ADHD is also one of the most researched mental disorders, and has many available treatments, such as stimulant and non-stimulant medications, cognitive behavioral therapy, ADHD coaching and strategies such as mindfulness meditation and exercise.
It’s also important to remember that ADHD isn’t the same for everyone! There are 3 different presentations (primarily inattentive, primarily hyperactive-impulsive, and a combination of both). ADHD is also on a spectrum — it ranges from mild to severe — and it is often accompanied by other conditions like anxiety or depression and learning disabilities like dyslexia. Therefore, what works for one ADHDer may not be right for others, but most ADHD brains benefit from a combination of treatment strategies. Medication is not a cure all answer!
Most importantly: Jessica is not a medical professional, nor does she claim to be one.
ADHD can only be diagnosed by a medical professional!
Building Emotional Intelligence Isn’t as Hard as You Think
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Dozens of times a week, we ask friends, family, and even strangers, “How are you?” Given this fact alone, you’d think our society was very interested in how people feel.
But all of us know that this question generally doesn’t get an honest answer. Instead, most people reply with, “good,” “fine,” or at least, “okay.” If we’re really honest with ourselves, most of us would be a bit uncomfortable if we got a more genuine answer.
For many of us, it can feel risky to get in touch with our feelings, let alone to express them to others. I was recently speaking with a close friend who was genuinely hurt by something his father posted in a family chat room. He had been ruminating about it for days. And yet, when I suggested that he bring it up with his dad, his answer was straightforward: “No,” he told me. “We don’t talk about feelings in our family.”
Psychologist Marc Brackett, the founder of the Yale Center for Emotional Intelligence, argues that this tendency to avoid feelings, though understandable, can be a real disadvantage.
In one experiment, Brackett and his colleagues divided middle-school teachers into two groups. One group was placed in a good mood by recalling positive classroom experiences, while the other group was placed in a bad mood by recalling negative classroom experiences.
Then, they all were asked to grade the same essay. The teachers who were in a worse mood scored the essay a full letter grade lower than those in a better mood. But here’s the real kicker: Most of the teachers said they thought their mood had no influence on their grading, even though it clearly had.
Whether we like it or not, our feelings affect our thinking and behavior. Being out of touch with these feelings just means we’re at the mercy of them. So, it behooves us to get to know them better.
Our ability to understand and regulate our feelings is what psychologists often call “emotional intelligence.” Luckily, emotional intelligence isn’t a fixed commodity, but rather something we can build by learning what Brackett calls “emotion skills.”
He has developed a system, organized around the acronym R.U.L.E.R., which has been used in nearly 2,000 schools across the world to teach such skills to children and teenagers. But it can be equally applicable for helping all of us develop greater wisdom about our feelings and use them to our advantage.
Here are the five skills you can start practicing now:
R: Recognize
The first step toward productively managing any feeling is to recognize that we’re having it. Although this may sound easy, it’s equally easy to ignore our feelings. Have you ever said, “I don’t care,” about a situation when you really did? Have you ever gotten a head or neck ache, only to later realize you were actually feeling emotionally stressed?
To better recognize our feelings, Bracket suggests using a technique known as the “Mood Meter.” At its heart, this technique involves asking yourself two simple questions:
How much energy does this emotion have?
How pleasant is this emotion?
Emotions can be high in both, low in both, high in energy and low in pleasantness, or low in energy and high in pleasantness. Emotions high in both energy and pleasantness include joy, excitement, and optimism, while emotions low in both include sadness and depression. Anxiety, anger, and frustration are examples of feelings high in energy but low in pleasantness, whereas calmness and contentedness are examples of feelings low in energy but high in pleasantness. By at least identifying in which of these categories our feelings fall, we lay a foundation for wisely dealing with them.
U: Understand
The next emotion skill involves understanding our feelings. In short, this involves asking the question, “Why am I feeling this way?” Because this wide-open question is notoriously difficult to answer, in his book Permission to Feel, Brackett suggests some more specific questions we can ask ourselves to figure out the reasons behind our feelings. Here are a few of them:
What just happened? What was I doing before this happened?
What happened this morning, or last night, that might be involved in this?
What has happened before with this person that might be connected?
What memories do I have about the situation or place in which this emotion occurred?
Understanding the causes of our feelings can help provide clues about how to address them. If I’m feeling anxious because my new boss reminds me of a person from my past who was cruel to me, I’ll want to deal with the situation very differently than if my anxiety results from a particular managerial decision my boss just made. Of course, it could be both—so it can take serious time and introspection to really sort out what we’re experiencing and why. Be patient and keep at it.
L: Label
It’s not enough simply to recognize and understand an emotion; we also can benefit from finding the right word to describe it.
Many of us have a relatively limited emotion vocabulary. Some of us stick with two words: bad and good. Others might have three or four: happy, sad, mad, and scared. Still others may not use emotion words at all, but prefer figures of speech like, “on top of the world” or “burning up.”
But in actuality, there are thousands of words to describe emotions in the English language alone. We certainly don’t have to memorize all of them, but Brackett suggests that more accurate labels are usually better for us. In his words, “We know from neuroscience and brain imaging research that there is real, tangible truth to the proposition that ‘if you can name it, you can tame it.’”
For a start, knowing precisely what feelings we’re experiencing can give us clues about how to manage them. Although you may recognize that you’re experiencing a negative, high-energy emotion, both “stressed” and “overwhelmed” might fit that general description. But which of these labels most accurately describes our feeling really matters, because they mean different things.
“Stress” generally means we feel that what we’re trying to do or handle exceeds our capabilities, whereas “overwhelmed” means there’s just too much of it, regardless of our capabilities. If we’re feeling overwhelmed, the best approach may be to reduce our workload the best we can, whereas if we’re feeling stressed, the best approach may be to upgrade our capabilities by learning new skills or reorganizing the way we do things.
E: Express
If the R, U, and L of R.U.L.E.R. are about getting into touch with our emotions, the E and R are about what to do with them.
There are lots of reasons we hesitate to express our feelings. Especially when emotions fall on the negative end of the spectrum, we may be afraid they’re inappropriate, will embarrass us, or will somehow injure the person we express them to.
According to Brackett, however, “Hurt feelings don’t vanish on their own. They don’t heal themselves. If we don’t express our emotions, they pile up like a debt that will eventually come due.” So it’s important to express them in some way.
But this doesn’t mean we should let our emotions run wild, saying everything that’s on our minds to everyone we wish. According to Brackett, the skill of expressing our feelings “means knowing how and when to display our emotions, depending on the setting, the people we’re with, and the larger context.”
If we’re feeling hurt by something our boss said, for instance, it’s in our best interest to express this differently than if a close friend said something similar to us. Depending on the level of trust, we may make ourselves more vulnerable to our friend than our boss, expressing our feelings in greater depth or detail. If there’s a good chance we could lose our job, we may even choose not to express our hurt at all to our boss, instead confiding in and seeking support from someone else.
R: Regulate
The final emotion skill involves determining how to cope with our feelings.
Whether or not we choose to express them, feelings impact us. Regulating our emotions involves dealing with them in a way that allows us to best meet our personal and professional goals—or at least prevent our feelings from interfering with them. This certainly doesn’t mean ignoring our emotions; as already discussed, this doesn’t work well. Instead, it involves learning to accept and deal with them wisely.
Techniques for helping us cope with our feelings run the gamut, and we should strive to use ones that work for us. Relaxation videos abound on YouTube and can help us soothe strong emotions. Meditation phone apps can be used to facilitate mindfulness, which may help us accept our feelings. Physical exercise can help us to “work out” our feelings and feel more grounded in our bodies.
But emotion regulation can also be very simple. “You can’t stand your neighbor? Avoid her,” writes Brackett. “Your parents are coming to visit and you don’t want them to see some of your more outré artwork? Hide it until they leave. You’re tired? Splash some water on your face.” The important thing is to acknowledge our feelings—not avoid them—and then take productive steps toward dealing with them.
Learning to be more emotionally skilled isn’t a panacea. It won’t eliminate all our negative feelings or bring about a constant state of bliss. Such goals are probably impossible. But part of emotional intelligence is realizing that our feelings aren’t our enemies. In fact, if we approach them wisely, they can be some of our best friends. Let’s all get to know these friends a little better.
About the Author
David B. Feldman, Ph.D., is a professor in the department of counseling psychology at Santa Clara University.
When shame becomes toxic, it can ruin our lives. Everyone experiences shame at one time another. It’s an emotion with physical symptoms like any other that come and go, but when it’s severe, it can be extremely painful.
Strong feelings of shame stimulate the sympathetic nervous system, causing a fight/flight/freeze reaction. We feel exposed and want to hide or react with rage, while feeling profoundly alienated from others and good parts of ourselves. We may not be able to think or talk clearly and be consumed with self-loathing, which is made worse because we’re unable to be rid of ourselves.
We all have our own specific triggers or tender points that produce feelings of shame. The intensity of our experience varies, too, depending upon our prior life experiences, cultural beliefs, personality, and the activating event.
Unlike ordinary shame, “internalized shame” hangs around and alters our self-image. It’s shame that has become “toxic,” a term first coined by Sylvan Tomkins in the early 1960s in his scholarly examination of human affect. For some people, toxic shame can monopolize their personality, while for others, it lies beneath their conscious awareness, but can easily be triggered.
Characteristics of Toxic Shame
Toxic shame differs from ordinary shame, which passes in a day or a few hours, in the following respects:
It can hide in our unconscious, so that we’re unaware that we have shame.
When we experience shame, it lasts much longer.
The feelings and pain associated with shame are of greater intensity.
An external event isn’t required to trigger it. Our own thoughts can bring on feelings of shame.
It leads to shame spirals that cause depression and feelings of hopelessness and despair.
It causes chronic “shame anxiety” — the fear of experiencing shame.
It’s accompanied by voices, images, or beliefs originating in childhood and is associated with a negative “shame story” about ourselves.
We needn’t recall the original source of the immediate shame, which usually originated in childhood or a prior trauma.
It creates deep feelings of inadequacy.
Shame-Based Beliefs
The fundamental belief underlying shame is that “I’m unlovable — not worthy of connection.” Usually, internalized shame manifests as one of the following beliefs or a variation thereof:
I’m stupid.
I’m unattractive (especially to a romantic partner).
I’m a failure.
I’m a bad person.
I’m a fraud or a phony.
I’m selfish.
I’m not enough (this belief can be applied to numerous areas).
I hate myself.
I don’t matter.
I’m defective or inadequate.
I shouldn’t have been born.
I’m unlovable.
The Cause of Toxic Shame
In most cases, shame becomes internalized or toxic from chronic or intense experiences of shame in childhood. Parents can unintentionally transfer their shame to their children through verbal messages or nonverbal behavior. For an example, a child might feel unloved in reaction to a parent’s depression, indifference, absence, or irritability or feel inadequate due to a parent’s competitiveness or over-correcting behavior. Children need to feel uniquely loved by both parents. When that connection is breached, such as when a child is scolded harshly, children feel alone and ashamed, unless the parent-child bond of love is soon repaired. However, even if shame has been internalized, it can be surmounted by later positive experiences.
If not healed, toxic shame can lead to aggression, depression, eating disorders, PTSD, and addiction. It generates low self-esteem, anxiety, irrational guilt, perfectionism, and codependency, and it limits our ability to enjoy satisfying relationships and professional success.
We can heal from toxic shame and build our self-esteem. To learn more about how to do so and the eight steps to heal, read Conquering Shame and Codependency: 8 Steps to Freeing the True You.
Darlene Lancer is a Licensed Marriage and Family Therapist and expert on relationships and codependency. She’s the author of Conquering Shame and Codependency: 8 Steps to Freeing the True You and Codependency for Dummies and six ebooks, including: 10 Steps to Self-Esteem, How To Speak Your Mind – Become Assertive and Set Limits, Dealing with a Narcissist: 8 Steps to Raise Self-Esteem and Set Boundaries with Difficult People, and Freedom from Guilt and Blame – Finding Self-Forgiveness, available on her website and Amazon. Ms. Lancer has counseled individuals and couples for 28 years and coaches internationally. She’s a sought-after speaker in media and at professional conferences. Her articles appear in professional journals and Internet mental health websites, including on her own, where you can get a free copy of “14 Tips for Letting Go.” Find her on Youtube.com, Soundcloud, Twitter @darlenelancer, and at www.Facebook.com/codependencyrecovery.
July 24, 2017Stephen Karpman, M.D., developed his “drama triangle” – victim, rescuer, persecutor – almost 40 years ago, and I find it’s just as relevant – and just as new to many people – as it was 40 years ago.
Even if you don’t spend much time yourself playing any of these three roles – you probably deal on a daily basis with people who do.
Knowing how to put our “big girl” or “big boy” pants on and get out of the triangle is essential when dealing with people who want to pull us in. Using our own wise mind to recognize when we’ve regressed into one of these roles ourselves (usually because of the usual culprit, needing to play those roles early in our family of origin conditioning) is also essential to make wise conscious choices in our intimate and social interactions with others.
May the reflections and exercises offered below save you much grief and help you enjoy healthy, game-free relationships.
REFLECTIONS
The drama triangle is a dynamic model of social interaction and conflict developed by Dr. Karpman when he was a student of Eric Berne, M.D. father of transactional analysis.
[Karpman and other clinicians point out that “victim, rescuer, and persecutor” refer to roles people unconsciously play, or try to manipulate other people to play, not the actual circumstances in someone’s life. There can be real victims of crime or racism or abuse, etc.]The three roles of the drama triangle are archetypal and easily recognizable in their extreme versions.
Victims
The stance of the victim is “poor me!” Victims see themselves as victimized, oppressed, powerless, helpless, hopeless, dejected, and ashamed, and come across as “super-sensitive,” wanting kid glove treatment from others. They can deny any responsibility for their negative circumstances and deny possession of the power to change those circumstances.
A person in the victim role will look for a rescuer, a savior, to save them (and if someone refuses or fails to do that, can quickly perceive them now as a persecutor.)
In terms of derailing resilience, victims have real difficulties making decisions, solving problems, finding much pleasure in life, or understanding their self-perpetuating behaviors.
Rescuers
The stance of the rescuer is “Let me help you!” Rescuers work hard to help and caretake other people, and even need to help other people to feel good about themselves, while neglecting their own needs or not taking responsibility for meeting their own needs.
Rescuers are classically co-dependent and enablers. They need victims to help and often can’t allow the victim to succeed or get better. They can use guilt o keep their victims dependent and feel guilty themselves if they are not rescuing somebody.
In terms of derailing resilience, rescuers are frequently harried, overworked, tired, caught in a martyr style while resentment festers underneath.
Persecutors
The stance of the persecutor is “It’s all your fault!” Persecutors criticize and blame the victim, set strict limits, can be controlling, rigid, authoritative, angry and unpleasant. They keep the victim feeling oppressed through threats and bullying.
In terms of resilience, persecutors can’t bend, can’t be flexible, can’t be vulnerable, can’t be human; they fear the risk of being a victim themselves. Persecutors yell and criticize but they don’t actually solve any problems or help anyone else solve the problem.
These are the most extreme versions of these three roles, but we can encounter people playing milder versions of these roles on a pretty regular basis.
Because Dr. Karpman was a student of transactional analysis at the time he identified these three roles on the drama triangle, there is a resemblance to the critical parent (persecutor) marshmallow parent (rescuers) and the wounded inner child (victim) Eric Berne described in Games People Play.
What gives the drama triangle much of its power and significance is the recognition that people will switch roles and cycle through all three roles without ever getting out of the triangle. Victims depend on a savior; rescuers yearn for a basket case; persecutors need a scapegoat.
The trap is, people are acting out these roles to meet personal (often unconscious) needs rather than being able to see the picture as a whole and take responsibility for their part in keeping the triangle going.
Dad comes home from work to find Mom and Junior engaged in a battle. “Clean up your room or else,” (persecutor) Mom threatens. Dad immediately comes to Junior’s rescue. “Mom,” he might say, “give the boy a break. He’s been at school all day.”
Any one of several possibilities might follow. Perhaps (persecutor) Mom, feeling victimized by Dad, will turn her wrath on him. In that case, she moves Dad from rescuer to victim. They then might do a few quick trips around the triangle with Junior on the sidelines.
Or maybe Junior joins Dad in a persecutory “Let’s gang up on Mom” approach, or then again, maybe Junior will turn on Dad, rescuing Mom with “Mind your own business, Dad. I don’t need your help!” So it goes, with endless variations, but nonetheless, pinging from corner to corner on the triangle. For many families, it’s the only way they know to interact.
(See Stories to Learn From below for more examples]
What’s needed is for anyone on the triangle to “wake up” to the roles they are playing repeatedly. One person shifting out of role can catalyze the others to shift out of roles and behaviors. What’s especially helpful is for the victim to begin to “grow up” and take responsibility for their own empowerment and resourcing themselves to meet their own needs.
[See Exercises to Practice below]Each role on the drama triangle has its own payoffs. Victims get to be take care of. Rescuers get to feel good by caretaking. Persecutors get to remain feeling superior to both victim and rescuer.
But the cost is to perpetuate a dysfunctional social dynamic and to miss out on the possibilities (and responsibilities) of healthy, resonant, resilient relationships.
POETRY AND QUOTES TO INSPIRE
It’s only when we become convinced that we can’t take care of ourselves that we move into victim. Believing that we are frail, powerless or defective keeps us needing rescue. Anxiety forces us to be always on the lookout for someone stronger or more capable to take care of us. This relegates us to a lifetime of crippling dependency on our primary relationships.
Victims deny both their problems solving abilities and their potential for self-generated power. This doesn’t prevent them from feeling highly resentful towards those on whom they depend. As much as they insist on being taken care of by their primary rescuers, they nonetheless do not appreciate being reminded of their inadequacy.
– Lynne Forrest
* * * * *
The rescuer is the classic co-dependent, enabling, overly protective – the one who wants to “fix it.” Taking care of others may be the rescuer’s best game plan for getting to feel worthwhile. There’s no better way to feel important than to be a savior!
Rescuers often gain satisfaction by identifying with their care-taking role. They are generally proud of what “helpers” and “fixers” they are. Often they are socially acclaimed, even rewarded, for what can be seen as “selfless acts” of caring. They believe in their goodness as chief caretakers and see themselves as heroes.
Behind it all is a magical belief, “If I take care of them long enough, then, sooner or later, they will take care of me, too.” Common phrases for the martyred rescuer are, “After all I’ve done for you, this is the thanks I get?” or “No matter how much I do, it’s never enough;” or “If you loved me, you wouldn’t treat me like this!”
A rescuer’s greatest fear is that they will end up alone. They believe that their total value comes from how much they do for others. It’s difficult for them to see their worth beyond what they have to offer in the way of “stuff” or “service.” They believe, “If you need me, you won’t leave me.” They scramble to make themselves indispensable in order to avoid abandonment.
– Lynne Forrest
* * * * *
The persecutor is actually shame based. This role is most often taken on by someone who received overt mental and/or physical abuse during their childhood. As a result, they are often secretly seething inside form a shame-based wrath that ends up running their lives.
They may choose to emulate their primary childhood abuser(s), preferring to identify with those they see as having power and strength – rather than become the “picked on loser” at the bottom of life’s pile. Persecutors tend to adopt an attitude that says, “The world is hard and mean; only the ruthless survive. I’ll be one of those.”
The persecutor overcomes feelings of helplessness and shame by over-powering others. Domination becomes their most prevalent style of interaction. This means they must always be right! Their methods include bullying, preaching, threatening, blaming, lecturing, interrogating, and outright attack.
The persecutor needs someone to blame. They deny their vulnerability in the same way rescuers deny their needs. Their greatest fear is powerlessness. Because they judge and deny their own inadequacy, fear and vulnerability, they will need some place else to project these disowned feelings. In other words, they need a victim.
It is most difficult for someone in the persecutor role to take responsibility for the way they hurt others. In their mind, others deserve what they get. These warring individuals tent to see themselves as having to constantly fight for survival. Theirs is a constant struggle to protect themselves in what they perceive as a hostile world.
– Lynne Forrest
* * * * *
[Out of the triangle….]The only way to “escape” the drama triangle is to function as an “adult” and not participate in the game.
– John Goulet, MFT, Breaking the Drama Triangle
* * * * *
Those in victim roles must learn to assume responsibility for themselves and initiate self-care, rather than look outside themselves for a savior. They must challenge the ingrained belief that they can’t take care of themselves if they are to escape the triangle. Instead of seeing themselves as powerless, they must acknowledge their problem solving as well as their leadership capabilities. There is no escape except to take total responsibility for their own feelings, thoughts, and reactions.
It is certainly possible to be helpful and supportive without being a rescuer. There is a distinct difference between being truly helpful and rescuing. Authentic helpers act without expectations for reciprocation. They empower rather than disable those they serve. What they do will be done to encourage self-responsibility rather than promote dependency. True supporters believe that the other can handle their own business. They believe that everyone has the right to make mistakes and learn through sometimes hard consequences. They trust the other has what it takes to see themselves through times of difficulty without rescuers needing to “save” them.
Self-accountability is the only way off the grid for the persecutor. There has to be some kind of breakthrough to them to own their part. Unfortunately, because of their great reluctance to do so, it may have to come in the form of crisis.
– Lynne Forrest
STORIES TO LEARN FROM
During the time my daughter and I were staying with my girlfriend and her daughter, I was missing a very expensive pair of earrings – over $200 worth, and announced to everyone what they looked like and asked had they seen them. Nope, no one had seen them.
Finally, one day, suspicious of my girlfriend’s daughter, I went into her room and looked into her jewelry box and there we my earrings! I snatched them back. When everyone was home later that night, I told everyone where I had found my earrings.
I was clearly the victim, right? The persecutor was clearly my girlfriends’ daughter and either my girlfriend or my daughter, who was very young, could have been the rescuer.
Well…My girlfriend could not come out of denial that her daughter had taken the earrings, and her daughter denied taking them, stating she had no idea how they wound up in her jewelry box, so my girlfriend began to feel angry at me for blaming her daughter, persecuting me but making me the persecutor and her daughter the victim and my girlfriend the rescuer of her daughter.
My girlfriend and her daughter not taking responsibility keeps us all in the triangle.
– Patty Fleener, MSW
* * * * *
A good example of the game could be this fictitious argument between John and Mary, a married couple. V = victim, R = rescuer, P = persecutor
John: I can’t believe you burnt dinner! That’s the third time this month! (P)
Mary: Well, little Johnny fell and skinned his knee. Dinner burned while I was busy getting him a bandage. (R)
John: You baby that boy too much! (P)
Mary: You wouldn’t want him to get an infection, would you? I’d end up having to take care of him while he was sick. (V)
John: He’s big enough to get his own bandage. (R)
Mary: I just didn’t want him bleeding all over the carpet. (R)
John: You know, that’s the problem with these kids? They expect you to do everything (R)
Mary: That’s only natural honey, they are just young. (R)
John: I work like a dog all day at a job I hate…(V)
Mary: Yes, you do work very hard, dear. (R)
John: And I can’t even sit down to a good dinner! (V)
Mary: I can cook something else, it won’t take too long. (R)
John: A waste of an expensive steak! (P)
Mary: Well maybe if you could have hauled your ass out of your chair for a minute while I was busy, it wouldn’t have gotten burned! (P)
John: You didn’t say anything! How was I supposed to know? (P)
Mary: As if you couldn’t hear Johnny crying? You always ignore the kids! (P)
John: I do not. I just need time to sit and relax and unwind after working all day! You don’t know what it’s like…(V)
Mary: Sure, as if taking care of the house and kids isn’t work! (P)
This argument could continue indefinitely. What is of interest is how one can remove oneself from the triangle. The simplest method is the non-defensive response. This works at any point no matter what the role the other person is taking as it doesn’t give a cue as to the next response.
For instance:
Mary: Well maybe if you could have hauled your ass out of your chair for a minute while I was busy, it wouldn’t have gotten burned! (P
John: Yes, that’s true.
Although Mary may attempt to restart the cycle by continuing to scolded, if John continues in the same vein, Mary will eventually run out of things to say. John’s calm response invites discussion rather than continued wrangling. Mary might realize that she didn’t ask him for help, and they might well be a le to resolve the situation by planning on a course of action should something similar arise in the future.
It works just as well for the victim role:
John I do not. I just need time to sit and relax and unwind after working all day! You don’t know what it’s like…(V)
Mary: I’m sorry you’re feeling so tired.
This acknowledges any real problem the other person might have without continuing the dance. Again, the other person may attempt to restart the cycle by continuing to complain, but again, with continued non-defensive response, the other person will run out of things to say.
Even the rescuer role can be treated in the same manner.
Mary: That’s only natural honey, they are just young. (R)
John: Yes, they are young.
Because we all have unconscious core beliefs about ourselves and how to interact with other acquired in the relational dynamics of our families of origin, getting out of the drama triangle requires conscious awareness of any roles, victim, rescuer, persecutor or any others that we identify with and might be playing out currently, the capacity to discern healthier non-defensive, non-shaming-blaming responses when we sense we’re getting sucked into the roles of the triangle, and a willingness to take responsibility for our perceptions, reactions and behaviors when we wake up and know we are in the triangle.
This is basic wiser self application of our mindfulness practice to notice, acknowledge patterns, stepping back to reflect on them and the consequences of the, then dis-identify with them, not perpetuating the cycle, choosing wiser responses or behaviors.
Not to duck out of offering relevant exercises here, but the exercises in Chapter 16: Using Reflection to Identify Options in my book Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-Beingare exactly the kinds of applications of your mindfulness practice that will help you get out of the triangle, or deal directly with anyone who is trying to pull you in.
Trained curiosity and assessment are not the soul of psychological change.
Posted Oct 13, 2019
Source: StartupStockPhotos/Pixabay
There is a vast gulf between diagnosable issues as seen through the lens of psychological expertise and the essence, identity, strengths, and hopes of a person before me. Psychotherapists mean well, but at times we all stray outside of the bounds of helpfulness. Here are seven ways psychotherapists get in the way of psychotherapy:
1. Interrogating
When people come into session in the midst of an emotional storm, the last thing they need is to be inundated with endless questions on the basis of an agenda that is likely intended more to fulfill organizational protocols than to promote a foundation of therapeutic empathy and rapport.
Questioning always runs the risk of interrogation. The details learned about people’s lives ever tempt helping professionals toward distraction. There is a distinct difference between a personality and a person, a diagnosis and a destiny. It is our responsibility to stir hope and catalyze strengths rather than to stew history and analyze at length.
2. Pathologizing
The concept of “mental disorder” is rigid and misleading. In short, diagnosis is description, and by and large, mental health diagnosis provides description of “software” issues rather than “hardware,” so to speak. It’s a language of understanding what type of struggle a person is experiencing. When therapists refer to people by these diagnostic labels, we may overgeneralize a person’s experience and distance ourselves from a critical resource: the powerful, complex, and fluid process of therapeutic understanding, the power center of effective therapy.
3. Shaming
We ever risk a false sense of expertise about people’s lives against the backdrop of anxiety about our own. If we’re not careful, we may find ourselves reinforcing the tyranny of the perceived should. Should is shame‘s accomplice, and therapists must take care not to aid and abet them.
4. Sympathizing
Researcher Brené Brown (2010) rightfully proclaimed, “Empathy fuels connection, while sympathy drives disconnection.” Saying you understand is unhelpful and probably not true. And let’s be honest: It’s usually a ploy to rush people out of their emotional state, which sends the message, “I really don’t care enough to walk with you through your suffering.”
Source: Gerd Altmann/Pixabay
5. Lecturing
Psychologist and psychotherapy researcher Les Greenberg (2002) wrote, “Darwin, on jumping back from the strike of a glassed-in snake, having approached it with determination not to start back, noted that his will and reason were powerless against even the imagination of a danger that he had never even experienced. Reason is seldom sufficient to change automatic emergency-based emotional responses.”
With a surge in cognitive therapies, there has been a surge in their wrongful implementation, with many therapists engaging in power struggles to convince people of faulty beliefs in order for new, more positive truths to simply work some magic ripple effect into their lives.
As an emotion-focused therapist, I have been prone to, for instance, encourage couples to engage in safer, softer, and more emotionally responsive interactions, yet when I have stood on my own soapbox, encouraging them to do so out of pace with their own readiness, I have violated my own guidance. Miller (1986) observed that people will “persist in an action when they perceive that they have personally chosen to do so.”
6. Babbling
Silence can provoke anxiety, even for therapists, who think they should surely be redirecting, conjecturing, advising. I find myself observing people in therapy watch me watch them watching me watch them. And I have found a power in it. Like a Rorschach ink blot, presence has power in and of itself to nudge a person’s anxiety so it presents and speaks up for itself.
My former colleague, Blanche Douglas (2015), wrote: “There was a method in Freud‘s madness when he prescribed the analyst be as undefined as possible, not disclosing details about his life and sitting behind the patient out of sight, saying little. This forced the patient to make meaning out of an ambiguous situation, and the only way he could do this was by recourse to his own experiences.”
7. Methodologizing
If a psychotherapist is lifeless or their technique too technical, their efforts to help may be worthless. Therapy, in this case, is not a relationship but a poor excuse for scientific experimentation. The mechanisms of some psychotherapies undermine their therapeutic value. When we fixate on therapeutic modality, we run great risk of missing prime opportunities to interject the most valuable therapeutic tool we have to offer—ourselves.
Source: Cristofer Jeschke/Unsplash
Conclusion
As a new therapist, I remember trying hard to demonstrate my own capacity for psychological insight—even though, I must confess for my wise professors’ sake, I was certainly not trained to be an egotistical show-off. Fortunately, somewhere along the way, I started to better understand and experience the disparity between knowing and being. All these years, I am still learning each day how to lean into the latter. There is something powerful in it, not just in the experience of the therapist but in the experience of the therapy.
The family therapy pioneer Lynn Hoffman, who sadly died in 2017, gave a language of values for sitting with clients—the non-expert position, relational responsibility, generous listening, one perspective is never enough.
If a therapist is not fully present as a warm, accepting, genuine, caring, and appropriately vulnerable person, the power center of therapy remains turned off. Whatever insight may come along the way, meaningful, sustainable change requires transformative experiencing. Analysis without encounter is nihilistic, all the apparatus of thought busily working in a vacuum. Only in the context of authentic relationship and therapeutic alliance can I grasp and catalyze the breadth and depth of formidable resources already existing within my clients.
Chronic insomnia is defined as at least three restless nights per week for at least three months. (Alyssa L. Miller, Flickr cc)
While the American College of Physicians (ACP) can’t say cognitive behavioural therapy (CBT) outperforms medications for chronic insomnia, the group does say psychotherapy is less risky than drugs.
“Sometimes we forget that sleep medications have the potential for serious side-effects in some patients, while cognitive behavioural therapy is very low [risk] to patients,” said Dr. Wayne J. Riley, ACP president.
“The evidence is clear that CBT and sleep hygiene can be long lasting, life long, durable and delivered at a lower cost,” said Riley, who is also affiliated with Vanderbilt University in Nashville.
About 6 to 10 per cent of people in the U.S. have insomnia. Through loss of productivity, the condition is estimated to have cost the country about $63 billion US in 2009, according to the ACP committee that wrote the new guideline, which is published in the Annals of Internal Medicine.
Chronic insomnia is defined as at least three restless nights per week for at least three months.
“We wanted to take a deep dive into the literature for what makes a big difference with insomnia,” Riley told Reuters Health.
The ACP commissioned two reviews of insomnia treatments. One focused on medications, and the second focused on psychological and behavioural treatments.
Medication and ‘sleep driving’
Overall, the first review found that some medications may improve sleep over a short period of time, but those come with the potential for changes in thinking and behaviour. Additionally, there is a risk for infrequent but serious harms.
The U.S. Food and Drug Administration says medications for insomnia should only be used for short periods. The agency warns those drugs may impair people during the daytime, lead to “sleep driving,” behavioural changes and worsening depression.
The review of psychological and behavioural treatments found that CBT for insomnia improved overall sleep with a low risk of harms, the researchers report.
Evidence collected separately for the two reviews found that “side-effects can be quite severe with the use of insomnia medications in contrast to CBT, where there are minimal side-effects,” said Riley.
CBT for insomnia is typically delivered in four to six one-hour weekly sessions. People are taught behavioural techniques such as sleep restriction and stimulus control, and they are also taught sleep hygiene.
When chronic insomnia isn’t helped by CBT alone, the ACP advises patients and doctors to consider a short course of medication. That discussion should touch on the potential benefits, harms and costs of medication, the ACP says.
Doctors should encourage patients with insomnia to engage in CBT, according two researchers whose editorial was published with the reviews and the guideline.
‘Prescription not the best solution in the long term’
But, they admit, CBT for insomnia might not be covered by insurance and is likely not available at doctors’ offices, write Dr. Roger Kathol, of the University of Minnesota in Minneapolis, and J. Todd Arnedt, of the University of Michigan Medical School in Ann Arbor.
“Unless access to and unencumbered payment for value-based behavioural interventions, such as CBT (for insomnia), in medical settings become a reality, patients with chronic insomnia will continue to receive suboptimal treatment and experience suboptimal outcomes,” they write.
Alternatives to in-person CBT for insomnia include group therapy session, telephone counseling, online lessons and self-help books, Riley said.
The ACP recommendations are similar to that of the American Academy of Sleep Medicine (AASM), said Dr. Alcibiades Rodriguez, who is medical director of NYU Langone Medical Center’s Comprehensive Epilepsy Center-Sleep Center in New York City.
The AASM’s 2008 practice guidelines for treating chronic insomnia endorse psychotherapy as a first-line treatment and suggests it be used when medications are prescribed.
“The recommendations made by the ACP will appeal to a broader group of physicians to make them aware of this,” said Rodriguez, who was not involved with the new recommendations. “Then the doctors know just giving patients who come to their office with sleep problems a prescription is not the best solution in the long term.”
A poet and residential school survivor is releasing her latest collections of poems, and she says they have been instrumental in healing from the scars of residential schools.
Louise Bernice Halfe was was born in Two Hills, Alta., and completed programs at the University of Regina and University of Saskatchewan. She attended the Blue Quills Residential School, near St. Paul, Alta., for six years.
While the recently finished Truth and Reconciliation Commission was intended to help survivors heal, Bernice Halfe said the process opened old wounds. This collection of poetry, Burning in this Midnight Dream, helped heal those wounds.
Traditional ceremonies, psychology needed to help others
“It’s been extremely challenging and frightening as well,” she said of the process of walking backward, and retracing her past through the poetry. “What scared me was the feeling of being exposed and vlunerable.”
She said she needed to press ahead as a process of “accepting responsibility of my own actions and behaviours,” but the poetry is “also for the people who don’t have the vocabulary to articulate the shame and the pain and the anger that goes within their own stories.”
Bernice Halfe has training in drug and alcohol counseling, and in social work. She also emphasized the importance of psychotherapy and talking as tools for healing.
‘How do you recover as quickly as the people in the Canadian public want us to recover? I don’t know; I hope it’s possible. It’s very very hard.’– Louise Bernice Halfe
When asked how she wants to contribute to conversations on the legacy around residential schools, she described a photograph that showed her parents’ wedding and all of her relatives connected to her parents.
“There’s been a generational impact on whole communities. How do you recover as quickly as the people in the Canadian public want us to recover? I don’t know. I hope it’s possible. It’s very, very hard,” she said.
Bernice Halfe said she wants to see more aboriginal therapists and psychologists. “Not the kind that just prescribe pills,” she said.
Part of that responsibility is shared by the government, which she said has been insufficient in providing deep healing for aboriginal communities to recover from the legacy of residential schools.
“I would like to see more people trained in psychotherapy, along with their [traditional] ceremonial practices,” she said. “We needing funding for education in our communities. We also need mental health services closer to the communities.
“I’m talking about talk therapy. I’m talking about psychologists,” she emphasized.
Louise Bernice Halfe launches her latest collection of poems on Thursday at McNally Robinson in Saskatoon at 7 p.m. CST.
In terms of health care, we have it pretty good. If you are unfortunately diagnosed with cancer, most, if not all of your treatment will be paid for. If you break your leg, you can go to the ER and get a cast and leave without a bill. If you require surgery, the government will pay for that too. But what if your issue isn’t physical? What if what’s holding you back in life is a mental concern? Well, then you’re kind of out of luck.
There are indeed mental health services that are covered by provincial programs such as OHIP here in Ontario. We are all allowed free access to psychiatrists, which sounds great on the surface. But the real story is that most psychiatrists are incredibly overworked and many have waiting lists over a year long. For anyone who has ever experienced a mental health crisis, you know that waiting a year just isn’t an option.
And if you are mentally well enough to wait for that year (or more) there is only so much a psychiatrist can do for you with their limited time and vast client lists. Sure, they can prescribe and monitor your medication. But they typically don’t have time to sit down with you week after week and get to the real reasons why you are facing either depression, anxiety, addiction or any other mental health issue.
Psychotherapists specialize in that kind of ‘getting to the root of the problem’ type of therapy. And each year, countless lives are changed by the hundreds of excellent psychotherapists we have in this country. But for every life that is changed by psychotherapy, their lives are also changed by way of having to spend their hard-earned money and by prioritizing their mental health, sometimes at the expense of other important bills.
Whenever I am discussing treatment with a new client, their first question is inevitably ‘is this covered by the government?’
My answer has to unfortunately be ‘no, it’s not. But someday, I sure hope it will be.’
There are of course some private benefit packages that do cover psychotherapy but most of us are not lucky enough to have such in depth personal coverage from our employers. And that leaves many paying out of pocket for what can be a fairly costly expenditure.
If therapy was free for everyone in Canada, we would see an incredible reduction in the amount of sick days due to depression and anxiety. Productivity would go through the roof and our emergency rooms would be able to focus more of physical injuries instead of having to attend to mental health crises as well.
We are a progressive country and we lead in many areas. Unfortunately we are falling flat when it comes to mental health treatment. We’ve decided that only the rich and prosperous can have access to therapy.
And that just doesn’t sound very progressive to me.
By JANICE WOODAssociate News Editor Reviewed by John M. Grohol, Psy.D. on September 27, 2014
While antidepressants are the most commonly used treatment for social anxiety disorder, cognitive behavioral therapy (CBT) is more effective and — unlike medication — can have lasting effects long after treatment has stopped, according to a new study. CBT is one of the most common forms of talk therapy or psychotherapy.
According to researchers at John Hopkins University, social anxiety disorder, which is characterized by intense fear and avoidance of social situations, affects up to 13 percent of Americans and Europeans.
Most people never receive treatment. For those who do, medication is the more accessible treatment because there is a shortage of trained psychotherapists, according to the researchers.
“Social anxiety is more than just shyness,” said study leader Evan Mayo-Wilson, D.Phil., a research scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health.
“People with this disorder can experience severe impairment, from shunning friendships to turning down promotions at work that would require increased social interaction.
“The good news from our study is that social anxiety is treatable. Now that we know what works best, we need to improve access to psychotherapy for those who are suffering.”
The study, a network meta-analysis that collected and analyzed data from 101 clinical trials comparing multiple types of medication and talk therapy, was a collaboration between the Johns Hopkins Bloomberg School of Public Health, Oxford University and University College in London, where Mayo-Wilson formerly worked.
For the new study, the researchers analyzed data from 13,164 participants in 101 clinical trials. All had severe and longstanding social anxiety. Approximately 9,000 received medication or a placebo, while more than 4,000 received a psychological intervention.
Few of the trials looked at combining medication with talk therapy, and there was no evidence that combined therapy was better than talk therapy alone, the researchers noted.
After comparing several different types of talk therapy, the researchers found that individual CBT was the most effective. CBT, which focuses on relationships between thoughts, feelings and behaviors, helps people challenge irrational fears and overcome their avoidance of social situations, according to Mayo-Wilson.
For people who don’t want talk therapy, or who lack access to CBT, the most commonly used antidepressants — selective serotonin reuptake inhibitors (SSRIs) — are effective, the researchers found. But they caution that medication can be associated with serious adverse events, that it doesn’t work at all for some people, and that improvements in symptoms do not last after patients stop taking the pills.
The researchers acknowledge that medication is important, but say it should be used as a second-line therapy for people who do not respond to or do not want psychological therapy.
According to Mayo-Wilson, the analysis has already led to new treatment guidelines in the U.K. and it could have a “significant impact on policymaking and the organization of care in the U.S.”
“Greater investment in psychological therapies would improve quality of life, increase workplace productivity, and reduce health care costs,” Mayo-Wilson said.
“The health care system does not treat mental health equitably, but meeting demand isn’t simply a matter of getting insurers to pay for psychological services. We need to improve infrastructure to treat mental health problems as the evidence shows they should be treated. We need more programs to train clinicians, more experienced supervisors who can work with new practitioners, more offices, and more support staff,” he said.
After I Was Diagnosed With Bipolar Disorder, I Decided to Move Forward
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When I was 17 years old, I was diagnosed with Bipolar Disorder, something that came as no surprise, as my life prior to my diagnosis was fraught with behavioral challenges. At 21 years old, after years of battling uncontrollable moods, fits of rage, a myriad of body image issues, addiction and frustration with finding adequate medication I found myself in my first psychotic episode. This was no way to live, I knew I was capable of so much more as an articulate young woman with big dreams. At 5 o’clock in the morning on July 7, 2011, after driving through the night with a head full of racing thoughts in a mind that possessed zero ability to cope, I found myself collapsed on the porch of my father’s home manic, enraged and inconsolable. I was surrendering, I could no longer fight the battle my life prior to that summer had felt so unrelenting and inhibiting. After a brief rest early that morning, the first few hours of sleep I had experienced in days, is when made my decision to thrive. For years prior to that hazy morning, I had been urged by loved ones to receive intensive clinical psychological treatment in a formal setting, but I believe part of me was always resisting in denial and arrogance. It was at the end of my rope where I found my desire to change the trajectory of my life. On July 11, 2011, I made the first imprints in the path toward my new way of being in the world. I spent 90 days in intensive psychological care and healing treatment where I acquired invaluable “tools” that allowed me to move forward in the world, the woman I was on my father’s porch that July morning became a shadow of my former self and an unwelcome stranger in my future.
Almost three years later not a day goes by where I don’t draw on the lessons learned through my decision to thrive. I am currently finishing my Bachelor’s degree in clinical psychology and work as a peer counselor to youth experiencing their first onset of mental illness in Los Angeles, California. Everything I do comes from a place of gratitude for my demons and experiences that catalyzed my decision to forge the path I am on today. For I would be nothing without them just as I would be nothing without the boundless compassion, patience and support of the loved ones in my life who have championed all of my efforts.
I used to think the notion that people could change was a farce … until I did it myself. I am changing everyday, creating a more authentic self with every opportunity to do so, and within the beautiful chaos of it all — I am thriving.
This is a great resource to learn some communication skills.
Creative Commons copyright.
Enjoy,
Rory
Challenge One: Listening — Empathy in Action
Connect More Deeply by Listening More Attentively and Responsively
A chapter in The Seven Challenges Workbook A Guide to Cooperative Communication Skills for Success at Home and at Work
by Dennis Rivers, MA — 2012 Edition
SUMMARY (repeated from Introduction) Listen first and acknowledge what you hear, even if you don’t agree with it, before expressing your experience or point of view . In order to get more of your conversation partner’s attention in tense situations, pay attention first: listen and give a brief restatement of what you have heard (especially feelings) before you express your own needs or position. The kind of listening recommended here separates acknowledging from approving or agreeing . Acknowledging another person’s thoughts and feelings does not have to mean that youapprove of or agree with that person’s actions or way of experiencing, or that you will do whatever someone asks.
By listening and then repeating back in your own words the essence and feeling of what you have just heard, from the speaker’s point of view, you allow the speaker to feel the satisfaction of being understood, (a major human need). Listening responsively is always worthwhile as a way of letting people know that you care about them. Our conversation partners do not automatically know how well we have understood them, and they may not be very good at asking for confirmation. When a conversation is tense or difficult it is even more important to listen first and acknowledge what you hear . Otherwise, your chances of being heard by the other person may be very poor.
Listening to others helps others to listen. In learning to better coordinate our life activities with the life activities of others, we would do well to resist two very popular (but terrible) models of communication: arguing a case in court and debating. In courts and debates, each side tries to make its own points and listens to the other side only to tear down the other side’s points. Since the debaters and attorneys rarely have to reach agreement or get anything done together, it doesn’t seem to matter how much ill will their conversational style generates. But most of us are in a very different situation . We probably spend most of our lives trying to arrange agreement and cooperative action, so we need to be concerned about engaging people, not defeating them. In business (and in family life, too) the person we defeat today will probably be the person whose cooperation we need tomorrow!
As Marshall Rosenberg reported in his book, Nonviolent Communication , “studies in labor-management negotiations demonstrate that the time required to reach conflict resolution is cut in half when each negotiator agrees, before responding, to repeat what the previous speaker had said.” (my emphasis)
When people are upset about something and want to talk about it their capacity to listen is greatly diminished. Trying to get your point across to a person who is trying to express a strong feeling will usually cause the other person to try even harder to get that emotion recognized. On the other hand, once people feel that their messages and feelings have been heard, they start to relax and they have more attention available for listening. For example, in a hospital a nurse might say, after listening to a patient: “I hear that you are very uncomfortable right now, Susan, and you would really like to get out of that bed and move around. But your doctor says your bones won’t heal unless you stay put for another week.” The patient in this example is much more likely to listen to the nurse than if the nurse simply said: “I’m really sorry, Susan, but you have to stay in bed. Your doctor says your bones won’t heal unless you stay put for another week.” What is missing in this second version is any acknowledgment of the patient’s present experience.
The power of simple acknowledging. The practice of responsive listening described here separates acknowledging the thoughts and feelings that a person expresses from approving, agreeing, advising, or persuading. Acknowledging another person’s thoughts and feelings…
…still leaves you the option of agreeing or disagreeing with that person’s point of view, actions or way of experiencing.
…still leaves you with the option of saying yes or no to a request.
…still leaves you with the option of saying more about the matter being discussed.
One recurring problem in conflict situations is that many people don’tseparate acknowledging from agreeing. They are joined together in people’s minds, somewhat like a two-boxes-of-soap “package deal” in a supermarket. The effect of this is, let us say, that John feels that any acknowledgment of Fred’s experience implies agreement and approval, therefore John will not acknowledge any of Fred’s experience. Fred tries harder to be heard and John tries harder not to hear. Of course, this is a recipe for stalemate (if not disaster).
People want both: to be understood and acknowledged on the one hand, and to be approved and agreed with, on the other. With practice, you can learn to respond first with a simple acknowledgment. As you do this, you may find that, figuratively speaking, you can give your conversation partners half of what they want, even if you can’t give them all of what they want. In many conflict situations that will be a giant step forward. Your conversation partners will also be more likely to acknowledge your position and experience, even if they don’t sympathize with you. This mutual acknowledgment can create an emotional atmosphere in which it is easier to work toward agreement or more gracefully accommodate disagreements. Here are three examples of acknowledgments that do not imply agreement:
Counselor to a drug abuse client: “I hear that you are feeling terrible right now and that you really want some drugs. And I want you to know that I’m still concerned this stuff you’re taking is going to kill you.”
Mother to seven-year-old: “I know that you want some more cake and ice cream, Jimmy, because it tastes so good, but you’ve already had three pieces and I’m really worried that you’ll get an upset tummy. That’s why I don’t want you to have any more.”
Union representative to company owner’s representative: “I understand from your presentation that you see XYZ Company as short of cash, threatened by foreign competition, and not in a position to agree to any wage increases. Now I would like us to explore contract arrangements that would allow my union members to get a wage increase and XYZ Company to advance its organizational goals.”
In each case a person’s listening to and acknowledgment of his or her conversation partner’s experience or position increases the chance that the conversation partner will be willing to listen in turn. The examples given above are all a bit long and include a declaration of the listener’s position or decision. In many conversations you may simply want to reassure your conversation partner with a word or two that you have heard and understood whatever they are experiencing. For example, saying, “You sound really happy [or sad] about that,” etc.
As you listen to the important people in your life, give very brief summaries of the experiences they are talking about and name the want or feeling that appears to be at the heart of the experience. For example:
“So you were really happy about that…”
“So you drove all the way over there and they didn’t have the part they promised you on the phone. What a let-down…
“Sounds like you wanted a big change in that situation…”
“Wow. Your dog got run over. You must be feeling really terrible…”
The point here is to empathize, not to advise. If you added to that last statement, “That total SLOB!!! You should sue that person who ran over your dog. People need to pay for their mistakes, etc.”, you would be taking over the conversation and also leading the person away from her or his feelings and toward your own.
Other suggestions about listening more responsively:
As a general rule, do not just repeat another person’s exact words.Summarize their experience in your own words . But in cases where people actually scream or shout something, sometimes you may want to repeat a few of their exact words in a quiet tone of voice to let them know that you have heard it just as they said it.
If the emotion is unclear, make a tentative guess, as in “So it sounds like maybe you were a little unhappy about all that…” The speaker will usually correct your guess if it needs correcting.
Listening is an art and there are very few fixed rules. Pay attention to whether the person speaking accepts your summary by saying things such as “yeah!”, “you got it,” “that’s right,” and similar responses.
If you can identify with what the other person is experiencing, then in your tone of voice (as you summarize what another person is going through), express a little of the feeling that your conversation partner is expressing. (Emotionally flat summaries feel strange and distant.)
Such compassionate listening is a powerful resource for navigating through life, and it also makes significant demands on us as listeners. We may need to learn how to hold our own ground while we restate someone else’s position. That takes practice. We also have to be able to listen to people’s criticisms or complaints without becoming disoriented or totally losing our sense of self worth. That requires cultivating a deeper sense of self worth, which is no small project. In spite of these difficulties, the results of compassion-ate, responsive listening have been so rewarding in my life that I have found it to be worth all the effort required.
Real life examples. Here are two brief, true stories about listening. The first is about listening going well and the second is about the heavy price people sometimes pay for not listening in an empathic way.
John Gottman describes his discovery that listening really works: “I remember the day I first discovered how Emotion Coaching [the author’s approach to empathic listening] might work with my own daughter, Moriah. She was two at the time and we were on a cross-country flight home after visiting with relatives. Bored, tired, and cranky, Moriah asked me for Zebra, her favorite stuffed animal and comfort object. Unfortunately, we had absentmindedly packed the well-worn critter in a suitcase that was checked at the baggage counter.
“I’m sorry, honey, but we can’t get Zebra right now. He’s in the big suitcase in another part of the airplane,” I explained.”I want Zebra,” she whined pitifully.
“I know, sweetheart. But Zebra isn’t here. He’s in the baggage compartment under-neath the plane and Daddy can’t get him until we get off the plane. I’m sorry.”
“I want Zebra! I want Zebra!” she moaned again. Then she started to cry, twisting in her safety seat and reaching futilely toward a bag on the floor where she’d seen me go for snacks.
“I know you want Zebra,” I said, feeling my blood pressure rise. “But he’s not in that bag. He’s not here and I can’t do anything about it. Look, why don’t we read about Ernie,” I said, fumbling for one of her favorite picture books.
“Not Ernie!” she wailed, angry now. “I want Zebra. I want him NOW!”
By now, I was getting “do something” looks from the passengers, from the airline attendants, from my wife, seated across the aisle. I looked at Moriah’s face, red with anger, and imagined how frustrated she must feel. After all, wasn’t I the guy who could whip up a peanut butter sandwich on demand? Make huge purple dinosaurs appear with the flip of a TV switch? Why was I withholding her favorite toy from her? Didn’t I understand how much she wanted it?
I felt bad. Then it dawned on me: I couldn’t get Zebra, but I could offer her the next best thing — a father’s comfort. “You wish you had Zebra now,” I said to her. “Yeah,” she said sadly.
“And you’re angry because we can’t get him for you.”
“Yeah.”
“You wish you could have Zebra right now,” I repeated, as she stared at me, looking rather curious, almost surprised. “Yeah,” she muttered. “I want him now.”
“You’re tired now, and smelling Zebra and cuddling with him would feel real good. I wish we had Zebra here so you could hold him. Even better, I wish we could get out of these seats and find a big, soft bed full of all your animals and pillows where we could just lie down.” “Yeah,” she agreed.
“We can’t get Zebra because he’s in another part of the airplane,” I said. “That makes you feel frustrated.” “Yeah,” she said with a sigh.
“I’m so sorry,” I said, watching the tension leave her face. She rested her head against the back of her safety seat. She continued to complain softly a few more times, but she was growing calmer. Within a few minutes, she was asleep.
Although Moriah was just two years old, she clearly knew what she wanted — her Zebra. Once she began to realize that getting it wasn’t possible, she wasn’t interested in my excuses, my arguments, or my diversions. My validation, however, was another matter. Finding out that I understood how she felt seemed to make her feel better. For me, it was a memorable testament to the power of empathy.”
Sam Keen describes a friend’s lament about the consequences of not listening deeply: “Long ago and far away, I expected love to be light and easy and without failure.
“Before we moved in together, we negotiated a prenuptial agreement. Neither of us had been married before, and we were both involved in our separate careers. So our agreement not to have children suited us both. Until… on the night she announced that her period was late and she was probably pregnant, we both treated the matter as an embarrassing accident with which we would have to deal. Why us? Why now? Without much discussion, we assumed we would do the rational thing — get an abortion. As the time approached, she began to play with hypothetical alternatives, to ask in a plaintive voice with half misty eyes: `Maybe we should keep the baby. Maybe we could get a live-in helper, and it wouldn’t interrupt our lives too much. Maybe I could even quit my job and be a full-time mother for a few years.` ”
“Maybe . . .“ To each maybe I answered: “Be realistic. Neither of us is willing to make the sacrifices to raise a child.“ She allowed herself to be convinced, silenced the voice of her irrational hopes and dreams, and terminated the pregnancy.
“It has been many years now since our `decision,` and we are still together and busy with our careers and our relationship. Still no children, even though we have recently been trying to get pregnant. I can’t help noticing that she suffers from spells of regret and guilt, and a certain mood of sadness settles over her. At times I know she longs for her missing child and imagines what he or she would be doing now. I reassure her that we did the right thing. But when I see her lingering guilt and pain and her worry that she missed her one chance to become a mother, I feel that I failed an important test of love. Because my mind had been closed to anything that would interrupt my plans for the future, I had listened to her without deep empathy or compassion. I’m no longer sure we made the right decision. I am sure that in refusing to enter into her agony, to share the pain of her ambivalence, I betrayed her.”
“I have asked for and, I think, received forgiveness, but there remains a scar that was caused by my insensitivity and self-absorption.”
[ Workbook editor’s note: I have not included this real life excerpt to make a point for or against abortion. The lesson I draw from this story is thatwhatever decision this couple made, they would have been able to live with that decision better if the husband had listened in a way that acknowledged all his wife’s feelings rather than listening only to argue her out of her feelings. What lesson do you draw from this story? ]
First exercise for Challenge 1: Active Listening. Find a practice partner. Take turns telling events from your lives. As you listen to your practice partner, sum up your practice partner’s overall experience and feelings in brief responses during the telling:
Your notes on this exercise:
Second exercise for Challenge 1: Learning from the past with the tools of the present. Think of one or more conversations in your life that went badly. Imagine how the conversations might have gone better with more responsive listening. Write down your alternative version of the conversation.
Suggestions for reading on the topic of listening.
The Power of Listening – An Ancient Practice for Our Future: Leon Berg
Free Article: Tell Me More an essay by Brenda Ueland, explores the transformative power of listening to friends and familiy members:
“I want to write about the great and powerful thing that listening is. And how we forget it. And how we don’t listen to our children, or those we love. And least of all — which is so important too — to those we do not love. But we should. Because listening is a magnetic and strange thing, a creative force. Think how the friends that really listen to us are the ones we move toward, and we want to sit in their radius as though it did us good, like ultraviolet rays.”
Free Article: Positive Deviant is a magazine article about the transformative power of deep listening, as it occurred in a program to reduce child malnutrition in Vietnam. It is one of the clearest examples I have ever read of what is now called “appreciative inquiry,” which advocates that helpers pay disciplined and systematic attention to the strengths, capacities and past successes of those people they wish to help.
[from the editor] Forms of compassionate listening have been practiced among Quakers and Buddhists for centuries, and among psychotherapists for decades. The late Gene Knudsen Hoffman (1919 – 2010) was both a Quaker peace activist and a pastoral counselor, and in my view she achieved two great things over the course of her life. First, she took the practice of compassionate listening out of the quiet environs of the Quaker meeting house, out from behind the closed doors of therapy session, and on to the stage of the world’s greatest conflicts. Her many trips to Russia and the Middle East have made her a legend in the peacemaking community. Second, she popularized compassionate listening in a generous way that invites and encourages other people to take up this practice, develop it and apply it in new areas. This small book is an expression of that generosity. Available for free around the world as an e-book, it includes both her lesson plans for Compassionate Listening Workshops and reports from Leah Green and Cynthia Monroe, two of her co-pioneers and creative colleagues.
Books: The following books can be found around the world, new and used, via the links below provided by the Global Find-A-Book service of Human Development Books, the publsher of this Seven Challenges Workbook. Click on the book titles below to bring up a Global Find-A-Book page for each title.
Listening is an essential skill worth every effort to learn and to master. Listening takes us out of our tendency toward self-absorption and self-protection. It opens us to the world around us and to the persons who matter most to us. When we listen, we learn, we grow, and we are nourished.
Why do we often feel cut off when speaking to the people closest to us? What is it that keeps so many of us from really listening? Practicing psychotherapists, Donoghue and Siegel answer these questions and more in this thoughtful, witty, and helpful look at the reasons why people don’t listen. Filled with vivid examples that clearly demonstrate easy-to-learn listening techniques, Are You Really Listening? is a guide to the secrets and joys of listening and being listened to. [From the publisher, Sorin Books] List price new, appx. $16. ISBN: 1893732886.
What do family members, coworkers, and friends want most but seldom get? Your undivided attention. Poor listening can be a cause of divorce, depression, customer dissatisfaction, low grades, and other ills. This Zen-based, practical guide will help you build relationships, sharpen concentration, create loyal clients, strengthen negotiating skills, hear what others miss, and get them to hear.[From the publisher, Quest Books] List price new, appx. $16. ISBN: 0835608263.
In this thoughtful anthology, eighteen contemporary spiritual teachers explore the transformative effects, and the difficulties, of skillful listening and suggest ways in which becoming a ‘listening warrior’ — someone who listens mindfully with focused attention — can improve relationships. Free of religious dogma and self-help clichés, the essays are inspiring, intelligent and accessible. [from the back cover] List price new, appx $17. ISBN: 0861713559.
You enteredtherapyfeeling broken, lonely,anxious, dissatisfied with your relationships and your career. Now you feel whole and healthy; your relationships have improved, and you’ve made some professional changes that have led to a more fulfilling career. You feel good about yourself. Life isn’t perfect, but you have come to accept these imperfections, and you feel equipped to handle life’s challenges when they come your way. Congratulations! The time, effort, and willingness to openly and honestly explore the most complex and painful areas of yourself and your life have paid off. Therapy worked. Now what? You have a standing weekly appointment with your therapist, and you have probably developed a strong therapeutic alliance with him or her. But lately you have noticed that you don’t feel a need to go to therapy and you struggle to find ways to fill the hour. These are some strong indicators that you are ready to leave therapy.
For most people, therapy is not forever. Very few people have reason to be in therapy for life. In fact, many of the people who make therapy a way of life are therapists. They have a personal and professional responsibility to maintain high levels of self-awareness. They must take precautions to ensure that their issues are not getting in the way of helping their clients, and that they are not letting their clients’ issues prevent them from living their own lives. Weekly therapy sessions can create the time, space, and support for therapists to do just that.
Certainly, there are some people who are not therapists who also come to view therapy as a way of life. These people are often deeply dedicated to self-growth, and therapy may provide the support they need as they pursue constantly evolving personal goals. However, the vast majority of people who come to therapy do so with the intent of getting help with something specific. Whether it is something as broad as wanting to feel better or something as narrow as making a decision about a career move, people usually bring a specific goal to therapy. For some, these goals can be achieved in a few short months, while for others, it can take years. But ultimately there is a resolution and they feel ready to end therapy. Thequestion then is how to do it.
One of the things people find most useful about therapy is that there is nothing you can’t talk about in a session—including your relationship with your therapist. In fact, a growing body of research indicates that much of the positive change produced by therapy comes as a result of the therapeutic relationship. For example, if your relationships improved while you were in therapy, it is likely, in part, because you learned new ways of being in relationships by actively participating in your therapeutic relationship. So take the well-honed skill set that you developed in therapy and open a discussion with your therapist about ending the therapeutic relationship.
This will likely come as no surprise to your therapist. He or she knows what you came in to work on and knows that you have achieved your goal. Plus, this is a natural part of the process—all therapists in training learn about how to help clients work through this final stage, called termination. This is a prime opportunity to review the goals that brought you to therapy and to reflect on the growth that allowed you to accomplish them. This part of therapy is kind of like a graduation ceremony—it is an opportunity to step back, look at how far you have come, and revel in your success. And, as with graduations, it is an opportunity to ponder and plan for what comes next. Part of termination involves reinforcing the coping skills that evolve during therapy and reminding clients to continue to draw upon them in the future. Another important part of this process is to identify indicators that may signal the need to return to therapy in the future.
Finally, working through the process of termination with your therapist will allow you the opportunity to process the ending of a powerful and unique relationship. While this is a deeply genuine relationship, it is also one that exists within strictly prescribed boundaries—within the therapist’s office during appointment times. Of course, there may have been phone calls and additional meetings scheduled during times of crisis, but there isn’t a healthy way to continue the relationship you have formed with your therapist outside of therapy. Feelings of grief, loss, and anxiety about ending the therapeutic relationship often come up, and termination is designed to address these feelings. Like all aspects of therapy, this can be a difficult process, but seeing it through can be invaluable in helping you continue to develop and implement the kind of sophisticated relational skills that enable you to have deeper, more meaningful, and authentic relationships.
I remember being endlessly entertained by the adventures of my toys. Some days they died repeated, violent deaths, other days they traveled to space or discussed my swim lessons and how I absolutely should be allowed in the deep end of the pool, especially since I was such a talented doggy-paddler.
I didn’t understand why it was fun for me, it just was.
But as I grew older, it became harder and harder to access that expansive imaginary space that made my toys fun. I remember looking at them and feeling sort of frustrated and confused that things weren’t the same.
I played out all the same story lines that had been fun before, but the meaning had disappeared. Horse’s Big Space Adventure transformed into holding a plastic horse in the air, hoping it would somehow be enjoyable for me. Prehistoric Crazy-Bus Death Ride was just smashing a toy bus full of dinosaurs into the wall while feeling sort of bored and unfulfilled. I could no longer connect to my toys in a way that allowed me to participate in the experience.
Depression feels almost exactly like that, except about everything.
At first, though, the invulnerability that accompanied the detachment was exhilarating. At least as exhilarating as something can be without involving real emotions.
The beginning of my depression had been nothing but feelings, so the emotional deadening that followed was a welcome relief. I had always wanted to not give a fuck about anything. I viewed feelings as a weakness — annoying obstacles on my quest for total power over myself. And I finally didn’t have to feel them anymore.
But my experiences slowly flattened and blended together until it became obvious that there’s a huge difference between not giving a fuck and not being able to give a fuck. Cognitively, you might know that different things are happening to you, but they don’t feel very different.
Which leads to horrible, soul-decaying boredom.
I tried to get out more, but most fun activities just left me existentially confused or frustrated with my inability to enjoy them.
Months oozed by, and I gradually came to accept that maybe enjoyment was not a thing I got to feel anymore. I didn’t want anyone to know, though. I was still sort of uncomfortable about how bored and detached I felt around other people, and I was still holding out hope that the whole thing would spontaneously work itself out. As long as I could manage to not alienate anyone, everything might be okay!
However, I could no longer rely on genuine emotion to generate facial expressions, and when you have to spend every social interaction consciously manipulating your face into shapes that are only approximately the right ones, alienating people is inevitable.
Everyone noticed.
It’s weird for people who still have feelings to be around depressed people. They try to help you have feelings again so things can go back to normal, and it’s frustrating for them when that doesn’t happen. From their perspective, it seems like there has got to be some untapped source of happiness within you that you’ve simply lost track of, and if you could just see how beautiful things are…
At first, I’d try to explain that it’s not really negativity or sadness anymore, it’s more just this detached, meaningless fog where you can’t feel anything about anything — even the things you love, even fun things — and you’re horribly bored and lonely, but since you’ve lost your ability to connect with any of the things that would normally make you feel less bored and lonely, you’re stuck in the boring, lonely, meaningless void without anything to distract you from how boring, lonely, and meaningless it is.
But people want to help. So they try harder to make you feel hopeful and positive about the situation. You explain it again, hoping they’ll try a less hope-centric approach, but re-explaining your total inability to experience joy inevitably sounds kind of negative; like maybe you WANT to be depressed. The positivity starts coming out in a spray — a giant, desperate happiness sprinkler pointed directly at your face. And it keeps going like that until you’re having this weird argument where you’re trying to convince the person that you are far too hopeless for hope just so they’ll give up on their optimism crusade and let you go back to feeling bored and lonely by yourself.
And that’s the most frustrating thing about depression. It isn’t always something you can fight back against with hope. It isn’t even something — it’s nothing. And you can’t combat nothing. You can’t fill it up. You can’t cover it. It’s just there, pulling the meaning out of everything. That being the case, all the hopeful, proactive solutions start to sound completely insane in contrast to the scope of the problem.
It would be like having a bunch of dead fish, but no one around you will acknowledge that the fish are dead. Instead, they offer to help you look for the fish or try to help you figure out why they disappeared.
The problem might not even have a solution. But you aren’t necessarily looking for solutions. You’re maybe just looking for someone to say “sorry about how dead your fish are” or “wow, those are super dead. I still like you, though.”
I started spending more time alone.
Perhaps it was because I lacked the emotional depth necessary to panic, or maybe my predicament didn’t feel dramatic enough to make me suspicious, but I somehow managed to convince myself that everything was still under my control right up until I noticed myself wishing that nothing loved me so I wouldn’t feel obligated to keep existing.
It’s a strange moment when you realize that you don’t want to be alive anymore. If I had feelings, I’m sure I would have felt surprised. I have spent the vast majority of my life actively attempting to survive. Ever since my most distant single-celled ancestor squiggled into existence, there has been an unbroken chain of things that wanted to stick around.
Yet there I was, casually wishing that I could stop existing in the same way you’d want to leave an empty room or mute an unbearably repetitive noise.
That wasn’t the worst part, though. The worst part was deciding to keep going.
When I say that deciding to not kill myself was the worst part, I should clarify that I don’t mean it in a retrospective sense. From where I am now, it seems like a solid enough decision. But at the time, it felt like I had been dragging myself through the most miserable, endless wasteland, and — far in the distance — I had seen the promising glimmer of a slightly less miserable wasteland. And for just a moment, I thought maybe I’d be able to stop and rest. But as soon as I arrived at the border of the less miserable wasteland, I found out that I’d have to turn around and walk back the other way.
Soon afterward, I discovered that there’s no tactful or comfortable way to inform other people that you might be suicidal. And there’s definitely no way to ask for help casually.
I didn’t want it to be a big deal. However, it’s an alarming subject. Trying to be nonchalant about it just makes it weird for everyone.
I was also extremely ill-prepared for the position of comforting people. The things that seemed reassuring at the time weren’t necessarily comforting for others.
I had so very few feelings, and everyone else had so many, and it felt like they were having all of them in front of me at once. I didn’t really know what to do, so I agreed to see a doctor so that everyone would stop having all of their feelings at me.
The next few weeks were a haze of talking to relentlessly hopeful people about my feelings that didn’t exist so I could be prescribed medication that might help me have them again.
And every direction was bullshit for a really long time, especially up. The absurdity of working so hard to continue doing something you don’t like can be overwhelming. And the longer it takes to feel different, the more it starts to seem like everything might actually be hopeless bullshit.
My feelings did start to return eventually. But not all of them came back, and they didn’t arrive symmetrically.
I had not been able to care for a very long time, and when I finally started being able to care about things again, I HATED them. But hatred is technically a feeling, and my brain latched onto it like a child learning a new word.
Hating everything made all the positivity and hope feel even more unpalatable. The syrupy, over-simplified optimism started to feel almost offensive.
Thankfully, I rediscovered crying just before I got sick of hating things. I call this emotion “crying” and not “sadness” because that’s all it really was. Just crying for the sake of crying. My brain had partially learned how to be sad again, but it took the feeling out for a joy ride before it had learned how to use the brakes or steer.
At some point during this phase, I was crying on the kitchen floor for no reason. As was common practice during bouts of floor-crying, I was staring straight ahead at nothing in particular and feeling sort of weird about myself. Then, through the film of tears and nothingness, I spotted a tiny, shriveled piece of corn under the refrigerator.
I don’t claim to know why this happened, but when I saw the piece of corn, something snapped. And then that thing twisted through a few permutations of logic that I don’t understand, and produced the most confusing bout of uncontrollable, debilitating laughter that I have ever experienced.
I had absolutely no idea what was going on.
My brain had apparently been storing every unfelt scrap of happiness from the last nineteen months, and it had impulsively decided to unleash all of it at once in what would appear to be an act of vengeance.
That piece of corn is the funniest thing I have ever seen, and I cannot explain to anyone why it’s funny. I don’t even know why. If someone ever asks me “what was the exact moment where things started to feel slightly less shitty?” instead of telling a nice, heartwarming story about the support of the people who loved and believed in me, I’m going to have to tell them about the piece of corn. And then I’m going to have to try to explain that no, really, it was funny. Because, see, the way the corn was sitting on the floor… it was so alone… and it was just sitting there! And no matter how I explain it, I’ll get the same, confused look. So maybe I’ll try to show them the piece of corn – to see if they get it. They won’t. Things will get even weirder.
Anyway, I wanted to end this on a hopeful, positive note, but, seeing as how my sense of hope and positivity is still shrouded in a thick layer of feeling like hope and positivity are bullshit, I’ll just say this: Nobody can guarantee that it’s going to be okay, but — and I don’t know if this will be comforting to anyone else — the possibility exists that there’s a piece of corn on a floor somewhere that will make you just as confused about why you are laughing as you have ever been about why you are depressed. And even if everything still seems like hopeless bullshit, maybe it’s just pointless bullshit or weird bullshit or possibly not even bullshit.
I don’t know.
But when you’re concerned that the miserable, boring wasteland in front of you might stretch all the way into forever, not knowing feels strangely hope-like.
I suffered a nervous breakdown at age 36 – and it turned out to be a breakthrough. Here are 15 important things about life and happiness that I have learned, and that I hope you will take to heart in the coming year.
I want you to do me a favor. Look to the upcoming year and ask yourself – realistically – what lies in store in 2012? If you’re like most people, a huge portion of your life will be spent anxiously plugging away at a job you may or may not enjoy with coworkers you may or may not like. Okay, yes, you work hard to build a better life for your family. But here’s the question: Will you have time to enjoy them? Will you be too exhausted to throw the ball with your son? And how many nights will you get home too late to tuck him in this year?
This pattern of stress and striving has to stop. We already live in uncertain and depressing times, and our lifestyles are driving us not toward new heights, but over the brink. And if you’re not careful, you may suffer the same fate I did.
When I was 36 years old, I was successfully leading my family’s auto parts business, I was well respected in my community, I had a wonderful wife and son… and I also suffered a nervous breakdown. Yes, at that point in my life, I enjoyed what I did and was truly proud of my successes, but I was also pushing myself too hard and prioritizing the wrong things, and eventually, it all caught up with me.
For months leading up to my breakdown, I suffered from a paralyzing depression and anxiety, and found it difficult to complete tasks as simple as deciding whether to order coleslaw or potato salad with my lunch. But I still consider myself to be very fortunate.
As horrific as it was, my breakdown was actually also my breakthrough. It was an in-your-face wake-up call that forced me to realize that I was driving myself too hard, and for the wrong reasons. I finally had to say, “Enough is enough! I am done destroying myself and ruining my life!” Admitting to myself that my former way of life wasn’t working was the beginning of my road to recovery and true happiness.
For the past decade, I have taken a closer look at what really makes people happy and unhappy, and I have seen most of my goals and priorities shift. In the same way, it’s in your best interests to shift your habits and focus in 2012. Call it a New Year’s resolution to simply be happy.
I have come to realize that how happy and fulfilled you are is largely under your control, and that it has less to do with success and accomplishments than you might think. I believe that most people are experiencing many – if not all – of the stressors that led to my breakdown, so please don’t wait until you, too, reach a breaking point to make changes in your life. I’m totally convinced now that true happiness is a possibility for everyone, so I’m asking you to take the lessons I have learned to heart.
If you’re ready to change the way you approach life before you drive yourself over the edge, read on for 15 life lessons that I have learned:
1. You have to choose and prioritize happiness – it doesn’t just happen. If you subscribe to the belief that your happiness is wholly dependent on what happens to you, you’ll always be dissatisfied. The truth is, your fulfillment largely depends on the choices you make: how you see the world, what you allow to influence you, what you focus on, and how you react to circumstances, regardless of whether they’re good or bad. In other words, it’s not what happens to you; it’s how you look at what happens to you.
If you want to make a dent in your stress levels, you have to make choosing happiness a priority every day. With all of the responsibilities on our plates, nothing is likely to happen unless we specifically focus on it. So make happiness one of the two or three priorities you absolutely must accomplish each day. To remind yourself, put a note where you can see it – maybe on the refrigerator or bathroom mirror. And if that sounds selfish, it’s not. If you’re extremely stressed or become depressed because of the way you’re living your life, you’re hurting many more people than just yourself. And what’s more important than teaching your kids to be happy? Always remember that children learn by example. If they see you living a harried, stressed life, that’s the pattern their lives will follow as well…and their children’s after them, and so on.
2. Striving for work/life balance is worth its weight in gold. Times are tough, and some of us are finding it necessary to work long hours to keep our jobs and livelihoods. Others have fallen into the trap of the work-ego addiction: over time, you become hooked on the “high” you feel when you accomplish something, get a promotion, etc., and you begin to spend more and more time at the office. Whatever the reason, if extremely long hours are becoming a habit for you, break it. No matter how good your intentions are, overloading on work will cause your relationships, mindset, and even health to suffer.
Prior to my breakdown, it was normal for me to work seventy- or eighty-hour weeks. In my personal dictionary, “rest” and “relaxation” were synonymous with “irresponsibility” and “slacking.” Boy, was I wrong. Working as much as I did is more than the human body is designed to take continuously. If you drive yourself that hard, you’ll eventually begin to run on fumes before you shut down entirely. Being firm about creating and maintaining a healthy work/life balance is no more selfish than prioritizing happiness – in this case, it’s about simple self-preservation! And if you’re still skeptical, remember this: no one looks back on their lives at age eighty and says, “Gee, I wish I’d spent less time with my family and friends and more time at the office.”
3. We are our own worst critics. If you’re like most people, you probably tend to focus a lot of your mental energy on the things you mess up rather than on the things you do well—even though most of us do a hundred things right for every one thing we do wrong. And although you may not realize it, focusing on that one wrong thing is very dangerous, because our thoughts are incredibly powerful. Until you give yourself permission to break free of the cycle of self-blame and negativity that causes you to be stuck demanding perfection from yourself in every situation, you’ll never have a chance to be a truly relaxed, content, and happy person.
It’s not easy to rewire your habitual thought processes, but you need to build yourself up more and beat yourself up less. I used to expect nothing less than perfection out of myself, which was delusional! We’re all human, which means that we’re going to make mistakes from time to time. That doesn’t mean that we’re in any way unworthy or undeserving of love. In fact, learning to love myself was at the core of my own happiness journey. If you aren’t satisfied with who you are, you’ll always be looking outside yourself for validation…and you’ll never be truly content. And like me, you might also push yourself beyond healthy limits in order to get accolades from other people.
4. It’s never too late to start living in the present. How often do your thoughts “live” in the present? More to the point, how often are they instead fixated on your “disappointing” or “disturbing” past or spent worrying about your future? If you are like most people, your percentage of time not spent in the present is way, way too high, and thus you’re missing out on life itself. If you’re letting what’s already happened eat away at you or fretting about what might come to pass, you’re not enjoying the blessings all around you. You’re exacerbating your anxiety and unhappiness by choosing to dwell on things you can’t change or control.
I used to spend a majority of my time rehashing my past mistakes and worrying about what might happen in the future, neither of which did anything for my peace of mind or self-esteem. In fact, these unhealthy and self-critical thoughts were a major contributor to my breakdown. Now that I’m making a conscious effort to live in the present, I’m actually enjoying all of the great things in my life instead of letting them pass me by unnoticed. Plus, I’m actually a lot more productive now that all of that mental space that used to be occupied with worries has been freed up!
5. Focusing on what you’re good at is best for everyone. If you aren’t good at something – especially if it’s work-related – chances are you’ll feel compelled to spend a lot of time and effort getting your skills up to par. It’s natural to want to shore up your weaknesses, but the fact is, this strategy tends to cause you a lot of stress for (most likely) mediocre results. Instead of trying to be good at everything, stay in your strengths as much as possible. When you’re doing what you’re good at, you’ll be happier and higher performing.
As I’ve said, I used to be a total perfectionist. I felt like I was a failure if I didn’t excel in absolutely everything I tried. It probably won’t be a surprise to hear that all I accomplished was making myself miserable when I failed to live up to my impossibly high standards. If that sounds familiar, I’d suggest focusing more time on a hobby or personal interest to start, even if you do it for only twenty minutes every other day. And if you determine that your career doesn’t utilize your strengths, start looking at online job postings or for local classes in your field of interest. It’s never too early—or too late—to start doing the things that make you happy.
6. Exercise is worth its weight in therapy. Yes, you’ve heard it (a million times) before, but exercise is one small change that yields really big, life-changing benefits. For starters, it will begin to make you feel more relaxed, stronger, and more capable of handling life’s challenges—also, it will improve your sleep, and it’s a natural anti-depressant that will help your attitude and outlook. In fact, exercise actually opens you up to future change by invigorating your mind and body.
I’m convinced that exercise is the single most important thing you can do to improve your life right now. Looking back, I believe that my breakdown occurred when it did because I had broken my feet and couldn’t work out. Before that point, exercise was essentially acting as a medication that helped to counteract the effects of the stressful lifestyle I was living, and after I recovered, it has continued to boost my energy and outlook. If working out is already a part of your life, great! If it isn’t, commit to walking just twenty minutes every other day to start out. You don’t have to join a gym, sign up for exhausting classes, and completely reorder your life to reap the benefits of this investment!
7. You need to feed your mind healthy ‘food.’ When was the last time you watched the nightly news and turned off the TV feeling positive and uplifted? If anything, hearing the headlines is more likely to be depressing and discouraging. Although many of us don’t want to admit it, the things we hear, read, and experience influence our own attitudes and outlooks, so it’s important to consciously “feed” your mind positive materials.
It may sound hokey, but over the years I’ve become a big proponent of motivational books, audio recordings, and DVDs. Whether we’re at work, talking with friends, or at home watching TV or surfing the web, most of us encounter a lot more bad news and predictions than we do good. No wonder we become negative and cynical! It’s important to seek out positive things that will counteract these influences and dispel unnecessary stress. Learn new, constructive things and expose yourself to fresh ways of thinking so that you don’t get stuck in a self-destructive rut.
8. Surround yourself with positive people. If you stop for a drink at the water cooler and find your colleagues griping about how much work they have to do and how unreasonable your boss is, you probably don’t think much of it. In fact, depending on how your own day is going, you might even join in. And although you may not realize it, your attitude will start to deteriorate. The fact is, if you spend a significant amount of time around other people who are negative, your own outlook will begin to mirror theirs.
It’s much easier for others to drag you down than it is for you to build them up. In terms of your attitude and happiness levels, you will be the average of the five people you spend the most time with, so you need to be around other people who share your commitment to happiness if you want to avoid unnecessary stress. I’m not suggesting that you completely sever relationships that aren’t entirely uplifting, but gradually, you need to gravitate more toward positive people and distance yourself from those who tend to bring you down. This might mean calling a positive friend and asking to meet up for coffee or a beer, or walking away from the water cooler when your coworkers begin to gripe and complain.
9. Invest in your relationships – especially your marriage. When we’re driving ourselves to the brink, personal relationships are usually one of the first things to suffer. After all, the more time you spend at work, the less time and energy you have to invest in friends and family. You don’t consciously realize it at first, but this gradual deterioration can leave you feeling unappreciated, angry, alone, and anxious. Remember, though, that loving, supportive relationships will majorly enhance your happiness levels, and that friends and family care about you and accept you in a way that your employer never will.
It’s never a waste of time to reach out to the people who are meaningful to you and tell them how important they are to you, or to try to address any unresolved grievances and apologize for the things you may regret. And there’s one relationship you need to focus on in particular: the one with your spouse or significant other. Put more work into this relationship than you do into anything else: your house, your car, or your job, etc. Celebrate your spouse every day. Tell her (or him!) all the time how beautiful she is and how lucky you are to have her in your life. Trust me: this can make such a great difference in your emotional health, your stress levels, and your overall happiness! I truly believe that I would not be as happy as I am today without the love of my wife, and I also believe that my breakdown would have been much worse without her support.
10. Take control of what you can. If you’re reading this, chances are your life isn’t exactly stress-free. It’s practically impossible to live in the modern world without a million worries ranging from work deadlines to bills to clogged gutters. While you aren’t omnipotent, you probably can influence at least a few of the things that are causing your anxiety. Try to eliminate or minimize situations that are stressors instead of constantly dealing with their effects. Often, it’s the little things that make the biggest difference when it comes to relieving stress.
Start by identifying the two or three things that cause you the most stress on a consistent basis – maybe having a messy house is one. Often, you’ll find that there are concrete things you can do to lessen or even eliminate the pressure. For example, you might have a frank discussion with your spouse and kids regarding chores. Or, you might finally hire a cleaning person to help you once or twice a month if you can now afford it. Also, if you can’t eliminate or change a stressor, such as a job you hate but can’t afford to quit, challenge yourself to handle it differently. Specifically, decide beforehand how you will react in a more enlightened way when certain stressful situations occur – actually visualize yourself handling them with poise instead of becoming outwardly or inwardly worked up. Having a game plan in place before the “beast” rears its ugly head really can reduce your negative reactions to stressors—big time.
11. Being friendly is a good investment. In our culture, it’s become a badge of honor to stride around with an air of importance and a stony face. After all, if you’re too busy to say hello, you must be important. Yes, it’s easy to become absorbed by your responsibilities – but you’re not doing yourself any favors by shutting out the rest of the world. Even if you don’t have time to answer all of your emails, you can still smile at people in the hall and say a friendly hello to the cashier in the grocery store. Making positive connections will bring more happiness to you and to others.
Have you noticed that although our society is more and more “connected” by technology, we interact less and less with other people on a meaningful, face-to-face level than ever before? Our plugged-in lifestyles aren’t doing us as many favors as we thought they would. Even when we’re not at work, we’re likely to be glued to our smartphones or laptops, which amps up our stress. Make a conscious effort to unplug and make a friendly connection with another human – even a simple smile or hello is great. The fact is, everyone on Earth is carrying some sort of burden. You can’t make their pain, stress, or grief just magically disappear…but you can be what I call a “lamp-lighter” – someone who makes others feel just a little bit lighter and happier on their journey, even if only for five seconds. When you make friendliness a habit, you’ll attract kindness and smiles in return…and you’ll feel great about yourself for making a positive difference in the world!
12. Helping others is the soul food of life. One of the (many) negative side effects of our busy lives is that we tend to think mostly about ourselves: how much work we have left on that big presentation, how we’re going to find time to take the kids to sports practice and pick up groceries, and much, much more. No matter how busy you are now, consider helping others to be an integral part of the healthy work/life balance that will help you to avoid unhappiness. This will give you perspective, make you feel good, and will prevent you from staying in the negative me-focused cycle that was making you unhappy in the first place.
Since my breakdown, I’ve become very involved in philanthropy. I’ve found that it really is better to give than to receive, and that reaching out a helping hand to someone who isn’t as fortunate as you tends to quash selfish impulses and highlight your own blessings. Giving of yourself doesn’t have to involve money, either – remember that your time, talents, and compassion are just as valuable as cash, if not more so. Consider visiting a disabled veteran at the VA, or simply rolling your neighbor’s trashcan up the driveway! And if you have kids, you’ll be setting a wonderful example for them. I promise you, whether you’re giving time, energy, money, or encouragement, being generous will build up your self-esteem, broaden your perspective, keep you anchored in reality, and connect you to your blessings – all components of a happy life.
13. It’s important to connect with something bigger than yourself. Yes, spirituality (much like politics) is a touchy subject. But believing in something bigger than yourself is essential to developing the kind of perspective you need to be happy. Whether you consider your Higher Power to be God, Yahweh, Allah, Buddha, Krishna, the Universe, or even just Nature or another entity, being willing and able to see and feel His (or Her, if you prefer!) presence in your life will enable you to move away from self-centeredness and focus your energy and concerns on the greater community. It’ll also provide solace and give meaning to unfortunate events and troubling life circumstances.
Personally, I’ve been connected to the Jewish faith for my entire life. But it was only after my breakdown that I really allowed my faith to grow. My personal belief that God exists and cares about me has changed the way I view the world—but you don’t need to espouse my beliefs, or even join an organized religion and attend services regularly. What I do hope you’ll do is make an effort to clarify your thoughts about faith and also make an effort to connect to your Higher Power, whether it’s through prayer, meditation, writing in a journal, doing random acts of kindness, or just spending time in nature. Eventually, I hope you’ll begin to see your Higher Power as a source of inspiration, renewal, strength, guidance, and aid – as I do.
14. A grateful heart is a happy heart. It’s very easy to take things for granted: the information your coworker emailed you, the fact that your car is running, and even the food you’re eating for dinner. The fact is, most of us have gotten into the habit of ignoring all of the good things in our lives. Instead, we focus our mental energy on being upset about what’s wrong and what we don’t have. Yes, cultivating an “attitude of gratitude” might be a clichéd concept, but the humility that comes from knowing you owe so much to so many others will, in turn, spur you to give back more often to those less fortunate than yourself. Plus, studies have actually shown that thankful individuals are 25 percent healthier than their counterparts, too!
To start tapping into the power of gratitude, just say “thanks” to the people who help you out during your day. And beyond that, try to notice all of the blessings in your life. If you live in America, you have access to great education, healthcare, and the freedom to worship and work as you choose. Those are huge things to be thankful for right out of the gate! We take these “basics” and much more for granted, and we often have others—whether it’s an ancestor of ours, a veteran, or a coworker—to thank for them. It’s extremely important to be aware of all of your blessings, and to honor and thank those whom you owe.
15. Asking for help isn’t a sign of weakness. All of the things I have learned from my breakdown will help you to cut your stress levels, and they’ll also aid you in cultivating a more balanced, happier life. But it’s also important to realize that feeling anxious, overwhelmed, or depressed are all very serious, and you shouldn’t expect yourself to easily “fix” these issues on your own.
If you feel that you’re in over your head, or if your best efforts aren’t working, please reach out and ask for help. I might never have recovered after my breakdown without the help of my friends, family, and medical professionals. This is all big stuff. You shouldn’t—in fact, you can’t—make big changes in your life alone. At the very least, you’ll need the support of those who love you.
Ultimately, I’ve learned that the quality of your life is largely up to you. If you’re anything like me – and if you’re honest with yourself – you’ll have to confess that a striving, stressful lifestyle is not making you happy. I’ll admit that many of the changes I’m asking you to make in order to avoid more unhappiness (and perhaps even a breakdown) go against what society says you should do if you want to be successful. But I have found out the hard way that a “successful” yet stressed out and unhappy life is certainly not, in reality, a truly successful life at all.
Todd Patkin is the Author of Finding Happiness: One Man’s Quest to Beat Depression and Anxiety and – Finally – Let the Sunshine In (StepWise Press, 2011, ISBN: 978-0-9658261-9-8, $19.95). The book is available at bookstores nationwide, from major online booksellers, and at www.findinghappinessthebook.com.
Patients with depression who fail to benefit from antidepressant drugs may do better if they are also treated with a type of “talking” psychotherapy called CBT, according to new research published on Friday. In the first large-scale trial to test the effectiveness of cognitive behavioral therapy, or CBT, alongside medication for depression, scientists said they found that the combination works where drug treatment alone fails. Nicola Wiles of Bristol University’s school of social and community medicine, who led the study, said the findings underline the need to increase the availability of therapy for depressed patients. “While there have been initiatives to increase access to CBT in both the UK and Australia, worldwide initiatives are rare,” she said in a statement.
Wiles and colleagues recruited 469 adults from across Britain who had not responded to at least 6 weeks of treatment with an antidepressant. For the study, 235 patients continued with their usual antidepressant medication, while 234 patients got their usual care plus CBT and were followed up for 12 months. The results, published in The Lancet medical journal, showed that after 6 months, 46 percent of those who got CBT as well as their usual care had improved – reporting at least a 50 percent reduction in their depressive symptoms. This compared to 22 percent of those who did not get CBT. Patients treated with CBT, which involves talking through behaviors and ways of thinking with a trained psychotherapist or psychologist, were also more likely to go into remission and have fewer symptoms of anxiety, the researchers said. Similar effects were reported at 12 months. Major depression affects around 20 percent of people at some point in their lives. The World Health Organization (WHO)predicts that by 2020, depression will rival heart disease as the health disorder with the highest global disease burden. While there are many antidepressants on the market, including top sellers such as Prozac and Seroxat, it is widely accepted that many antidepressants work in only half of patients half of the time, and drugmakers are struggling to come up with a new generation of drugs in this field.
Willem Kuyken, a clinical psychology professor at Exeter University who also worked on the study, said its results showed that doctors and patients should be looking beyond drugs. “This trial provides further evidence that psychological treatments like cognitive therapy can provide substantive and lasting help to people who suffer depression,” he said. Wiles added, however, that even in wealthy countries such as Britain, where there has been a recent push to invest more into psychological therapies, many people who have not responded to antidepressants still don’t get the chance of trying intensive CBT that take between 12 and 18 sessions.
In the United States, only about a quarter of people with depression have received any form of psychological therapy in the last 12 months, she said.
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By listening and then repeating back in your own words the essence and feeling of what you have just heard, from the speaker’s point of view, you allow the speaker to feel the satisfaction of being understood, (a major human need). Listening responsively is always worthwhile as a way of letting people know that you care about them. Our conversation partners do not automatically know how well we have understood them, and they may not be very good at asking for confirmation. When a conversation is tense or difficult it is even more important to listen first and 
