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Providing Support

  • Most of us think to say, “is there anything I can do?” when someone we care about is struggling. While we are generous in offering our willingness to help, we may be adding to the “to-do” list of the person in need; to receive the help offered they now have to become a project manager who coordinates, organizes, and thinks up the items on their “how to help” list.
  • For most of us when we are really struggling we are in “just get to the next moment mode”, which means the parts of our brain that might help ease our burden (like the parts of us that can plan, brainstorm ideas, or be creative) become less accessible.
  • One of the most supportive things you can do to help someone in need, in addition to asking “what can I do”, is to offer your ability to plan or to be a “creative problem solver” on their behalf. Essentially, you can offer support by “loaning” your brain to their problems.
  • If this is not intuitive to you, try accessing your powers of empathy regarding the emotions you think they are struggling with in their current situation: Are they struggling with helplessness? Loss? Fear? From what you know of them, what provides comfort to them? If you don’t know them them that well, then offer what might provide comfort to you.
  • If the relationship isn’t quite that close, consider offering something concrete that doesn’t involve a need to plan or think too far ahead. Because a person in a difficult situation is often in “here and now” crisis mode you will be meeting them at their current capacity level by not asking them to look too far ahead.
  • We have to be careful not to let our desire to lift their burden overpower our ability to hear them when they communicate (with words or actions) what would be helpful for them. It’s not unusual for people to need space, time, or distance, which can be hard to receive when you really want to help. 
  • The truth of it is when someone is struggling, everyone around them may also struggle with their own helplessness about their limited ability to lift the burden from them. Our own desire not to feel our helplessness can sometimes drive us towards taking too much action, or action that overwhelms the party in need.
  • Remember that truly supporting someone is also about showing them their perspective and preferences matter; which means not over-inserting ourselves and paying attention to cues from them about what they (rather than we) perceive to be helpful. 
  • If nothing else, be mindful of your questions. Often, to help ourselves feel safe we want to understand “what happened’, which puts the person in crisis in a position to satisfy our desire to understand. Follow their lead about how much they want to talk, it will show them you are there for them, rather than to satisfy your curiosity.
  • Try and remember; you cannot take away someone’s pain, but you can ease it by “loaning” your brain and problem solving skills to their situation; by offering something concrete that doesn’t require too much planning; and by respecting their process and hearing them in what they communicate (in words and in actions) they need. 

We all know that when we are experiencing a crisis we can’t “think straight”. Translated into more concrete terms, this usually means the times when we need help the most, we struggle to identify our needs, articulate them to others, and think ahead about what will help moving forward. 


For many of us, our “crisis mode” is not one that is particularly good at planing or creativity, two parts of our intellect that are often most useful when we find ourselves in an overwhelming situation. Put simply, we struggle to slow down and think step by step about what we need, the situation needs, and our future selves will need.


If you are trying to support an individual or family in need you can – of course – start with “is there anything I can do to help?”. Some folks like to feel a sense of control and do have ideas for what they need, so it’s a helpful starting point. You do not, however, necessarily have to end there.  


Offering your abilities to plan, identify creative ideas, or offering to do something concrete (like get groceries) actually offers two things – whatever it is you offer – and something less tangible; the brain power we lose access to when we are struggling, in a crisis, or busy trying to wrap our heads around digesting difficult news.  


Do remember, there can be a delicate balance between recognizing when it might be helpful to do some thinking or acting on someone’s behalf and inserting yourself too much. Often times our eagerness, desire to help, and desire not to feel helpless ourselves, can interfere with our ability to listen in the moment to cues or words that indicate someone wants or needs less from us. This means, make your offer, but receive their answer, and recognize receiving their answer is a way in which you are supporting them. 


Finally, be mindful of why you’re asking questions about “what happened”. Your curiosity is natural, but remember that it most often serves your desire to understand, rather than the other party.  If you are there to provide support, offer to talk, keep an eye on the allure of satisfying your curiosity, and follow their lead about how much sharing or revealing they’d like to do.

Comments:

  1. Ok, so how do I do all of this? One way is to offer support openly (in the event they have ideas) while also offering some ideas you’ve come up with, like, “Please let me know if there is anything I can do to help. One idea I have is that I could get you groceries. I could also bring by some puzzles for Johnny to play with with he’s recovering? Let me know how that sounds”. Then, it becomes your job to listen to how they respond, which includes what they say explicitly and what they don’t say. Ultimately, a part of supporting someone well is recognizing the line between where our needs end, theirs begin, and the intersection of the two. We want you looking for cues from them that what you are offering and providing is useful to them.
  2. A helpful tool that I have come across over the years for individuals in crisis, or in need of coordinating support from groups of people is called Caring Bridge. This is a way to keep people updated on “what’s happening”, as well as coordinate ways to help on a shared schedule / in a shared system.  As a reminder I post resources I believe are valuable, and I do not accept compensation of any kind from third parties I endorse. I am suggesting this because I have seen it be helpful to families in need in both my personal and professional life, and it’s a resource I’d like to share. 
  3. I have a tangentially related post on this topic – about what happens when our desire to serve our own needs for safety can interfere with our ability to effectively process something terrible that’s happened to someone else. This is usually not the case when we are trying to provide support to others, but it’s another version of how our needs can get tangled up in the situation we are observing and can then skew our perception.  
  4. Helping others can get us into sticky territory with boundaries. When you’re providing support, remember to pay attention to what you need too. Posts to help with that include my post on finding balance in relationships, which walks you through how to keep an eye on yourself and the other party; My post on finding balance between “shoulds and wants” can help you reflect on what is driving you to provide support to others; and my post on building insight into recognizing where your limits actually are will be helpful if you find yourself in positions where you over-extend.

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Secure Attachment

  • Many of us look for “chemistry” in romantic relationships. Often times that “chemistry” is actually the activation of our attachment circuits.
  • Attachment patterns are initially formed in infancy and become a template for which we base intimate relationships on moving forward in our lives.
  • When we think about attachment patterns, we are thinking about how we connect to others, how secure we feel in that connection, how able we are to trust, rely on others / ourselves, and how comfortable we feel with exploration away from (and distance in) our closest relationships.
  • We form that “blueprint” attachment to the people we are most dependent on in infancy and in the earliest years of our lives. For most of us, that is our parents.
  • So yes, even though you don’t remember it, those early attachment experiences shaped you, and continue to effect you in relationships moving forward.
  • If, in those early relationships we consistently felt security (i.e. comforted, taken seriously, and attended to while we were in duress) AND accepted in our needs for distance, exploratory play, and independence we are likely to develop what’s called a “secure base” in our attachment relationships.
  • That secure base feels something like, “I know I can count on them to be there if I need them, but I also know the quality of the relationship won’t change if I want to do my own thing, have my own space, and go at my own speed”.
  • Only about 50% of the population connects to others with that secure base. The remaining 50% struggle with some combination of these dynamics in relationships.
  • Our attachment patterns hugely impact who we are drawn to, what our experience of dating is like, how our relationships go, what types of conflicts we are likely to have, and how comfortable we feel with commitment and distance in relationships.
  • Knowing and understanding our attachment patterns can make us more efficient and self-aware daters and partners. This can help us find a good match and take care of ourselves and our partnerships, even if we’re with someone who has a different attachment type.

Our attachment patterns hugely inform who and how we date, what we expect of ourselves and others in intimate relationships, and who ignites a “spark” in us. I’m always a bit hesitant of the whirlwind romance built exclusively on a spark, not because I don’t believe in love, but because I do believe in the power of our attachment circuits.

Our earliest relationships become a roadmap of sorts where we learn how to maintain a sense of connection to others. When we are infants we are in a state of complete dependency on our caregivers, and even though we have no conscious memory of that time, we are highly aware, perceptive, and paying close attention to what works to get us what we need from our caregivers and what doesn’t.

We take the information collected at that time and use it to generalize to other relationships as a blueprint for how relationships work, and how we should work in relationships for them to be successful. Did you often need to really cry and scream to get your parents to drop what they were doing to help you? You probably internalized that you need to be LOUD with your feelings for people to pay attention to you. Did you seek closeness to a caregiver who often struggled with physical affection? Well, perhaps you learned relationships go better when everyone takes space.

While we aren’t going to remember these experiences from infancy, we can look at how we attach, relate, connect, and trust in relational settings as adults to come to understand which roadmaps feel closest to ours. There are four primary attachment types (or roadmaps): Secure, Anxious, Dismissive, and Unresolved.

As unique as we all are as individuals, there are predictable patterns of relating we all fall into and the more we know and understand our patterns the more we can 1) challenge and change patterns that don’t work for us 2) Look for romantic partners who compliment our attachment style 3) Have constructive conversations with our partners about our attachment similarities and differences to strengthen our relationships.

Lots more to come on attachment. For now, consider how securely you attach in different types of relationships. Resources below to help on that journey.

Comments:

  1. Coming back to “the spark” I mention throughout the post. That “spark” is most likely to be felt in relationships where there is at least one party who is not operating from a secure base. There will be more on that in a future post, but I want to be clear that a “spark” isn’t “bad” it’s just often confused with “love at first sight” or “true love”, and in my experience it usually has a lot more to do with attachment patterns. Also, to be clear, if there is a spark in your relationship that doesn’t mean it’s a problem, it just may mean you and your partner will feel intense chemistry in some ways, and perhaps intense disconnects in others. That’s ok, and can all be worked through with two willing and committed parties. This will all make more sense once we get further into attachment types.
  2. A little more on attachment types: these are general patterns, but they are not hard patterns, meaning we all have a tendency to fit into one of the four categories, but we can slide around depending on the relationship, how we are doing, and the context in our lives. We can also attach securely in some types of relationship, but not in others (friends vs romantic relationships, men vs women, etc). As promised, more to come!
  3. If you’re a parent reading this your first thought might be, “oh lord I didn’t feel like picking my kid up this morning and now I’ve scared them forever”. Don’t be so hard on yourself – attachment patterns are formed over many experiences and are much more about the big picture of the relationship than about anomalies. No parent meets their child’s needs all the time, and quite frankly no parent needs to. Part of feeling secure in a relationship is having the confidence that a relationship can endure even with differences between the involved parties. That missed hug this morning can be a opportunity to strengthen the security of a relationship when paired with something like: “Daddy / Momma loves you, but I’m not going to pick you up right now. We can snuggle later.”
  4. A strong / secure connection doesn’t always mean “giving in” or never disappointing the other party, but it does often mean validating the other party’s experience. For more on how to validate AND set limits see this post on validation. If you’re a parent and you need help with this, you are not alone! This is not always intuitive, especially if it wasn’t your experience in childhood. For more guidance on incorporating healthy boundaries with validation check out Big Little Feelings, they have a paid course and free content through their instagram account (and as a friendly reminder I do not get any kick backs/ payment for referrals I make to resources, I just tell you about them because I think they are helpful).
  5. This post has more details on how our attachment history impacts our dating world.
  6. The best book I’ve found for clinicians on attachment based work is David Wallin’s attachment in psychotherapy. Here are some useful excerpts about how secure attachment affects development and relationships: “Secure babies appear to have equal access to their impulses to explore when they feel safe and to see solace in connection when they do not” (page 19). “Children with a history of secure attachment show substantially greater self-esteem, emotional health and ego resilience, positive affect, initiative, social competence, and concentration”. (page 23) “If our early relationships were secure, the result may well be a capacity to respond – that is to think, sense feel, and act – with openness and flexibility” (Page 65). Full Citation: Wallin, D. J. (2007). Attachment in Psychotherapy. Guilford Press.
  7. The best book for non-clinicians I have found on attachment theory is calling “Attached: The new science of adult attachment and how it can help you find – and keep – love”. I have some gripes about this book that I would tell anyone before recommending they read it. 1) I think there is a bit of critical tone towards the dismissive stance in the book, and a bit of a favorable tone towards the anxious stance. The fact is each attachment style has its upsides and downsides and dismissive isn’t “worse” than anxious (or vice versa). They are just different. 2) they do not cover the unresolved attachment type, which I think is a disappointing miss. 3) There is not enough of an emphasis on the fluid nature of attachment types; a person who is usually one attachment type is not ALWAYS that way in all relationships, even if they are that way most of the time. 4) It mentions the ability to move towards secure attachment, but I don’t think enough time is spent on it. 5) There have also been critiques on it being heteronormative and too simplistic which I think are both fair. So, in short (maybe not so short now), It’s a great introduction, the best I’ve found, I’ve recommended it many times – but don’t take it as the whole story.
  8. If you’re not up for reading a whole book, this article is a great start – though I don’t love the description of the attachment styles themselves or what forms them.

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One Mindfully

  • A simple, but transformative skill: learning how to be fully and wholly present in just one moment at a time.
  • Learning “one mindfully” (as we call it in the DBT world) can reduce anxiety, improve concentration, increase our ability to handle a crisis, increase our ability to connect to our authentic selves, and increase our efficiency.
  • The opposite of this concept is “mindlessness” (not fully being present with any activity – i.e. “going on autopilot”) or multi-tasking (attempting to do two activities at the same time).
  • The most common way many of us “multi-task” is something most of us would not identify as multi-tasking: Thinking about one thing while doing another.
  • Like the time you were in a meeting but actually preoccupied by the conflict you had the night before. Or, when you were writing an email while thinking about how to prepare for something later in the day.
  • When we use one-mindfully we work to be present with our whole selves, which means paying attention to the content of the moment while also paying attention to internal cues about our experience of that moment. 
  • We set an intention for what we will focus our attention and energy on, and we work to keep ourselves focused on that intention despite urges to split our attention, or give in to distraction.
  • This does not mean that we cannot choose to change where spend our energy and attention or that we have to completely finish before shifting our attention; it means that when we change what we are doing (and where we are focusing) we do so with intention and awareness, even if we are right in the middle of something.
  • This also does not mean we cannot transition quickly between tasks (think about cooking: you are chopping the carrots, then stopping to stir the onions). We can be wholly present with one activity while another in the background does not have our attention. 
  • This skill centers us, and requires that we recommit again and again to what we will spend our energy on in the face of distractions. It also requires that we reassess as time goes on to determine if we want to continue recommitting to that moment, or to changing where our focus will be.

Most of us struggle fairly significantly with “doing” one thing at a time. This is because many of us are “doing” one thing, but thinking about another. In this way, we’ve become accustomed to leaving the present moment for one in the past, one in the future, or one that may never happen. When we do this we reduce our ability to concentrate by dividing our attention. We also decrease the likelihood we will pick up on important cues from the environment around us; when we are distracted we are not able to be as perceptive.

In simple terms this skill is “doing” one thing at a time, but more complexly it is devoting your attention and energy to only one “thing” at a time. As Marsha Linehan says, this means, “When you are thinking, think. When you are worrying, worry. When you are planning, plan. When you are remembering, remember. Do each thing with all of your attention”. Dialectical Behavior Therapy, and Marsha Linehan, would encourage all of us to spend as much time as possible being wholly present with whatever moment we are engaged in.

Many of us are spending large chunks of our time distracted, and not present in both mind and body in whatever moment we are in. To be wholly and fully present means paying attention to your outer world (i.e. the conversation you are in) and your inner world (your internal reactions to that conversation in your thinking, feeling, and sensing). Although it sounds simple enough, it is actually a lot of input to pay attention to at any given point in time and takes some practice straddling both your inner and outer worlds simultaneously.

One-Mindfully can be a powerful grounding and centering tool because it focuses us simply on the moment we are in. A common treatment for trauma, anxiety, and depression is learning how to be in and stay in the present. Like any new skill, I encourage folks to try this first in “low stress” situations (i.e. ones that are not likely to incite a lot of activation in your inner world) before high stress situations (i.e. ones where you expect to have a lot of thoughts, intense feelings, or intense sensations).

See comments for more on this skill including ideas for how to implement it today.

Comments:

  1. Often, I see this struggle to be “one mindful” in the way many of us manage our relationships with our computers during the workday. Does this sound familiar: “You’re writing an email and you get a pop-up notification that you’ve gotten a calendar invite. Without even thinking you stop writing the email, review / accept the calendar invite, and then try to return to your email. But wait, now you lost where you were and so you re-read your last sentence, get back in the mindset of the the response and boom, an instant message comes in asking you if you saw the most recent email from so-and-so about this-thing or that-thing. So you scroll to the top of your inbox and read the email, respond to the instant message but wait now you can’t find that email you just had opened. Ok, you found it. But wait what were you saying, and ok now there is only 5 minutes left before the next thing on your calendar and somehow you haven’t gotten to that response yet. Now you feel this anxious pressure to get it out, but you are also aware this isn’t the quality response you wanted to send out so now you have to decide if it’s more important to get it out quickly or thoughtfully…etc”. Multiply that experience throughout your day and your day ends with you feeling frazzled, unproductive, behind, like you’ve missed a bunch of things and like you’ve been ping-ponging around all day. And that’s because you have! All those notifications are very stimulating and they are prime ways in which we forget to insert that intentionality into our decision about where we spend our time and attention when we are with our devices. One low-stress way to start trying to introduce this skill into your life is by bringing thoughtfulness to what notifications you need on, and how you respond to those notifications when they are on. As Marsha Linehan might say, “When you are writing an email, write the email.” If you find you are tempted to be distracted by your phone turn it over or put it on silence. If you are expecting to hear from someone important while you write, work to make yourself accessible in a way that will not distract you (i.e. ask them to call you, or silence texts from other people except that one person). Setting up a routine that enables a mindful perspective can take some work, but it should help improve concentration and productivity and leave you feeling better at the end of the day. 
  2. Back when therapy was always in an office you were forced to take a one-mindful perspective with your session. You didn’t have a screen, or your phone handy and the temptations to engage with something outside the content of the session were much less accessible. If you are doing remote based therapy try and re-create the in-office experience as much as possible by eliminating the possibility of something outside of the session distracting you away from being fully in the session.
  3. If you are someone who commonly multi-tasks or operates in a “mindless” manner, it will take time time and deliberate practice to bring a more “one-mindful” stance to how you spend your time. For tips on how to bring this concept to your life at a pace that works for you, see my post on how to sustainably make long-term changes.
  4. This concept / skill is kind of like living your life in real time meditation, albeit a meditation where you are responsive to your environment. Like our meditative practice, your mission throughout is to regularly bringing your attention back to your chosen focal point. For an introduction to meditation, and this concept of returning to a chosen focal point, see my introduction to meditation post (which has more direct parallels to today’s post), and my post on general meditation.
  5. Sometimes we find that we can’t control our attention. That’s ok. No one is perfect at this. Sometimes we are coping best by accepting what is not within our control, and often times what is out of our control is content of our inner worlds. (If you struggle with this concept this post on acceptance might help). This can mean the thought, feeling, sensation, or external circumstance arising is too distracting or powerful to redirect yourself from (i.e. you just got news of something upsetting and of course you can’t focus on your previous intention). At that time, it can be helpful to view that as a cue that you need to switch your attention over for a period of time, even if you don’t want to.  A powerful way in which you can stop ruminating (when you can’t stop thinking about something) is to set a timer for ten minutes, and just be with the worry. After ten minutes, when the timer goes off, you may find it’s easier to redirect your attention back to a different focal point. After ten minutes of really fully devoting yourself to it (instead of having it simmer in the back of your thoughts for hours at a time where you ping pong between thinking about that and all the other things in your day) you may have found a solution, or exhausted all the different ways you can think or worry about something, but either way it’s more likely to feel less pressing. There are other skills to combat intrusive worries for another day.
  6. Regarding the idea of perfection – it is not realistic (or even the goal) to exclusively live in a “one mindfully” stance. Sometimes we do want or need to split our attention and that’s OK. The key is to selectively and with awareness choose to do so, and to use one mindfully with more important tasks.
  7. A little more on identifying and understanding multi-tasking. There are three ways of multi-tasking: attempting to do one activity while you think about another activity (sitting in your meeting and thinking about that conversation you had last night), attempting to think about two things at the same time (going through the grocery list while you try and plan out that email to your boss), or attempting to do two things at the same time (talking to your friend and scrolling on your phone). A one-mindful perspective would encourage you to limit each as much as possible. 
  8. If you find yourself regularly tempted to split your attention or “zone out” start trying to pay attention and get curious about it. Sometimes there is a lot we can learn about what we are trying to distance ourselves from when we pull our full attention away in these ways.
  9. Marsha Linehan’s skills, including one-mindfully, are outlined in full in her skills training manual and associated skills training workbooks.

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What is Trauma?

  • We can think of a traumatic experience as our brains saying “this is more than I can handle”.
  • This means what is traumatic for one person may not be traumatic for another; each person has their own unique tolerance levels for being in (and capacities for coping with) different types of stressful situations.
  • An experience has the potential to be traumatic for any of us if it pushes us beyond our capacity to cope, manage, make sense of what is happening, and feel safe (relationally, emotionally, and / or physically). 
  • Feeling safe and secure are the opposite of the vulnerability, fear, and helplessness that are experienced when we are in a traumatic situation.
  • While there are most certainly ranges in the severity of trauma, too many of us hold too narrow a definition for what qualifies as “traumatic”.  As a result we are often critical and judgmental of ourselves and others when trauma responses make themselves evident. This interferes with the process of healing from trauma and easing those trauma responses.
  • When we’ve experienced trauma it effects our brains; development; and sense of trust. We can become limited in our ability to be vulnerable, connect, remain focused, plan for the future, and adapt in moments of stress.
  • The responses that are typical of a traumatic experience are actually our body’s way of trying to protect us; numbness so we don’t have to feel the pain, anger so we can fight back, forgetting or blacking out so we are not consciously haunted by a memory, a limited ability to plan for the future so we can stay attuned to present threats, and challenges with vulnerability to prevent us from being exploited by others.
  • We would be best served to think of trauma (and the impacts of it) existing on a spectrum. Most of us have experienced something in our lives that deeply overwhelmed us, and most of us would go to great lengths to not go through that experience again. Trauma responses are our brains way of trying to protect us from going through a painful experience again.
  • We cannot recover from or heal trauma with the typical problem solving methods we use in other areas of our lives. If you’ve tried, it’s likely you’ve gotten stuck, frustrated, angry, judgmental, critical, or hopeless about changing what cannot be healed through logic and willpower alone. 
  • I often find it’s helpful to work backwards; if you see, feel, or notice a trauma response, trust what your reactions communicate to you, even if you don’t identify as having a trauma history. If what I’m writing sounds familiar there a good chance something on the trauma spectrum is present and interfering with your ability to move forward in your life.

Sometimes our trauma is evident, other times it can only be found in the echoes it leaves behind. After trauma, a combination of the following dynamics are often present:

  1. A struggle to trust and feel a sense of safety, even in scenarios where it might not be intuitive that someone wouldn’t trust or feel safe. Individuals who have experienced trauma remain on guard for something that could hurt them, and at times hurt their relationships in an effort to protect themselves. This can include a more limited ability to relate and connect to others due to difficulties feeling secure enough to make oneself vulnerable.
  2. A brain that has experienced trauma is literally under more stress than a brain that has not (see comments for the science of this). After trauma, biological changes to the brain can lead to a struggle with planning, adapting, attention, concentration, and managing or expressing emotions in a constructive manner. This means work, planning, finances, relationships, communication and problem solving can all be effected. 
  3. A struggle with hopelessness or powerlessness are common and often caused by how out of control, unfair, or unpredictable life can feel after experiencing trauma. Those pervasive struggles can lead to difficulties with taking initiative, independence, and motivation.

While the desire to tame trauma responses is natural, it is counter productive to try and change them through the same tactics we use when we need to change patterns, solve problems, or break old habits in other areas of our life. When we use these tactics and don’t see changes we can dig in and tell ourselves to “try harder”, “get it together” or “endure through” leaving us angry, critical, and judgmental at our lack of progress.  Unfortunately, this lends itself to shame, feelings of inadequacy, hopelessness, and giving up none of which helps us heal, change, or grow. 


Our work, instead, is to retrain our brains to no longer need the trauma responses. The core of that work is in finding safety. More on that in another post. For now, consider your life and relationships through the lens of trauma and its impacts.

Comments:

  1. Trauma doesn’t just have to be a single incident, in fact most often it is not. For more on understanding trauma see this post on relational trauma.
  2. Another way to think about trauma is having to operate / function / live outside of our window of tolerance without the ability to bring ourselves back within the window.
  3. Our brains are always working to try and to keep us safe. This prior post addresses how the past can inform the present.
  4. As Bessel Van Der Kolk explains, “Traumatized people become stuck, stopped in their growth because they can’t integrate new experiences into their life”. While this language is strong, what he communicates is that trauma interferes with our ability to be objective and adaptive in the present moment, especially in scenarios that trigger a trauma response. We are less able to appropriately “read” threats accurately when we have a trauma history because our brains are so busy trying to protect us from getting hurt again. We can get unstuck, but to do so we first must accept trauma responses for what they are, and then work to heal from our trauma so we no longer need the response. The quote is from Page 53 of “The Body Keeps the Score”.
  5. There are many useful resources out there on trauma. A personal favorite that I often encourage my clients to read is “Trauma is Really Strange” by Steve Haines. He accessibly explains what trauma is, how it effects you, and steps towards healing in a 30 minute read filled with pictures, scientific evidence, and explanations of the biology behind trauma and trauma responses.
  6. More on the Biology of Trauma from Bessel Van Der Kolk’s “The Body Keeps the Score”: “Under ordinary circumstances the two sides of the brain work together….when something reminds traumatized people of the past, their right brain reacts as it the traumatic event were happening in the present”. He goes on to explain the left side of the brain essentially shuts down while the right brain is so activated, which means the part of our brains that helps us find words and internally organize our experience is inaccessible. At that moment, we can’t “grasp the long-term effects of our actions, or create coherent plans for the future”. (Page 45).  He goes on to explain that “the stress hormones of traumatized people… take much longer to return to baseline and spike quickly and disproportionately in response to mildly stressful stimuli” (Page 46), what this means is that the stress our bodies experience when we have a history of trauma is actually higher than the stress on a body without the same history. The repeated presence of these stress hormones have detrimental impacts on our brains, “The insidious effects of constantly elevated stress hormones include memory and attention problems, irritability, and sleep disorders” (Page 46). Full Citation: van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin.
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Rethinking “Lazy”

  • The concept of “laziness” is an inadequate way to think about the dynamics underlying someone’s difficulty with motivation, participation, energy, and engagement.
  • This is because a person’s “inherent laziness” becomes our explanation for why they disengage from something we believe they “should” be able to engage with. When we use this term we steer ourselves away from curiosity that would help us dig into whatever may be causing someone’s disengagement.
  • Calling ourselves or others “lazy” is often a tactic we use to elicit shame or express disapproval when we don’t otherwise understand someone’s disengagement from something we (or they) believe would benefit them.
  • Sometimes we say it in the hopes of stirring up motivation, or in the hopes of giving ourselves permission to give up and accept (with some level of resentment) the disengagement of ourselves or others.
  • In all my work with my clients over the years I have yet to find a situation where “laziness” was truly an adequate explanation for the complex and addressable dynamics contributing to “laziness”.
  • Here are a handful of examples of what may actually be happening for someone when they fall into a pattern we might label as “laziness”. There are more possible examples today’s comments, and many more possibilities out there. See the full content of today’s post for further explanation as to why this concept is damaging and unhelpful.
    • Fear can shut down motivation and energy. We can disengage with something even if (on some level) we want to participate in it if it intimidates us, or if it has the potential to embarrass us or leave us feeling like a failure. Sometimes we’re not connected to that fear, and finding the fear can take some digging.
    • Hopelessness can shut any and all of us down if it gets too powerful. We don’t believe it will make a difference, or there is a point in our participation so we shut down and disengage.
    • We over-use coping mechanisms like distraction or avoidance when we are overwhelmed by a topic or activity we (or others) are “supposed” to engage with (i.e. procrastination). This can often happen if we don’t have strong time management skills or realistic expectations of ourselves and our capacities.
    • Sometimes we aren’t interested in the things others (or we ourselves) tell us we “should” be interested in. We can build whole lives around expectations without ever really connecting with our genuine and authentic interests and motivation. This is often the case in “extreme” laziness as someone starts to shut down and pull away from a life they don’t really want to be living.

I consider the concept and term “Lazy” to be unproductive, limiting, and damaging. When we use a term like “Laziness” about ourselves or others we attribute “the problem” to someone’s personality, often leaving them feeling helpless, ashamed, and inadequate. This way of thinking about someone’s disengagement often creates an overwhelming and insurmountable barrier to understanding and addressing the underlying dynamics that create the “lazy” behavior.

When we assign “laziness” to a person or behavior I think it’s a sign we’ve hit an empathic wall with ourselves and others; we’ve given up, gotten frustrated, and so we look for a way to say “it’s out of my hands, it’s who I am (or they are)”. In attributing problems in ourselves or others to concepts like “laziness” we inadvertently miss huge opportunities to understand and address underlying issues because we’ve given up and determined its an issue of willpower.

Often when we use this term it’s a reflection on both our struggles with the situation and our inability to understand why we or others have disengaged from something that logically feels like it makes sense to participate in. It is natural to be frustrated and angry when things don’t make sense to us, but we short-change ourselves, others, and the situation when we think of ourselves and other’s in-terms of laziness. When we assign the lack of engagement to a person’s character or “way of being”, we generally stop getting curious about internal and external factors that may be interfering with someone’s participation.

For most of us “lazy” is a wall. It’s a road to nowhere.

In moments when we are tempted to use the word “lazy”, I would instead encourage us to bring as much curiosity as we can to the situation. If we can accept that someone must have a valid reason for not engaging with a topic, then our mission becomes to search, find, understand, and address that reason. Sometimes we must be relentless in that search, and in our faith that there must be something valid underlying something that otherwise doesn’t make sense.

Comments:

  1. I mention character assassination in the post. Read this post on fair fighting to learn more about what it is and why to avoid it.
  2. This post taps into how our lives can be ruled by “shoulds”, To learn more about how to disempower the “shoulds” see my post on acceptance.
  3. I think of terms like “lazy” in the same way I think of a judgment. I have a whole series on understanding the problems with, identifying and deconstructing judgments.
  4. Continued examples to help you start getting curious about what may be under “laziness” in yourself or a loved one in your life:
    1. Sometimes we don’t know how to motivate ourselves. What motivates one person may be different from what motivates another, which means even members of the same family may need to find different tactics to get themselves going on something. If you are stuck try a different motivational tactic.
    2. Many of us are living day to day with histories of relational trauma that deeply effect motivation and energy. Many people with histories of relational trauma don’t know it.
    3. Secondary gains are a real thing. Sometimes we are inert because action would mean making a sacrifice or losing something that we otherwise value .
    4. Sometimes we aren’t listening closely enough to our limits (which are often not where we want them to be) or differentiating between our shoulds and wants.
    5. Exhaustion and unrealistically high expectations shut us down and interfere with potential. Sometimes the energy or capacity we feel we “should” have is not the energy we actually have. We label ourselves as “lazy” when we don’t meet expectations we hold for ourselves, but sometimes those expectations are the problem themselves. Learn more about how change happens to help with setting realistic expectations for yourself.
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Meditation

  • For us to be happy in our lives, we need to be able to be alone and at peace with our inner world. There are many roads to this place, including the following path.
  • First, I recommend you master grounding. This helps us learn that we can recenter ourselves when we’ve gotten to an emotional edge.
  • When we’re confident in our ability to ground, we become confident that we can bring ourselves back from a place of intensity. This makes our thoughts, feelings, and inner world less scary because we know how to reset.
  • Next, I recommend foundational (sensory based) meditation for 30 seconds to two minutes a day.
  • The goal with this type of meditation is to begin watching your inner world without reacting to it, or it controlling your attention or behavior.
  • When we get skilled at this we can better tolerate our feelings, reduce our impulsivity, and more easily think and process before acting and responding.
  • The final step, which is outlined in today’s post, is to begin meditation without a sensory anchor. Instead, our anchor is our internal world.
  • Unlike foundational meditation where we come back to noticing a sensory anchor, in this type of meditation your centering point is yourself. You come back to noticing what is in your body, what feelings you feel, what urges you have, what sensations you can notice, and what thoughts flow in and out.
  • Just like foundational meditation, the goal is to notice what’s there, notice if you’ve drifted off into a thought chain or if you’ve tried to “clear” your mind, and to reset to a state of curiosity and attentiveness to all that is happening in your inner world.
  • See further explanation about this next stage of meditation, and the benefits of it, in today’s post.

Once you’ve gotten comfortable with grounding and foundational meditation (and there is no right about of time for that), you can start experimenting with free form meditation. This is when we try and be present in our inner world without an identified “anchor” other than ourselves.

In my previous post on meditation I encouraged you to pick a sensory based focal point (like noticing your fingers touching, or a beverage in your mouth), and then set a timer while actively watching your internal world to “see what comes up”. The goal of that exercise is to be present with your mind and body as it goes through each moment, neither trying to “clear” your mind nor holding on to any given internal experience that comes up.

The process for this next stage is nearly identical. Set a timer (so you don’t give in to urges to stop), but instead of picking a sensory anchor to return to, the anchor is simply your internal world itself. Your mind will drift, you may hear a noise, or have a thought or feeling that preoccupies you. That’s ok. Your job, during this exercise, is to notice that you’ve drifted or started engaging with a distraction, and then to return to what you have intentionally chosen to focus on, which is what you notice in your body, and what’s happening with your thoughts, feelings, sensations, and urges moment to moment.

Meditation gives us the ability to insert intentionality into our choices by helping us learn to observe and collect information before acting. Although we “notice” rather than “act” in meditation, we are practicing tolerating the intensity of how inaction feels. The better we get at tolerating that experience in our inner world, the more skilled we become at not feeling pulled to act (before it makes sense to) in our lives.

With time, meditation enables us to better control our attention. Instead of our attention and focus dictated by what’s “loud” (be it a feeling, thought, person, event etc), we notice “what’s happening” and how it effects us. Then, we can choose when to engage with it based on a host of factors including our emotional availability, the true urgency of the issue, and our commitments, values, priorities, and readiness.

Notes:

  1. Want to start the journey? First, see my post on grounding. In it there are lots of tips for skills you can use when you are outside your window of tolerance to help you return. Once you’ve gotten skilled at grounding (and this can take a very long time, so be patient with yourself) move on to foundational meditation .
  2. When I’m teaching this to my clients I tell them the only reason I want them stopping the meditation is if their body is in danger (like a fire alarm goes off, then yes, listen and react to that!). Otherwise, if you realize all of sudden you need to go to the bathroom, ok. Cool. Keep noticing what that feels like while looking out for what else is happening in your internal world. Maybe your leg starts to fall asleep. I don’t want anyone to hurt themselves, so use your judgment, but this exercise would encourage you to notice what that feels like without reacting to it. Maybe you realize you missed an important call. Notice the feeling of panic, and wait the until the timer goes off to handle it. In your real life, of COURSE we want you responding to cues of distress from your body and your world, but we want you to do so in a thoughtful rather than a reactive way. Meditation helps you become skilled at noticing without quickly reacting, and should help you eliminate those hair trigger responses and insert more intentionality into your day to day decisions.
  3. I often share this story when I’m teaching clients how to meditate, because I think it helps illustrate how this is both a simple and yet simultaneously hard skill to build. I took a class in graduate school that provided concrete training on many of the skills in this account, including meditation. Every class my professor would have us do a sensory based meditation. Inevitably, someone would show up late, slam a door, bang a chair around – etc. I would then stop refocusing myself in the meditation and instead think something like: “ugh, they are ruining it! How am I supposed to focus on what I’m thinking or feeling while they are being so disruptive”. I felt annoyed, frustrated, disrespected, angry, and distracted. It took me weeks to get it – that it’s my job to learn how to refocus myself, rather than their job not to distract me. It’s my job to notice what that stirs up in me, and to try and learn from it by reflecting on it after the meditation, rather than to look to them to live their lives in such a way that they don’t create noise in mine. What I experienced was a “thought and feeling” train (outlined more in the foundational meditation post) and it’s my job to notice when I’ve hopped on that, and to return to what I choose to focus on until the time is right for me to understand how and why that train was a tempting distraction for me to engage with.
  4. When we meditate anything that is not what we intend to focus on is considered a distraction for that moment, even if at a later time it will be a focal point of our attention.
  5. What about mindfulness based programs like headspace? My answer would be, it depends on what you are looking for and how you use them. Programs of that nature can be great for relaxation, and, I would imagine (I don’t know the platform inside and out) that there are non guided meditations accessible within it. A guided meditation can be a GREAT starting point as something to do to help quiet an active mind, even before you try the foundational meditation exercise I suggested in my post from July 19th. That being said, focusing your attention on listening to words, and following the direction of those words is ultimately an outside “distraction” that takes you away from being present with your inner world. When you are busy following directions to notice your breath, to count backwards, etc you are not alone with your inner world; you are following a guide through it. Again, this is a GREAT entry point to being present with your inner world, but I’d encourage you to go beyond a guided meditation to work on being with yourself and going at your own pace though your inner world.
  6. Sometimes I think of this exercise like snorkeling or scuba diving. Above the surface of the water you can’t even imagine (without spending some time looking) at how much is happening underneath. While you are in the exercise it is not your job to “touch” the fish (i.e. engage with the thought), it is simply your job to observe this world, and see what crosses the path of your attention without trying to change or alter it. You are just there as an observer to take it all in. Your thoughts, feelings, urges, impulses, and sensations are each individual components of the world for you to observe with detachment and curiosity.
  7. The goal of this particular exercise is not to relax you, instead it is to help you tolerate all of the intensity of your inner world without trying to control it. I’d encourage you to start at moments when you feel more calm, but over time try it out (even for 30 seconds) at a time when you feel something more intensely.
  8. The beauty of meditation is that we gain control over what we pay attention to. Have an intense thought or feeling come up, but need to focus on that project? Did you have an upsetting conversation, but feel like this isn’t the right time to really think or process through it? Meditation helps us gain control over where we place our attention so that we can spend our time and our energy on our chosen focal points, and return to the intrusions at another time. This is how people learn how to walk on coals (I am NOT suggesting this!!), or manage chronic pain, they have a strong ability to move their attention away from that particular stimulus onto a chosen stimulus. Even though we practice for a short amount of time, that “muscle” builds. The strength and skill in meditation is NOT in controlling your thoughts, or never having them drift away, it’s in noticing what’s happening in your internal world and then being able to redirect your attention to your chosen focal point. Sometimes we have to do this many times over the course of a minute, this is successful meditation. The ability to redirect back to the chosen focal point is the skill.
  9. I want to be clear: sometimes the distractions we “refocus away from” in our lives are important for us to act on at some point, rather than continue to refocus away from. Meditation can teach you to disengage, but we want to think of that as “disengage until the right time” for some topics. You will be avoiding or denying in you life if you constantly refocus away from something that needs to be addressed.
  10. I’ve written a handful of other posts that explain the value of meditation. The first explains the value of meditation in further detail, and the second helps us understand more about how our inner world works and how to “control” it.

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How to Fight Fair

  • We want you getting through your disagreements with as little pain as possible.  Avoiding these 8 “don’ts” is the first step to getting there. 
  • Avoid disrespectful communication. This means: no name calling, derogatory language, hostility (i.e trying to intimidate the other party or yelling), expressing your negative feelings in a physical manner (i.e. hitting, breaking, throwing etc). If it’s not “OK” to do at work, it’s not “OK” to do at home. 
  • Avoid a dismissive stance. You’re not going to get through to someone if you are judging them, using sarcasm, interrupting them, rolling your eyes, or engaging in other behaviors or gestures that indicate you’re not taking the perspective of the other person seriously. Even if you think someone is not being reasonable you can communicate that without these tactics.
  • Avoid counter-complaining. Don’t bring up your own complaint in response to someone else’s.  This means you don’t respond to “you never do the dishes” with “you never do the laundry”. This deflects the conversation from the concern being addressed. If you have a related concern think of that as a separate issue for a separate conversation.
  • Avoid dumping. Don’t bring up numerous and unrelated concerns at a time.  If you’re bringing up the problem, bring up one problem. You will overwhelm the other party if you bring up too much at once. All topics of concern are important, and so to address them effectively you need to pace them.
  • Avoid rehashing. Leave problems you have previously resolved in the past. Sometimes old problems are related to current ones, and while that can be acknowledged respectfully, you will run the conversation in circles until a point of exhaustion if you have to re-resolve old issues whenever a new one comes up. 
  • No character assassination. This means talking about the entirety of someone’s personality, rather than a specific problem you have with them or what is happening. This means no “you’re lazy”, but instead, “I’m upset at how often you don’t participate at times when we have a lot to do”. 
  • Be careful about words like “always” and “never”, very few things actually ALWAYS or NEVER happen, and it’s a quick way to shut the other party off if you overgeneralize about the frequency of an issue. We often do this as a way of trying to make our point when we feel dismissed, but even if the other party is taking a dismissive stance, this tactic is often an exaggeration and often leaves other party to feeling even more entitled to dismiss us.
  • Don’t force resolution. Do not put pressure on yourself or the other party to resolve issues prematurely, or only on one person’s timeline. This means: no chasing someone around and continuing to talk if the other person has asked for a break, no putting off the conversation indefinitely because one party doesn’t want to deal with it, and no “resolving” the issue if you’re not ok with the resolution but just want to “make up” and make it go away. These are recipes for disconnection and rehashing.

Conflict is inevitable in relationships, especially close ones, given no two people bring to their relationships the exact same values, priorities, concerns, and needs at any given point in time.  Even the most compatible people will have conflict at some point, which is a clash in what one party needs or wants with what the other party is willing to authentically offer, provide, or agree to. Conflict can mean fighting, but doesn’t have to; it may help to think of “conflict” more like a conflict of interest between the involved parties. 


For most of us, when we hit a point of disagreement between ourselves and those we are close with we communicate in ways that are familiar and intuitive for us, often shaped by what was modeled for us, and what we have done in the past. What is intuitive or familiar may not, however, be effective. 


For our relationships to go well, we need to deal with conflict in a manner that helps us resolve the issue while still holding respect for our relationship and the other party; both parties need to feel considered and as though their needs, priorities, concerns, and desires are taken seriously. This means when one person has a problem, both people have a problem. Taking on this attitude of acceptance will help strengthen the relationship and keep your connection strong.


As a couples therapist, one thing I pay attention to is how couples communicate with each other when they have a disagreement.  If they don’t have the tools to work through conflict productively important topics don’t get adequately addressed. Over time, relationships can erode because of the hurt created by the conflict itself, in addition to the inability of the couple to resolve issues between them. 


The first step to taking care of your relationship while you address a concern is getting the communication “don’ts” from this post out of the conversation. Getting rid of these tactics can  help you move through conflict and may help improve your relationship and feelings of closeness and connection.


A future post will cover the “dos” for resolving conflict. For now, see what ways you can come up with to eliminate these “don’ts” from your conversation and your mindset.

Notes:

  1. A helpful tip – removing the “don’ts verbally may not be enough. Truly try and challenge yourself to remove the “don’ts” from your mindset and perspective as well. In relationships, even if someone isn’t saying it, we can feel it when someone isn’t taking us seriously. 
  2. Some conflict can be resolved in a single conversation or two. Some conflict is about fundamental differences between the parties involved, and will be revisted again and again. This does not necessarily mean that the involved parties are incompatible, and getting the “don’ts” out of the conversation can help us better live with our differences. 
  3. Further notes on disrespectful conversation: If you don’t communicate with respect, you will create a problem while you are trying to resolve a disagreement. When we communicate disrespectfully it is usually a way of expressing anger, which, while valid to feel, needs to be handled respectfully so as not to derail an otherwise productive conversation. Sometimes, when we’ve grown up around conflict that includes disrespectful communication we can have trouble recognizing it – calling someone “stupid” or their thoughts or beliefs “ridiculous” is a version of disrespectful communication.
  4. We often counter-complain when we are in a defensive state of mind, meaning we use the counter complaint as a way to rationalize, deflect, and justify our perspective and actions at the detriment of understanding, connection, receiving feedback, or accepting the impact of our actions. Often times we are more prone to defensiveness when we are focused on how we are “right” or when we are focused on our intentions (rather than our impact).  
  5. Want some more tips on “fair fighting” for couples? See this post about how the way we fight can effect the stability of our relationship.
  6. Do you find you have trouble accepting the validity of other’s concerns? See this post to help you understand the power of validation (even when we disagree), and this post to help you accept even if you dislike or disagree.
  7. Do you generally find you have trouble balancing taking care of yourself, others, and what you want or need in relationships? It is a tough balancing act. See this post for tips.
  8. Judgments can be tough to identify, but I’ve got prior posts covering how to identify a judgment and how to reshape them.
  9. Does the idea of not resolving conflict quickly leave you feeling uneasy?  See this post for more information.
  10. Do you want help with addressing conflict or connection in your relationship, but are on the fence about whether it’s “too soon” for couples therapy? See this post to help you decide whether it’s time.
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What is an Emotion?

  • If you want to manage and cope with your emotions, a helpful starting point is understanding what they are, how they work, and how (beyond feeling them) they effect us.
  • What emotions we feel, and how intensely we feel them, is simply a combination of chemical processes in our brain and sensations in our body working as a feedback loop in response to signals from one another and our environment.
  • An example: You feel scared. Your brain sends that fear signal to your body. Your heart may start racing, you you may start sweating, you may instinctively raise your shoulders up by your ears. You may think to yourself, “this isn’t safe, I’m in danger”.  Your brain then detects all that activity which continues prompting the emotion of fear.
  • Feeling emotions for extended periods of time is simply this feedback loop restarting again and again as we experience the emotion, thoughts, and associated body changes.
  • Each emotion has a series of specific body changes and sensations associated with it. Those body sensations are unique to each person, but there is often overlap between people in how they feel each particular emotion.
  • The more we can learn to notice and observe our emotions and their impact on us, the less controlled we are by them. An entry point to this (and there are others) is noticing and identifying what is happening in your body as you are feeling your emotions.
  • It can be a helpful exercise to think of something that made you feel a particular emotion, reconnect with that feeling, and then do a scan throughout your body to notice how the emotion effects you. 
  • You can build up a personal catalog of identifiers for each emotion (i.e. anger makes me feel heat in my chest and tension in my jaw, guilt makes me feel a pit in my stomach and a knot in my throat etc).
  • There will be more to come on this topic, including why we have emotions and tips and skills for managing them.
  • See today’s post for a further explanation of why we need to pay attention to our bodies if we want to better manage our minds

If you’ve studied philosophy you know there is an age old question about the differences between mind and body. In this day an age, those of us familiar with neuroscience know that mind and body are actually part of the same intricate system of circuitry, feedback loops, and signals. Emotions are a complex part of this system, but simply put they consist of (neurochemical) changes in the brain that go on to have an effect on our bodies, thoughts, behavior, and even our interpretations of the environment around us.


Understanding how to manage our emotions becomes easier once we understand that they exist in a feedback loop with our bodies. We can enter that loop and begin the process of taming, settling, regulating, and managing our emotions by becoming familiar with how each emotion effects our body.  


Try and bring curiosity to your body when you realize you are feeling an emotion. What do you notice? Pay attention to temperature, tension, pressure, tightness, etc. You may need to scan around to different parts of your body to gather all the information about what’s happening. As a bonus, the process of stepping back and observing yourself will likely help lower the intensity of the emotion you are experiencing. 


If you’re not used to directing your attention to your body you may be surprised at how much is happening in it. If you find you feel numb and can’t feel your body that’s a cue you’re out of your window of tolerance and need to ground (see comments). You may also find you don’t feel some emotions even though you know they exist. Try accessing a lower intensity version of those emotions, for example if you are someone that can’t connect with feelings of anger, try connecting with frustration, or irritability – and notice how that effects your body.


Over time, that increased awareness of our body can help us detect emotions before they get too big (increasing our odds of wrangling them back in), and offers us the opportunity to intervene in the feedback loop with strategies to manage our emotions. More on those strategies in a future post, but for now work paying attention to your personal feedback loop and its effect on your body.  

Comments:

  1. This post contains a fusion of information from (1) Marsha Linehan’s Skills training manual for DBT, and her theory of emotions (pages 87, 88, and 137 of the manual), (2) Bessel Van Der Kolk’s “The body keeps the score”, (3) Daniel Siegel’s “Mindsight” and (4) David Wallin’s “Attachment in Psychotherapy”.
  2. As David Wallin explains, “Asking our patients to label what they feel…invites them to observe that experience rather than simply identify with it and feel overwhelmed. Enhanced bodily awareness and the growing sense that feelings can be painful without being intolerable sets the stage” for healing. This quote is from page 81 of David Wallin’s Attachment and Psychotherapy, a book meant for therapists but readable for not-therapists who are interested in learning more. Full citation: Wallin, D. J. (2007). Attachment in psychotherapy. New York: Guilford Press. 
  3. Scientists rely on this fact, that our emotions are neural processes, to make advances in medicine and to better understand human behavior and functioning. They’ll use scans /testing devices in research studies to help them determine what emotion a person is feeling based on which part of the brain shows the most activity. “In the early 1990s novel brain-imaging techniques opened up undreamed-of capacities to gain a sophisticated understanding about the way the brain processes information…PET and later… fMRI scans enabled scientists to visualize how different parts of the brain are activated when people are engaged in certain tasks or when they remember events from the past. For the first time we could watch the brain as it processed memories, sensations , and emotions and begin to map the circuits of mind and consciousness” – Page 39 of Bessel Van Der Kolk’s “The Body Keeps the Score”. Full citation: van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.4
  4. Want to know more about the connections between how your brain, your emotions, and your thoughts work? See my previous post Your Brain as an Association Machine for more information. 
  5. I mention the feedback loop between our brains and our body in this post. Did you know most emotions last only a few seconds to minutes? If you’re feeling something for an extended period of time the feedback loop is restarting, which means there is an opportunity for you to intervene. Learn more about the brevity of emotions here.
  6. Not sure you buy into the idea that you want to feel all your emotions? Or maybe you only want to feel some of them? Check out this post that explains the value in negative emotions.
  7. Think you’re not someone who is effected by your emotions? Think again – we’ve all got them, and they can effect us even when we push them away or don’t feel them.
  8. I mention Grounding and The Window of Tolerance in this post. If you find you need to ground a lot while trying to be in your body it’s a cue that you would benefit from therapy. It will help you widen your window of tolerance.

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Insurance Premiums and Deductibles

  • While I am not an insurance broker, I have come to see time and again how a lack of training on our complicated insurance system creates barriers to accessing care in the United States. 
  • This is the second post in a multi-part series aimed to help you understand how American insurance works so that you can protect your finances and use your insurance benefits to help you access any and all medical treatment, including mental health treatment.
  • The first post covered the basics of insurance networks. Today we’ll cover the basics of insurance payments: Premiums and Deductibles. 
  • Premiums: This is the “subscription” fee for your specific insurance plan for you and / or your family to be members of the plan. This gets paid directly to your insurance company. Premiums are usually paid monthly and can change from year to year.
  • If you get your insurance plan through your employer one of the big perks is that employers often contributes to the cost of the premium. You may pay $10 – $500 or more a month, and that still may only be a fraction of that “subscription” fee for your plan.
  • Deductible:  A deductible is set amount you must pay towards your medical treatments before insurance kicks in and contributes to the cost of treatment moving forward. You pay your deductible to your medical providers. Deductibles reset annually, and the deductible amount can change from year to year.
  • For some services the “deductible is waived”, this means your insurance contributes to the cost of the medical service right away. For other services you will have to pay the deductible amount in medical care before your insurance plan contributes to the cost.
  • Often, plans with low premiums have high deductibles or other fees. This means you pay less every month as your set fee, but when you need to access care you may be on the hook for more.
  • So, you want to pay attention to your premium cost (this is how much you pay a month to have a membership to your plan) AND your deductible amount (this is how much you have to pay before your insurance starts contributing). 
  • See today’s post for more information about types of deductibles, why insurance premiums can increase if you leave a job and go on COBRA, and for examples about how all of this works.

Generally speaking, premiums are straight forward when you think of them like a subscription fee. The only caveat to that is understanding what happens if you leave a job and want to access your insurance through COBRA.


When you leave a job in the US you are often eligible for COBRA. This means you can keep the same insurance plan for a period of time that you had at your company, but (unless your company agrees to continue contributing to your premium payments) you are responsible for the premium costs. Often premiums go WAY up if your company isn’t chipping in. This is because you were always only paying a fraction of the subscription fee and one of the perks of being an employee was the company’s contribution to the plan. 


Deductibles are less straight forward given there are individual, family, in-network and out-of-network deductibles on most plans. First, let’s understand key language: Once you’ve paid for enough of your medical expenses to hit the magic number of your deductible it is considered “satisfied” or “met”. 


Individual and family deductibles are aimed to protect a family from having to pay too much in medical expenses in any given year. The deductible is considered satisfied for all members when the family deductible is met, even if individual deductibles aren’t met. I know that’s confusing, there is an example in the comments (#4) that will help. 


You may see that your in-network deductible is drastically lower than your out-of-network deductible. This is because your insurance company has a contract with in-network providers that outlines every possible medical service and how much the company will pay for that service. Your insurance company wants you to see these providers because they’ve vetted them, their credentials, and their training; and all parties have agreed in advance what the costs will be. If you see someone in-network you have to pick from the insurance company’s in-network provider list, but (often) it will cost you less. You can decide if its worth it to you for any given provider to see someone out-of-network. 

Comments

  1. I know this may seem unimportant, confusing and /or boring, but understanding how this works empowers you to select plans based on your medical need and can simultaneously help you protect your finances. Plans are usually selected once a year, so bookmark this and come back to it for a refresher when your plan is up for renewal.
  2. Are you someone that wants the freedom to see whatever provider you choose? Look for a plan with excellent out of network benefits, then you protect your finances and can have freedom in selecting a provider.
  3. See the first post in this series on in-network vs out-of-network for more information to help you understand american health insurance.
  4. An example of meeting a $700 deductible: $10 for a prescription, $500 for a lab test, $190 for a medical appointment. That adds up to $700, meaning the deductible would be met. A key point: Not ALL types of medical expenses count towards meeting your deductible, again, this can be plan specific and is a good question for you to ask as you’re deciding what plan you want to be on. 
  5. Family vs individual deductibles explained through an example: Imagine a family of four, two parents, two kids. Each person could have an individual deductible of $700, and the family deductible could be $1400. That means once the family, as a cumulative unit has paid $1400 towards their deductible the deductible is considered met for all family members. Otherwise, it is met for each individual when they hit their individual deductible amount. Meaning if one kid hits $700 and one parent his $700 the deductible would be considered met for all family members, INCLUDING the two individuals that have not spent anything towards their deductible. Even if each member only hits $351 they would still have met the family deductible because they are over that $1400 family number. This is can create an incentive for family members to be on the same plan depending on the size of the family and the size of the deductibles. 
  6. Empower yourself by asking your HR department or insurance provider “what services are waived under the plan’s deductible” (translated into non-insurance speak, this means what services will be covered as though I’ve met the deductible even before i’ve met it). It’s not uncommon for preventive services to be covered including services like therapy!
  7. If you’re planning to leave a company, ask your HR department about what the full premium costs are so you know what to expect if you’re planning to enroll in your plan through COBRA. You may also be able to negotiate the company continuing to cover a portion of your premium costs depending on the circumstances of your departure.
  8. Have you ever heard horror stories about a provider or hospital charging someone $3,000 for a bandaid? The reason that can happen is because out of network providers / hospitals are entitled to charge whatever they want. In-network providers are the only providers bound by a contact with the insurance company that limits how much they can charge to the patient.
  9. Be aware, there are insurance nightmare stories out there about certain labs / facilities / providers not being in-network, and patients not being notified in advance that they will be accessing an OUT of network lab from an otherwise IN network provider or hospital. This is something to discuss with your provider in advance to make sure they use external labs or other providers that accept your plan.
  10. You may be asking yourself why would I see an in-network provider if I have a high deductible because I will be paying anyway. Good question. The advantage of seeing an in-network provider even if you have a high in-network deductible is that even though you are paying in full, your insurance has capped how much your provider can charge you. If you see an out of network provider the insurance company has no influence over what the provider charges, and it’s often more than the rate an in-network provider will be allowed to charge (see comment above on the $3000 bandaid).
  11. How do HMOs and PPOs and POS etc fit into this? Essentially HMOs are small “in-network” plans and “PPOs and POS’s” are large “in-network plans”. With most HMOs you have to get a referral from your primary care physician to see anyone else and have insurance cover it, but that too depends on the plan. With PPOs you don’t need a referral but “in-network” and “out of network” still applies. 
  12. What about medicaid and medicare? Same thing applies, some providers and facilities accept medicaid and medicare and others don’t.
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Displacement

  • Our feelings are harder to access in environments where they are not welcome. This can be with certain people who we feel shut us down, and it can also be with our internal world if we believe certain feelings are bad, unproductive, or unacceptable.
  • When we can’t access and process through our feelings directly we may find ourselves prone to using displacement. When we “displace” we focus our energy, attention, and conversation around something other than the core issue at hand.
  • Displacement can be an indirect way of addressing an emotionally charged / intense topic or a topic we can’t find an accessible entry point into discussing or feeling our way through.
  • Example: you’ve had a bad day at work and take out your anger on your family once you’re home. Perhaps you’re feeling angry about work, and simultaneously feeling like you can’t change that environment / express yourself there and maintain professionalism (i.e. you can’t find an accessible entry point at work to handle your concerns in a direct way).
  • Although you don’t want to be irritable at home, you may (consciously or unconsciously) rationalize to yourself that your family is “stuck with you” and so you release your frustrations at home. In this scenario the person has displaced their anger at work onto their family members and in an environment where they feel their negative emotions are more tolerated.
  • Sometimes displacement of this nature can happen even when we don’t consciously *feel* angry. So yes, this means you can have a feeling, not register that you are having it, and then direct a release of it toward some other topic or person in your life. 
  • The trouble with displacement is we focus our attention, energy, and conversation around the focal point, at times without acknowledgement or awareness of the underlying issue(s) at hand. 
  • Unfortunately, even if we can “resolve” the displaced issue (in this example the conflict with our family), we haven’t resolved the core issue (work) and the recipient(s) of our displacement often leave the interaction(s) feeling like the other has been unreasonable.
  • If we are regularly displacing in our lives we run the risk of resentment in relationships, having the same fight repeatedly, believing our internal world is unreasonable, and feeling confused by or untrustworthy of our reactions. 
  • More in today’s post and comments about how displacement can creep into relationships and decrease our ability to solve problems in our lives. Also, tips for how to find displacement and what to do about it.

When we “displace” we focus our thoughts, communications and/or reactions to a “stand-in” person / object / situation as opposed to the actual person / situation we are having a reaction to. When someone says they feel treated like a punching bag, often they are describing being the recipient of someone else’s displaced feelings. 


Displacement can happen in lots of ways, imagine you and your spouse are in a fight about how the dishes are loaded in the dishwasher. More often then not those types of fights are a displacement of a different, larger, and more emotionally overwhelming topic. Instead of facing that topic head on, we can displace onto something more accessible and concrete, like how the dishes are loaded. In this scenario the intense emotions about a larger dynamic (could be anything, perhaps how heard one party feels) are displaced onto a smaller dynamic (how the dishes are loaded) that comes to represent the larger one.

Sometimes we can displace as a way of protecting ourselves from feelings we don’t want to have or believe we shouldn’t be having. At those times we can be fully wedded the the notion that we are having reactions to “the dishes” rather than some larger problem we don’t want to be true of our relationship or in our lives.


Other times when we displace, we may feel aware that the strength of our reaction doesn’t totally make sense. A helpful way to get to core of an issue when you suspect displacement is at play in yourself or others is to ask (in a collaborative, non-judgmental, and accepting manner):

  1. Can you articulate why there is so much emotion or heat around this topic?
  2. Does it feel like this type of thing happens in other ways we may not be discussing?
  3. What else happened today or recently that this reminds me of that I might also be having a reaction to? 
  4. Does it feel like we might really be talking about something or someone else here?

Until we can get to the core of the issues we face we are at risk of having the same underlying concern or conflict around “stand-in” topics. With curiosity and introspection we can work to understand and know ourselves better to catch displacement in the act, and get to addressing core underlying concerns.

Notes

  1. One of the reasons that therapy is effective is that a skilled therapist provides a space for someone to feel their feelings without judgment. The relationship becomes a safe place to release your emotions, and it’s not uncommon for patients to find themselves surprised by what comes out in a session. If this has happened to you in treatment this is often a great sign that you feel safe in your relationship with your therapist and they are helping you access, process through, and release what is already there and needs room to come out.
  2. Once we’ve gotten good at recognizing the signs of displacement in ourselves and can recognize when we’re displacing from one topic to another the displaced topic itself can become a helpful entry point into conversation. For example, “I’m noticing myself feeling angry about the dishes but as I think about it, I’m realizing it’s not just the dishes, it’s more that the dishes are one example of how I feel like I ask you to do something and it doesn’t happen. I think we really need to talk about this because I can tell I’m getting resentful”. 
  3. Affairs in relationships can happen for many reasons, but one avenue for thinking about them (and there are many others) is through the notion of displacement. If you are having an affair one of many questions you can ask to build introspection and awareness is what need aren’t you getting met from your partner or your life that you have displaced into this other relationship? 
  4. I mention in the post that sometimes we can feel like our reactions don’t totally make sense for the situation we are in. Sometimes this is because we are displacing, but all feelings are valid even if they are about numerous situations at the same time. See this post on the cumulative nature of emotions as well as this post on how our brains make associations for a deeper dive into that topic.
  5. I mention in the post that our feelings are harder to access in environments where they are not welcome including our internal world if we believe certain feelings are bad, unproductive, or unacceptable. See more here for how to approach your internal world in a way that won’t shut it down .
  6. I mention in the post that we can have an emotion and not register we are having it. It’s true. For more about how this works see this post on emotional blocking.
  7. Alcoholics Anonymous groups talk about displacement too, though they use the phrase “Coming out Sideways” to discuss how emotions or reactions can come out “sideways” to a focal point other than the core issue, problem, concern, or person. 
  8. Our insight into our use of displacement can vary even if we are otherwise self-aware and reflective. We can be very self-aware in some categories of our life and in some relationships, as less so in others. Further, we can displace more around certain types of issues than others. Our insight can vary based on a variety of factors including whether we’re in our window of tolerance, or when we’re operating outside of our limits.
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