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The Myth of Exposure Therapy

  • Many of us wrongly believe that “exposure therapy” is repeatedly putting ourselves in a feared situation in the hopes it will decrease our anxiety in that situation.
  • I.e. “If I get on the plane enough times my fear of flying will go away”.
  • While low-level anxiety often dissipates with repeated exposure, higher level anxiety is made worse or stays the same with this tactic.
  • That’s because what makes exposure therapy effective is that the therapist exposes someone to a feared situation AND helps them have a different set of internal responses
  • It is that repeated experience of being in a situation and having a DIFFERENT internal experience that can shift our relationship with the situation.
  • An exposure therapist would NOT advocate for white knuckling your way through
    Exposure therapy isn’t the only way to deal with fears of this nature, but the key for any and every individual to be aware of is that exposure therapy is not simply putting yourself in the situation time and time again and “pushing” through it.
  • If you want to work on a feared situation I’d encourage you to work to increase your awareness of where that line is between “high” and “low” anxiety situations
  • In low-anxiety situations – sure – expose yourself. You may just need to get the hang of it. 
  • You can address high anxiety situations in a variety of ways including formal exposure therapy, standard therapy, working to build insight into what’s under the anxiety in an effort to help it dissipate, and increasing your mindfulness and grounding skills (info on those two in the comments).

I can’t tell you how many times a client has walked into my office talking about a struggle in a particular situation; a fear of flying, anxiety with public speaking, difficulties with crowds. Often, they tell me about how they have “white-knuckled” their way through this situation time and again in an attempt at “exposure therapy”. More often than not, they find it doesn’t work.


This is when I tell them that’s not how exposure therapy works. When a therapist is helping a client with an exposure the therapist is both EXPOSING the client to the situation they struggle with AND helping them have a DIFFERENT internal experience while doing so. It is that repeated experience of being in the situation and having a DIFFERENT internal experience that can shift our relationship with the situation. 


For most of us, if we knew how to have a different internal experience while in the situation we would have done that long ago. What may feel intuitive to us in those moments (and perhaps not in our control)  is to have the reaction we’ve always had. 


Getting on the plane 35 times in an effort to expose yourself to a feared situation in the hopes it will neutralize (or numb) you to it can work with situations where you feel anxiety in a low intensity manner (i.e. think about performance anxiety where we are jittery the first few times, but with repeated experience we get more and more comfortable). With higher intensity anxiety you may actually be reinforcing (i.e. strengthening or making worse) the anxious response by exposing yourself to it without having built up coping strategies or skills for how to manage your internal world while you are exposed to the situation. 


What I can do with my clients, and what you can do too, is work know ourselves well enough to know where that line is between the “low(er)” anxiety situations and the “high(er)” anxiety situations. When our anxiety is lower we often just need to stick with it and get the hang of it. You should notice yourself feeling less and less anxious over time. When anxiety is higher, the anxiety doesn’t change or get worse with repeated exposure. That’s a cue not to keep going without a different set of internal responses.

Notes:

  1. How much anxiety we feel in a certain situation can vary based on a variety of factors. I.e. one day a situation might be “low intensity” and the next day the same situation might be “high intensity”.  The key here is to work to pay attention to knowing your own anxious cues and responding to what they tell you.
  2. I am not a specialist in exposure therapy, and in fact when I have clients in need of this type of treatment I will send them to a specialist for a series of sessions to work with someone in the situation they are struggling with to come up with strategies specific to their situation and their needs. This is often short-term work and it can be done alongside a longer therapy.
  3. One tactic you can try if you want to try building that different set of internal responses is strengthening your grounding based skills (those help combat anxiety by keeping you in the present) and mindfulness skills (those both keep you in the present and help you increase your ability to control your attention. Both Mindfulness and Grounding will help you “tame” your anxiety in those moments, though there are many more skills and techniques that an exposure specialist could work with you on (sometimes in as little as 4-6 sessions) if you’re really stuck with something. 
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Deconstructing “We create our own reality”

  • “You create your own reality.”  Often meant to be empowering, for many it can feel hugely invalidating
  • A constructive way to consider this concept is accepting that our expectations (which are informed by our prior experiences) often lead us to behave in ways that increase the likelihood that what we expect will be what we experience 
  • This can keep us locked in a cycle where what we expect (even if it’s not what we want) is likely to be what we experience again and again.
  • Paul Wachtel’s “Cyclical Psychodynamic Model” explains how this can happen. In short, the past teaches us what to expect, we engage with the present based on those expectations, and how we engage effects others and influences the outcomes we experience.
  • Broken down further: our expectations of how a situation will go influences how direct, open, vulnerable, friendly, trusting, and collaborative we are with any given person or at any given time. 
  • Others then responds to the presence (or absence) of those dynamics in a way that often leads to the outcome we expected.
  • An example: imagine you expect someone to be dismissive of your perspective. You may approach them with tentativeness and apprehension trying not “ask too much” or irritate them. This may make it more difficult for you to be clear, direct, and open about the topic at hand.  
  • As a result of how you approached the topic, they may not understand you (leaving you feeling dismissed and unheard), or become irritated by their confusion / your vagueness (confirming your sense that they wouldn’t want to hear it). 
  • In this way, we can all inadvertently participate in shaping the outcomes of any given situation or dynamic based on the intersection of how our past experience informs our expectations and current behavior. 
  • More on this (including further examples and what to do about it) in today’s post and notes.

Chances are you’ve heard some version of the phrase “we create our own reality”. For many, this statement is confusing and invalidating, especially for those who have experienced trauma, systemic failures, or an inadequate developmental landscape. Paul Wachtel, a leading scholar in the world of psychotherapy, explains how we all participate in “creating our own reality”. 


Per Wachtel, we learn from our relationships and experiences what we can expect from others and how others tend to perceive us. Based on what’s happened in our past, we come to expect certain behaviors, dynamics, and outcomes from people / situations. We carry those expectations with us into new relationships / situations and those expectations influence how we behave and interact. Our behavior and way of being with others then influences how others are with us, often in a way that continues to provide the experiences or dynamics we expected. 


We can get locked in cycles where perhaps we don’t want an outcome, but expect it, and participate in our interactions in a way that makes it more likely the outcome will come to reality. The trouble is, many of us are often acting on expectations that are so hard wired we may not be aware just how powerful they are in influencing our behavior and relationships.
For us to constructively participate in “creating” our own reality in line with the life we want to lead we need to accept our prior experiences and expectations tend to lead us to behave in ways that increase the likelihood that what we expect will be what we experience.  If we want to change our lives and start having different experiences we may need to work to override our “automatic” and “intuitive” ways of being.


If you find yourself experiencing the same dynamic or patterns with others, start with yourself.  You may need to work to identify how you think others see you, what you expect of others, your sense of what others expect of you, and how all of that informs how you are in your interactions. Therapy, a mindfulness practice (which increases our ability for objectivity), reflective work, and feedback from trusted others can help us uncover these dynamics and work towards changing them.

Notes:

  1. The theory I’ve outlined is from Paul Wachtel’s book, “Relational Theory and the practice of Psychotherapy”, specifically chapter six’s discussion of the Cyclical Psychodynamic Model. Full Citation: Wachtel, P. L. (2008). Relational theory and the practice of psychotherapy. Guilford Press.
  2. Wachtel (pages 104-105) provides an example of two children to help us further understand how this dynamic can occur. He asks us to imagine one child who is friendly, outgoing, and open.  This child will likely evoke friendliness in others and learn from those interactions that others are eager to interact with him. Another child is more shy, withdrawn, and hesitant to approach others. He will not be as likely to experience as much engagement as the first child, because he is not initiating as much or as openly friendly. The example of the children goes further, to explain how even the same situation can be participated in very differently, and in ways that continue to reinforce whatever the child’s natural tendencies are. He encourages us to consider how each child might interact with someone who is grumpy. For the child who is more prone to friendliness and openness that expectation that people are largely friendly and interested may help her engage with that person in a way that eventually does lead to a positive social interaction (like a smile). For the child who is more weary to interact he may be more likely to take someone’s grumpiness as a sign to back away, further reinforcing his beliefs about how interested others are in him. 
  3. This perspective *does not* hold that we have complete control over outcomes in our life. This is more about the subtle ways in which our expectations inform our behavior, and that influences those around us. So no, this does not mean it’s your fault that some situations have turned out the way they have, but it may mean it’s worth considering how you participated, especially if you find yourself in a pattern that keeps repeating.
  4. A thought provoking quote from the book to help you reflect on how this happens, “In a host of ways, many of them not easy to identify or notice, each of us repeatedly induces others to behave in ways that are likely to maintain the pattern between us”. (page 105)
  5. Wachtel wrote portions of this chapter for therapists, to help them accept that we do a disservice to our clients if we ONLY help them identify and process through how the past effected them. He explains we also need to help our clients see how the past continues to inform the present, and how our behavior and the behavior of those around us are an interplay. Without addressing all aspects of this, and helping to build insight into both how and why the pattern developed and how it currently plays out we leave our clients struggles insufficiently addressed.
  6. If you are doing the work of changing cyclical patterns in your life, this means you are also changing how you are in relationships. It’s important to know that others have gotten used to your cyclical patterns too, and that they may need some time to catch up and adjust. See this post for further discussion.  
  7. I further outline how we use our past to learn and make connections that effect our present day in this post.
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No One Creates All the Problems in Their Life…

  • If something affects you, bothers you, or creates problems for you, it’s yours to participate in fixing, even if you didn’t create it or it’s not “your” fault. 
  • Some of us are given the tremendous advantage of having the majority of our physical, social, emotional, and financial needs met from an early age. Most of us are not. 
  • When we don’t have those needs met it can effect our ability to trust, connect, hold boundaries, be vulnerable with others, and be in touch with our inner world in a productive way. 
  • Regardless, the accountability and responsibility lies within each of us to do what is in our power to move towards creating the life we want to have. 
  • For many of us that can mean “cleaning up” after early formative experiences you didn’t have control over, but that have shaped you into being a person who has developed dynamics or patterns that create problems in your life moving forward.
  • Those dynamics and patterns become our responsibility to manage and deal with as we go through our lives, even if they were formed because of experiences we didn’t create
  • Many of us can get stuck in the in-between of “it affected me” but “I didn’t cause it”, leaving us in a passive or helpless place wishing for someone else to “clean up”, “deal with”, or tolerate some dynamic within us. 
  • While, there is validity in the feelings of fear, anger, loss, and sadness that are tied to how unfair a situation may be, those feelings are your responsibility to work through so they don’t interfere with your ability to move towards creating the life you want to lead
  • No one creates all of the problems in their life; regardless each of us is responsible for dealing with them anyways.
  • With this mindset we can be the victim of something, but not a casualty of it

According to Dialectal Behavior Therapy we are ultimately the ones responsible for participating in our lives in a way that brings us meaning, joy, and satisfaction. Our ability to connect, relate, trust, share, hold boundaries, be vulnerable, and be productively connected to our thoughts and feelings is hugely shaped by our early relationships, relationships we have at a time when we don’t get to choose who we are around. For some of us, those relationships and that environment provide a ripe and fertile ground for healthy and safe development. Most of us, however, hit some “snags” along the way and struggle on some level with the dynamics just listed.


Those “snags” are our responsibility, even if we didn’t participate in creating them. For example, your difficulty with vulnerability becomes your responsibility, even if you were the victim of earlier experiences that made being vulnerable inaccessible. 


DBT encourages each of us to hold our end goals, values, and priorities in mind, and to do what we need to – and can do (there will be limits here) to get ourselves in the life we want to lead. This does not mean “what happens” in your life is your sole responsibility. There are far too many external forces at play for that to be possible. What it does mean is the roadblocks you hit are yours to work through, regardless of how they got there.


For some of us we run into a thought traps around a fairness or a “who caused it” mindset. We can come to believe because a “mess” or “problem” in our life wasn’t created or initiated by us it isn’t our responsibility to participate in dealing with. We can get so focused on “who created it” or “how it got there” that we become distracted, helpless,  and more focused on what is outside of our control (the choices someone else made) than what could be within our control (how we cope, manage, or can grow as a result of an experience).


There is validity in the unfairness or the bitterness felt around cleaning up a problem you didn’t create. Own, accept, process and work through those feelings rather than let them stop you from focusing on your growth and your goals.

Notes:

  1. This perspective would most certainly acknowledge that some of us have more work to do than others because of factors totally outside of our control. That’s unfair. But it’s reality, and for us to be able to have the life we want its our work to do. 
  2. This does not mean there is no point to working to make the world and our society / culture a more fair place. What it does mean is that we don’t want the unfairness of something to create passivity in us that stops us in our tracks and strips us from working towards what is meaningful and important to us as individuals. What this principle says is that it may be unfair, but you are ultimately the one that suffers if you let that stop you or hold you back.
  3. This perspective would also not say that “if we are unhappy it is our fault”, however it would say if we are unhappy we want to be on the lookout for ways in which we may also be struggling with passivity or helplessness in certain areas that may be interfering with our ability to improve our circumstances. For some, a lot more energy is focused on “who started it”. While is helpless to bring insight and awareness into how something developed, if we stop there we are at a stalemate of helplessness.  
  4. I can appreciate some may be reading this and thinking about it through the lens of community or systemic factors that have a huge impact on wellbeing (think gangs, gun violence, etc). This principle is much more about helping an individual challenge patterns of helplessness or passivity that may be keeping them stuck than it is about how to effect change on a much larger system (like a community). It is worth noting that the systems we are in have a huge impact on our wellbeing, happiness, and health and the more privilege we have the more able we are to minimize the impact of those systemic forces. If you read the post thinking more about larger systemic forces I’d encourage you to go back and re-read it through the lens of the individual.
  5. Unsure why you’d want to be in touch with your inner world? See this post on Emotional Blocking, and this post on how our emotions are like traffic signals.
  6. Helplessness and passivity are often NATURAL and HEALTHY reactions to environments where we don’t have control. If you struggle with these dynamics know that you may be applying a tactic that used to work in one life scenario in a way that no longer serves you. See Your Brain as An Association Machine for more information on how this can happen.
  7. Elements of this post may be confusing for someone that identifies as “co-dependent”, given the lack of clear boundaries I am describing. If this is you, think about this through the lens of how you can “fix” by focusing on what is within your internal world or scope of control rather than how you can “fix” by working to change another person.
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Building Mastery

  • There are concrete steps you can take to improve your self esteem, confidence, and sense of worth / value.
  • To feel good about ourselves we need to be doing something routinely that we feel proud of.
  • For us to feel proud of something it needs to be hard enough that it is a challenge, but not too hard that it’s overwhelming.
  • If it’s too easy we won’t really feel proud of it, and if it’s too difficult we’ll feel overwhelmed or defeated.
  • A common area of struggle in this arena is that many of us don’t actually hold realistic expectations for what’s “too difficult”.
  • This is one of the reasons many new years resolutions fall apart – many of us don’t accurately assess where that sweet spot is between “a challenge” and “unrealistically challenging”.
  • To be successful at setting and achieving realistic goals many of us have to wrestle with our “shoulds”.
  • We can feel like “I should already be____”, so when we set a goal we are inadvertently trying to make up for lost time.
  • This often backfires. When we try a challenge and it’s too far out of reach it actually DECREASES self-esteem, and can leave us feeling lazy, out of control, inadequate and generally unmotivated.
  • Accept where you are now, pick a goal to work towards that it just beyond that, and gradually work to get to the final milestone.

Marsha Linehan outlines in her Dialectical Behavior Therapy Treatment Manual exactly how to increase your sense of self esteem and confidence, and it’s through a process she calls “Building Mastery”.

Taking on appropriately challenging activities, goals, and tasks is a tool we can use to help us boost our sense of worth, confidence, and self esteem. If you’d like to try building #mastery you want to pick a #goal to work towards that feels challenging, but is realistic with how you live your life. For that sense of mastery and #accomplishment to be built the goal needs to be just out of current reach, but still accessible with effort.

If you find you are often someone who doesn’t meet the goals you set for yourself, your ambition might be blinding you from what is realistic and sustainable in your life. For many of us, we set goals that require we make changes that are too far out of reach, we then can’t meet the goal, and wind up feeling defeated, lazy, and incapable. This puts us at risk of giving up, and over time, this can erode at our sense of worth, ambition, and ability.

If you find yourself in a position where you set goals and routinely don’t meet them it’s not a signal that you are failure, you “can’t do it”, or that there is no hope – it’s often a signal that you have selected a goal too challenging for where you are at this juncture in your life. And yes, something can be too challenging even if you think it “should” be simple.

When you find yourself at the crossroads of wanting to make a change, wanting to learn a new skill, or wanting to boost your self esteem remember the key concepts behind building mastery, which includes setting an appropriately challenging goal and building on it over time. If you cannot achieve it, find a way to make the goal a little less challenging. Maybe it’s too much to exercise 5 times a week, but maybe 4 times or 3 times is more accessible (at first). You can always keep setting end goals that are a challenge beyond what you’ve mastered, but the key is doing so in a way that maximizes sweet spot between not enough of a challenge and too much of one.

Notes:

1 . It’s not uncommon for people to hold beliefs like, “exercising is good for me, so I should be able to do it regularly” or “I want to be a person who________’s every day, so I’m going to start that now”. The challenge is, we start with the end goal in mind, feel overwhelmed by how much it actually requires of us, and often give up and feel defeated. We come to believe “I’m not a person who can _____, because I tried and it didn’t work”. And yes, we did try, but we didn’t try in a way that was within that window of “challenging enough”. Instead, we may have unknowingly picked a goal that was too challenging without recognizing it in that way because we believed it “should” be within our reach. Unfortunately, this approach actually diminishes our sense of self-esteem because we are unable to stick with a goal we set. Read here for more on how “shoulds” can show up in disguise and throw us off track.

2. For more information on how to set realistic goals for yourself, and how to make gradual changes see this post.

3. Been trying to make a change for ages and it just won’t stick? In addition to exploring the reasonableness of your goals, it may also be time to consider “Secondary Gains”.

4. Do you have a hard time letting go of the “shoulds”? This is not uncommon. Really. It holds many of us back. This post may help.

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The Ripple Effects of Change / Introduction to Systems Theory

  • One of the most unexpected parts of working towards personal growth is that our relationships change 
  • This is because when we grow we often change habits, patterns, capacities, and expectations.
  • Because of this, when we change ourselves we may no longer be the same in our relationships.
  • Sometimes our growth means we connect differently, which means some relationships can feel like they lose the glue that once held them together.
  • Sometimes others struggle with our changes, because they’ve come to depend on us to be a certain way; some way that serves a need for them – a need we may no longer be able to fill while being our authentic selves.
  • When we change and start taking on a new role (or no longer take on a familiar role) it can throw off the sense of balance that others have come to depend on when everyone participates in familiar and predictable ways.
  • Many relationships can grow and evolve together, but some cannot. When we “grow out of people” this is often what it means; not that we are better than them, but that our new way of being is no longer compatible with the needs of each party.
  • Sometimes our growth helps us see other’s behaviors or words through a different lens, causing us to see the relationship differently, and potentially participate in it differently (or not at all) moving forward.
  • To take care of your health and wellbeing you may need to change how you participate, and, others may be effected by how that changes the larger dynamic.
  • So, if you’re making changes in your life, be aware, a lot more than just you may change.

When we change, grow, and evolve there are often unexpected ripple effects in our relationships. Just as there are “growing pains” with physical growth, we can experience growing pains with emotional, relational, and psychological growth.


Our personal growth usually involves concrete changes in how we live our lives. We can set new or remove old boundaries, we may shift how we spend our time or where our limits are. When we grow we may find we talk about different topics with friends or family or look to others for different kinds of support. We may also find that we connect with others in ways that are different from how we used to connect. We may bring new availability to others, or, we may not be available in ways that we were before.


When we change in the ways I’ve described, it means we are different in our relationships with others. Often our growth happens in personal or private moments outside the observation (or awareness) of friends of family. This means as we change we may surprise people, or people may not know what to to expect of us and may look for us to continue participating in the relationship in the way we have in the past.


Our change can challenge some of our relationships; if we are not longer able to fill a predicable role within our relationships others around us may feel confused, lost, angry, or unable to connect. We too can experience loss as relationships that once felt predictable change. 

All of this is natural, healthy, and normal when we grow. If you are working on making changes, expect for this to effect the relationships around you. Work to be consistent with the changes you need to make, and expect others may not “get it” at first.  Be patient (and consistent) with others and yourself during this adjustment period. Some will struggle with your adjustments, and others will adapt with time.

Notes:

  1. A common example of this (and one used as an example in my graduate school class on family treatment) is the TV family “The Simpsons”. Marge holds the responsibility for keeping the family organized and running while Homer earns money, and doesn’t do much more to attend to the emotional or relational needs of the family. Homer has come to depend on Marge to do the parenting, and Marge has come to depend on Homer to earn the money. Imagine how “thrown off” the family would be if one day Homer became a much more involved parent. A burden would be lifted off of Marge – but – Marge also may feel lost, untrusting, and unsure what to do with herself as her entire identity is formulated around caring for her family and cleaning up after Homer’s (literal and figurative) messes.  More in this article from the Baltimore Sun .
  2. What I am describing here is an extension of what (in the therapist world) we call “systems theory”.  In short, this theory describes all of us as being components of larger systems (family systems, work systems, cultural systems, etc). These systems can reinforce behavior, roles, and dynamics within us as individuals and within our relationships. So, when you change one part of a system, the rest of the system needs to adapt too. If you see a therapist describe themselves as a “systems therapist” it means they operate with this framework in mind.
  3. This dynamic is often common is families where one person is identified as “unwell” (physically, emotionally, developmentally – etc). A number of members of a family may get used to thinking of themselves in caretaking roles, and they may rely on the unwell member to be less able or capable. If the “unwell” person becomes more independent and capable over time other member of the family may struggle with how to relate to them, and how to relate to each other as roles change and shift. Identities and a sense of purpose can be lost, and sometimes families can come to depend on a dynamic of having an “unwell” member to keep a sense of balance intact. This “unwell” member can also be called “the identified patient” in therapist lingo, which means the person the family, organization, or system has come to rely on to hold the position of being unwell. 
  4. If you find you have a hard time “catching up” when those around you have made changes I’d encourage you to work on mindfulness – taking in each moment as its own unique and individual experience with a person. We can simultaneously hold awareness of how someone “used to be” while paying attention to current actions and behaviors to allow room for their growth. We may need to spend time processing through losses or gains we experience when those around us grow. This introduction to meditation may be a helpful starting point.
  5. Sometimes even “positive” changes can be met with resistance or pushback from those around you, or perhaps you are finding yourself struggling with someone else’s “positive” changes. That may be because their are secondary gains in place for the person who has not made the change, but who is effected by it.
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Foundations of Meditation

  • A step-by-step guide to the Foundational Meditation for Mental Health
    • 1.  Make sure you are comfortable enough to not move for the duration of the exercise 
    • 2.  Pick a “Focal Point” using one of your five sense. I recommend starting with touch and waiting to use sight until you are more advanced.
      • Ideas:
        • Try pressing your finger tips together or
        • Put a beverage in your mouth and don’t swallow it
    • 3.  Set a timer for 30 seconds.
    • 4. Close your eyes and work to notice “what comes up”. (I.e. what thoughts enter your mind, what sensations you feel in your body, and what emotional feelings you notice internally). Once you notice something return to the focal point you’ve selected. 
    • 5. You stop when the timer stops.
    • Do this once a day for a month. After a month you can gradually increase to up to two minutes (or longer), though I have found 30 seconds a day can be enough for someone to see significant gains.
    • The only time we’d want you breaking the meditation is if you are in danger (i.e. a fire alarm goes off etc), otherwise, it is your job to notice whatever urges arise without acting on them, including urges to move your body, end the meditation, think through something – etc.
    • You will drift away many times; this is the whole point of the exercise.  You are working on increasing your ability to notice when you drift away and come back to your chosen focal point
    • This is not meant to be relaxing, it is a very active process of observing your mind body. What you are doing with this exercise is strengthening your ability to have an internal experience that you don’t react to
    • It’s ok if you get irritated, want to stop, find yourself feeling tempted to move, wonder if you’re doing it “right”. These are all just thoughts, feelings, senses, and urges and it is your job to notice them without acting on them.

Regardless of whether or not you have a meditation practice already, I always encourage my clients to start with this foundational exercise. When we meditate in this way we strengthen our ability to cope by working on being present with our thoughts, feelings, and bodily sensations.  We are noticing them, but not letting them dictate our actions or behavior.


When I introduce this skill to my clients I introduce it to empower someone to strengthen their ability to improve their concentration and to be less controlled by their emotional states. I also use it to help them increase their ability to control their attention, which makes them less susceptible to triggers.


The goal is to work on being present with what comes up, to notice it, and then to let it go and be present for the next “thing” (be it a thought, sensation, or feeling). 


Many of my clients get stuck in one of two places, so be on the lookout for these traps:

  1. They start “Chaining”, meaning they have a thought and then they react to that thought with another thought, or maybe a feeling, and so on and so forth so the meditation exercise becomes more like a stream of consciousness. This is normally how our minds work, so it will probably start to happen during the exercise. It’s ok, you’re going to get better at catching that and then redirecting yourself. Instead work towards noticing a thought, and then letting it float away while waiting for the next one. 
  2. The other common trap is: “Blocking”. This is when you try and “clear your mind” so that you have quiet or stillness. While that can be a great centering or relaxation exercise, it is not the type of meditative exercise we are trying to work towards. We want thoughts, feelings, and sensations to float into awareness so you can strengthen your ability to notice them and then re-direct your attention.

The skill with meditation is not in preventing your mind from wandering, it is in noticing when it wanders and then bringing it back to your chosen focal point. 


 You should find, after a month, you are less “reactive” and more able to notice your thoughts and feelings without having the urgency to respond to them. 

Notes:

  1. The focal point can be anything that uses one of your five sense. I personally find touch is the most accessible, but here are examples from all five senses. The key with any of these is to use it as an anchor, something you return to in-between the internal thoughts, feelings, and sensations you notice throughout the exercise.
    1. Taste: Put a candy in your mouth and notice the taste of it. Resist the temptation to move it around / crunch on it.
    2. Sound: Just listen to the sounds around you – this works best if you’re not in a completely quiet space, though if it is “quiet” you may find there were more sounds than you had been aware of when you quietly listen.
    3. Sight: Watch trees in the wind, watch snow or rain fall.
    4. Smell: Sit over a coffee or tea, spray a perfume or cologne.
  2. With step one, I encourage you to sit in a way in which you are comfortable, BUT as you get more and more advanced you might want to try sitting in a way this is slightly uncomfortable. This will give you an opportunity to work on sitting with your physical discomfort and tolerating the sensation of it.
  3. There will be a second post to come covering how to move away from having a focal point. As you get more and more advanced your focal point can get less specific, but phase one meditation is about working on noticing the drift and re-centering back to the established focal point. Eventually just “you” can be your focal point. 
  4. If “nothing” happens (i.e. you try this exercise every day for a week and you just have a blank mind) you can try scanning around your body to see what you notice or prompting yourself with questions about what’s happening in different areas of your body).
  5. If this is highly activating (which it might be if you struggle with anxiety, intense feelings, or you have a history of trauma) start with grounding and try decreasing the time to 15 or 20 seconds. Once you get really good at grounding you are likely to feel safer and more able to tolerate the exercise.
  6. Want to learn more about who may benefit from meditation? The post “Why Meditation” covers more details on how meditation can increase our ability to cope. The post “Controlling our Attention” covers how meditation can increase out ability to accept what we cannot control. Meditation can help us increase our ability to release our emotions, as covered in the post “Emotions are Brief“.
  7. I was trained on this in graduate school, and I remember we would start off every class with a two minute exercise. Inevitably someone would arrive late and shuffle around the room, drop a bag, pull out a chair, etc. I remember feeling and thinking “ugh! They’ve disrupted the peace! It’s interfering with the exercise”. Initially, I was not able to step back and recognize that my irritation at being “interrupted” and my thoughts about that were actually just another thought and feeling to notice. The exercise can’t be interrupted, because the whole purpose of it is to notice what comes up (internally or externally), and then come back to your chosen focal point. That noticing can include noticing your own irritability, like in my case, as well as noticing your own experience of distraction. The better we get at noticing and returning our attention to our chosen focal point in the exercise, the better we get with this skill in our day to day lives. 
  8. Over time, this exercise will teach you to be more mindful of your internal world and less reactive to it, which means (eventually) you may not need to do it on an ongoing basis. Instead, may find you are more and more used to being connected with your internal world, and this awareness without reactivity will happen more organically and naturally throughout your day.
  9. You may notice there is a focus on “not reacting” or “acting” in this exercise. That’s because we are working to introduce intention to when you act on internal experiences. The goal in life is, of course, to act and respond as is indicated for any given situation, and meditation of this nature helps introduce a pause so that you can increase your ability to notice your internal experiences before reacting to them. In life you won’t always just sit and notice, but that’s exactly what we do when we meditate – we strengthen our ability to resist the urge to act. There will, in life, be times where acting intuitively / quickly  makes sense (think about emergency situations), so we are not eliminating the ability or need (at times) for a quick reaction – but we are working to introduce intentionality so we can be more in control of when we act quickly.
  10. Chelsea Handler’s book, “Life will be the death of me” covers how meditation fundamentally changed her life.
  11. Jon Kabat-Zinn’s “Wherever you go there you are” is an excellent instructional book on meditation.
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You Married Your Parent?

  • When we are drawn to relationships that parallel our relationships with our parents we are often drawn to how we FELT in the relationship and our experience of the relationship.
  • This can include the role we take on in relation to the other person, what we expect of them and how they’ll react, and our sense of how we’re supposed to be around them.
  • Your experience of a relationship is likely to be unique to you, which means it may not be similar to experiences other people (including your siblings) had of your parent.
  • An example: For the parent that had a temper, think about your experience of that, perhaps it’s something like ‘I had to walk on eggshells around her, and I felt like I had to keep her protected from something that might make her too angry. I was often scared or nervous when something might upset her’. 
  • While your spouse may or may not have a temper, you can explore whether or not there is an experiential parallel in how direct you feel you can be with your partner, or if you feel like it’s your job to keep your partner “in a happy zone” because it’s hard for you to trust they’ll be able to productively manage upsetting information independently. You can also consider how similarly you feel when you anticipate they’ll be upset
  • We end up in parallel relationships often because we are drawn to that familiar feeling, role, dynamic, or experience. 
  • When we build insight and understanding into what our relationship was like for us we can make decisions (in an active way) about whether that served us (or not) and whether that’s an experience we want in our relationship(s) moving forward (or not).
  • So when we question, “am I dating my parent”, we want to be on the lookout for both traits between your partner and your parent as well as your experience of each relationship. 
  • You can end up “marrying your parent” by marrying someone who makes you feel the same way or take on the same role in the relationship even if they have very different personality traits. 
  • See post for more information and sample questions to ask yourself to help you build this understanding. 

For most of us, when we consider whether or not we’re dating or married to “our parent” (as the expression goes) we think about this concept in terms of interests or personality traits. For example: my mother was organized and so is my spouse; my father was a runner and so is my partner; my parent had a temper and so does my wife. 


Many of us know we are drawn to what’s familiar, and so yes, we can be drawn to familiar personality characteristics. When I’m thinking about whether or not someone may be replicating an earlier relationship pattern in a current relationship I’m also on the lookout for “experiential” parallels, something I find far fewer people have heard of or considered. 
By experiential, I am referring to YOUR experience in the relationship. We’re looking at how our personality interacts with the personality of another person for a unique relational dynamic between us.


For many of us it can be hard to get descriptive in a concrete way about our experience of our parents as the relationship becomes our standard for “normal” far before we have the capacity for words or for memory.


A helpful way to explore this idea is to focus on your experience in the early relationship and your experience in your current relationship and see what parallels arise. Ask yourself questions about your experience, and it’s ok if your responses surprise you.

Samples:


How understood, alone, connected, or important did I feel? 

When a problem arose did I feel safe in discussing it? Afraid? Like it was my job to  figure it out alone? Maybe it wasn’t my job at all?

How was accountability handled? Who took responsibility for problems or accidents?

When a change needed to be made did I feel like it was my job to adapt, did I expect  them to adapt? Did we all work towards making changes? 

When something needed to be figured out was I included? Ignored?

These prompts will help you connect with how you felt, the role you took on, what you expect of others, and what the relationship was like for you.  We can then use that information to help us change patterns that may not serve us moving forward, and work towards keeping dynamics that did work well for us and our relationship. 

Notes:

  1. If you’re having a difficult time getting descriptive about the relationship (i.e. going beyond “the relationship was good” or “the relationship was bad”) read more about how to find and use descriptive language in ways that help us move beyond words like “good” or “bad”. 
  2. Still having a tough time identifying your experience? When you try and explore it let go of how you think you “should” feel and allow yourself to be present with whatever comes up, even if it feels surprising or uncomfortable. 
  3. This post also relates to a prior post where I cover how our early experiences shape our understanding of what to expect of ourselves and those around us. 
  4. An example of relational experiences that occur with specific personality traits: For the parent who got a lot done, ‘I always knew I could rely on her to take care of things, but I also always felt like she was so busy, or distracted, or not really present with me and so I got used to feeling like she wasn’t totally plugged in to me’. Whether or not your partner “gets a lot done” in the way your parent did, if we were having you pay attention to your experience of the relationship we’d want you to be reflecting on how important you feel when you’re together, and exploring how much you feel like your partner offers you their full attention when you’re together, and how available to you they are. 
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Long Term Vs Short Term Self-Care

  • Care of the long-term self is just as important as care of the short-term self
  • When we care for our long-term self we make an investment in the future or prioritize what feels sustainable to us with regard to our energy, our commitments, our values, and our limits. We trade off what might feel comfortable or bring joy in this moment for something that will help life be more full at a later time.
  • When we care for our short-term self we do something that helps us feel good, relaxed, or at peace in the moment. Often we have fun, are in the present, and aren’t as focused on “what’s coming up”.
  • You will be at risk for cycles of depression and burnout if you don’t pay enough attention to caring for the long-term self OR the short-term self.
  • Taking care of your short-term self is essential to happiness and well-being. We can’t be happy in our lives if we’re not experiencing positive emotions on a regular basis.
  • If we over-invest in our short-term self we are avoiding addressing our future, which can leave us feeling anxious and uneasy as we know, deep down, we are “kicking the can down the road” and not addressing our long-term needs and well being.
  • If we over-invest in our long-term self we can be cheap, grumpy, or unhappy in our day to day lives. We can miss out on important experiences and opportunities.
  • We can stretch ourselves too thin when we over-prioritize either self. With over-prioritizing of the long term self we can live life without enough regard for the present, and we can miss out on positive experiences feeling like we’re always reaching never arriving. With over-prioritizing the short-term self we can over-commit, over-schedule and not set ourselves up sustainably leading to cycles of overwhelm and burnout.
  • Each of us has a different “balance point” between these parts of ourselves, and that balance point changes at different stages in our lives (meaning this is a consideration to revisit again and again).
  • Takeaway: when you’re trying to engage in “self-care” remember both your long-term and short-term self. If you’re noticing cycles of burnout think about how much you are considering either self in the decisions you make about how you spend your time, money, and energy.

For many, “self-care” routines can feel like a cycle of burnout, rest and repeat. We hear suggestions when we’re at the end of our rope like “get a massage”, “take a day off”, “try a yoga class”, and yes – all of those are absolutely self-care. I would classify them as “self-care of the short-term self”.

Having a special / positive experiences can make a day better, but ultimately if our version of “self-care” only cares for our short-term self we can neglect the needs of our long-term self. If we don’t care for both aspects of ourselves we will struggle with satisfaction, happiness, and leading a sustainable life.

Caring for the long-term self is about taking control (where you can) to set life up with regard to what feels sustainable, manageable, and not overwhelming to you. It’s also about making some decisions with respect to your future and prioritizing the experience of your future self. Caring for the short-term self is much more about what will be fun or feel good in the moment.

When we have a history of trauma, or when we are in survival mode we are more inclined to not consider the long-term self, as it can take a sense of safety in the world around you to believe that you can invest in yourself and your future; the more safety we feel in our lives the more able we are to consider both our long-term and short-term selves.

Many of us are inclined to lean towards caring for the short-term self or the long term self, and for each of us we need to find the right place of balance. Places to look for clues as to where you fall on this spectrum are how you spend your free time, spare money, and extra energy. How much of each do you allow yourself to “save” or “spend”?

While the popular and common notions of self-care do take care of (and are important) for the short-term self, we need to remember the long-term self. If you are in a cycle of burnout at work or with family or friends, short-term self-care may help you feel better in the moment, but what’s needed is long-term self-care to interrupt a cycle that’s got you stretched too thin and out of balance.

Notes:

  1. This post covers topics similar to those covered in my post on wants versus shoulds.
  2. Marsha Linehan’s Dialectal Behavior Therapy treatment covers the need for regular positive experiences and it is her treatment protocol that prescribes it as essential for a happy life. Per the treatment plan, without regular positive experiences no one, regardless of their privilege or circumstances, can be happy and satisfied with their lives.
  3. Sometimes this concept is best understood if you think about how it applies to money. If you spend all your money on a goal for the future and very little money on experiences that make you happy or comfortable in the moment you are likely to be putting a premium on your long-term self at the expense of your short-term self. Alternately, if you spend all your money on the here and now, (things that bring you temporary joy like vacations, nice food, or items that won’t appreciate in value in the long-term) you are taking care of your short-term self at the expense of your long-term self. There is such a thing as not preparing enough for the future, BUT there is also a thing as preparing too much and missing out on present-day experiences, living too cheaply or in a way that leaves you stressed out and frazzled.
  4. The more privilege we have the more control we have over factors like how much we work, how much vacation we take, how much money we have to save or spend and how much we time we can spend on leisure vs work. This concept can be applied relatively, and regardless of your level of privilege you can work towards caring for yourself by working towards considering what will help you feel good now, what will help you feel good later, and trying to find a balance between the two.
  5. What about vacations? Vacations are an incredibly important tool to reset, have new experiences, relax, learn, spend time as a family, and (temporarily) reduce burnout. However, there has been research that shows that the effects of a vacation wear off very rapidly after a return to work and those effects diminish even faster with a more demanding workload. Vacations are great, but you are more likely to find happiness by paying attention to your day to day experience and finding ways to improve that then relying on vacations to “reset” you.
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Thought Management Tool

  • Anxiety can be a runaway train. The following six step thought management tool helps you slow it down and regain control.
  • Step One: identify the raw worry thought. Just get it out there. It doesn’t matter if once you write it down it seems ridiculous.
    • Example:
      • I’m going to fail at giving this presentation
  • Step Two: Rephrase the worry thought so there is descriptive (rather than judgmental) language.  This will enable you to get to the “core” of the worry.
    • Example:
      • “I’m going to fail at giving this presentation” BECOMES
        • I’m going to freeze up and not be able to remember all the points I want to present
        • People won’t think I’m smart  / capable 
  • Step Three: List out all the reasons why you believe this worry could come true. 
    • Example:
      • People can be judgmental
      • people that don’t know me well may draw conclusions about how capable they think I am from this presentation
      • I have frozen up during presentations before.
  • Step Four: List out all the reasons why you believe this worry won’t come true.
    • Example:
      • People that know me are likely to use this presentation as only one instance in their sense of me and who I am
      • People that don’t know me will hopefully trust that I was assigned this presentation because others believe I can do this
      • I don’t know that people will be as quick to jump to conclusions as I fear
      • There will hopefully be opportunities to gain respect (even if I lose it) in the future
      • I haven’t always frozen up at presentations. Sometimes they go ok.
  • Step Five: Now identify your priorities, goals, and what really matters to you about the situation you are in.
    • Example:
      • I want to build my reputation at this company as someone that is reliable, capable, and a valuable member of the team
      • I want to be given more opportunities like this in the future
      • I want to build my confidence so I’m not always so anxious before presentations
      • I want the presentation to go well (i.e. I, my boss, and the client are satisfied with it).
      • I want to get better at giving presentations
  • Step six: Identify what you can do to address the worries you hold (with respect to the priorities you’ve established), how you can troubleshoot for the things you know are likely to “go wrong”, and how you can help yourself feel more comfortable.
    • Example:
      • I want to ask someone who has presented in front of these people before how “tough” an audience it is so I can be prepared for what to expect
      • I can remind myself that if people judge my intellect or my capacity based on one presentation then that’s not in my control and it’s short sighted on their part
      • I can practice before hand to feel more confident
      • I can remember to pause and collect my thoughts for a moment if I need to
      • I can bring bullet points with me so I remember the key points and one of my bullet points can be the remember to pause and collect my thoughts when I need to

One of the challenges with anxiety is that it can accelerate our thinking. We can get overwhelmed quickly –  to a point where we can’t identify what we are thinking or feeling, we just feel anxious, out of control, and (often) helpless to stop it.


Therapists work to help their clients slow down the speed of anxious thoughts and come to understand them. The tool in today’s post helps you slow down worries, understand key concerns, reduce helplessness, and feel more in control (which is often one of the reasons anxiety gets so severe). This tool gets you focused back on what matters to you and what you CAN control.


I recommend starting with writing this down or typing it out. In time, this may become automatic enough that you can do it in your head.


Step One. Raw Worry thought(s). You may have many, that’s ok, run through the exercise with each of them. The point of this column is to try and put words to the internal chaos so you know what you’re working with. Sometimes just clarifying the worry can help reduce anxiety.


Step Two. Rephrase the worry thought so there is descriptive (rather than judgmental) language. Judgments are often short-cuts that stop us in our tracks and leave us stuck in developing a plan of action. Substitute words like good, bad, right, wrong, should, shouldn’t, fail, succeed, hard, and easy with more descriptive language. See posts from 4/11-4/15 for detailed instructions on how to do this.


Steps three and four help challenge the likelihood of the worry coming true by forcing you to really think through the possibilities of what could happen.


Step Five: Pause and think through priorities. Look out for judgmental language here (i.e. instead of I want to do a “good” job, define what a “good” job means). The priorities for the situation don’t have to link up to the prior steps. This is a centering step to help you get to the heart of what matters to you and in this situation.


Step six: This gives you actionable steps, reduces helplessness, empowers you, and helps you gain control where control can be had. 


After completing the exercise you are likely to feel centered and able to take steps to move towards meeting your goal(s)

Sample completed tool below for anxiety about giving a presentation:

Notes:

  1. Deconstructing judgments is a key step and one that may require more detailed instruction. If you’re getting stuck on this step read this post to help you identify a judgment, this post to learn more about how judgments limit us, and this post to learn more about how to deconstruct a judgment.
  2. I developed this tool, but it contains concepts merged from DBT and CBT
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Secondary Gains

  • If you have been trying to make a change in your life, but find yourself unable to sustain it, you may want to consider “secondary gains”
  • Secondary gains are the positives or benefits associated with something that is otherwise problematic in our lives
  • Often, we are so focused on how a behavior, choice, or response is “a problem” that we don’t see how it benefits us  
  • Sometimes there are perks to thought patterns, reactions, ways of relating, or behaviors that otherwise concern us or the people around us.
  • We may not be aware of the perks, and it can take active reflecting and internal exploration to identify how we may be benefiting from something we or others in our lives identify as problematic
  • For example: Maybe our angry outbursts help us regain control, or help us feel powerful at a time when we’re feeling helpless. Maybe our excessive drinking helps us feel confident and enables us to be relaxed and in the moment in a way we otherwise struggle with.
    Sometimes, our secondary gains are actually concepts that we hold onto – concepts that help us manage in our lives and in the world at large. 
  • If you are finding yourself stuck, and unable to make a change despite your best efforts it’s time to consider if there are secondary gains. 
  • Once you’ve identified them, you may need to reconcile how to receive those “gains” elsewhere from other concepts, actions, or behaviors, or if that’s not possible than face the losses that may come with making the change you want or need to make.
  • Further explanation in post and detailed examples in comments.

Despite our best efforts and intentions sometimes we find ourselves unable to make a change. We can get stuck in a pattern of doing something we desperately wish we could stop. This can apply to any change we want to make, from how we think about things, to behaviors, to substance use, or relationship patterns.  We know our choices, responses, or how we are handling ourselves is not what we want, yet we cannot stop or break the pattern or cycle and engage in a new way of being.


As a therapist, when I hear about situations like this I will find myself curious about possible “secondary gains”. Secondary gains are some added benefit, something positive, some way in which some part of this pattern or cycle actually DOES benefit you.


When I start asking clients about this, I often get a lot of “nothing. There are no benefits. I hate that I do this and I wish I could stop”. It can be hard to “flip the script” and start thinking of how something you dislike about yourself or your choices actually serves you or benefits you.

Even for problematic patterns, behaviors, or choices there may be positives too, positives that we would lose when we make a change, and positive that draw us back into the cycle again and again. These positives are the “secondary gains” that can make change difficult.


So, while it might be something we wish we weren’t engaging in, sometimes the only way for us to make a change is for us to allow ourselves to consider how we ARE benefiting from it. To do this, we often need to actively suspend our narrative that “it’s bad” (even if we know it’s problematic) and give ourselves permission to list out what is good, helpful, unique, or powerful about it. That work, of being honest with yourself about what is “good” about this “bad” thing can bring about some difficult truths, but it is essential for you to get in touch with them to get over the road-block of secondary gains.


Once we can get in touch with how we are benefiting, we can figure out how to get those benefits in other areas of our lives, or process and accept the losses that will come with making a change.

Notes:

  1. Example: Imagine you want to slow down your drinking. You’ve make a lot of efforts to cut back, but you can’t seem to stick to them. It might be helpful to consider what you would lose if you cut back on your drinking. Maybe alcohol helps you relax in a way nothing else does, maybe it drowns out your anxiety in social situations. If you work on increasing your capacity to relax, or decrease your social anxiety you may no longer need the secondary gains of alcohol and it may be much easier to cut back.
  2. Example: You can’t seem to stop snapping at people in your life (i.e. yelling) when you’re frustrated, overwhelmed, or upset. You know this is an issue, and you feel ashamed about it, but you can’t seem to change the pattern. Perhaps it’s helpful to consider what you gain by KEEPING the behavior intact. Maybe it’s the only way you know how to release your own emotions and it feels like your feelings won’t settle until you let them out in this way. Maybe you hold a fear that if you don’t yell at someone they won’t change, and so it feels (on some level) like this is the only way someone can “learn their lesson”. Maybe when you snap and yell it’s actually a way you regain control, since everyone else’s behavior instantly stops. If you can work through the ways in which you actually feel safe, protected, and in control by snapping and then work to find other ways to feel safe and in control in those moments without the snapping behavior the snapping will be much easier to change. This may mean working on decreasing your reliance on the control you feel when your anger erupts.
  3. Example: You’ve gotten into a pattern of cheating on a spouse or partner. You feel terrible because you believe in monogamy but you find yourself again and again drawn towards someone outside of your relationship. It may be time to consider what you DO gain either from the person, how the person makes you feel, the outside relationship, or the experience of courting someone. Maybe there is something enlivening in the risk taking, maybe it helps you feel attractive in a way you haven’t for sometime, maybe you find yourself more able to be honest with a stranger than with your partner and you crave that ability to be honest in your life. You may need to work to find ways to incorporate those positives into your life and / or your relationship. If you can give yourself permission to explore what you are gaining by the behavior and the relationship(s) it will be much easier to change the pattern(s).
  4. Example: You find yourself in a pattern of getting overwhelmed with obligations or responsibilities. You feel like you can’t say no to things because you feel guilty when you do, but time and again you find yourself burned out. As much as you try and set more boundaries you can’t seem to and the cycle repeats again and again. It may be time to consider what the secondary gains are here. Maybe you actually feel proud of yourself for being able to “manage so much”, and maybe it boosts your self-esteem to “get so much done”. You may also enjoy telling others or telling yourself about the list of accomplishments, and you may also feel like “this is what is means to be a good friend / family member / colleague etc”. So despite your burnout and misery, you may not be able to make the change without first finding other self-esteem boosting experiences and without working through this concept you’ve held onto about what it means to be a good support to others.  
  5. Example: You’ve fallen into patterns of helplessness in relationships. You ask for things before trying for yourself more often than not and its hurting relationships in your life. This may become hard to change if there are secondary gains to the helplessness. Perhaps you take comfort in people stepping in to help you, perhaps its how you reassure yourself that you’re not alone. It may be a way in which you feel powerful or in control by asking something of others and having them provide. You may feel scared of failure if you were to try doing things more independently and while you know this tends to rub people the wrong way and hurt your relationships, you don’t feel you can let go of the pattern. Facing how this way of being benefits you, and working to build in those benefits in other areas of your life will make it much easier to change the behavior.
  6. Secondary gains are not the only barriers to making changes. See this post on “how change happens” for more help understanding barriers to change.

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