Why 2021 isn't the relief we thought it would be

We all know that 2020 was a difficult year for so many people. The emergence of the COVID 19 virus, the racial upheaval and reckoning, the political intensity and elections were all challenging and overwhelming for many. Yet, somehow, we survived it and made it through. We looked to 2021 as a new beginning, a fresh start, where we would leave the misery of 2020 behind. Unfortunately, 2021 brought with it many of the same challenges, accompanied by a year’s worth of accumulated struggle from 2020. 

As a mental health provider, I’ve been observing the depression, anxiety, burnout, malaise, substance abuse, relationship struggles, irritability, and general “I just don’t feel good,” that have emerged in 2021.  I think most people are surprised that it’s hitting now, as hope reemerges for many people her in the USA (caveat: this article primarily applies to people living in those countries and communities that are experiencing some relief from the crises of 2020. I send compassion and care to those who are still in the midst of the storm, and my fervent hope that relief is on the way).

I want you to know that these feelings are normal. It’s exceedingly common to feel this way. I also want to tell you why you might be feeling this way.  Here are a few possible reasons you might be experiencing this emotional response.

Crash after the Crisis: I’ve written about this topic before, but in relation to the crash after treatment is completed for an illness.  Basically, we defer or delay our feelings in order to deal with the immediate crises, such as managing children at home, transitioning to working from home, losing or changing jobs, financial stress or fear, health concerns for yourself and others, mourning deaths, racial grief and outrage, and/or fear about current or future political developments. 

It’s evolutionarily wise to defer our feelings, because we’d be unable with all these real life issues while having the appropriate emotional responses, such as terror, fury, despair, hopelessness, helplessness, and overwhelm.  Unfortunately, feelings don’t disappear just because we’ve managed to push them away. We have only delayed processing the feelings, and they will return when some part of you decides you are safe enough to do so.  For many of us, as the changes of 2021 arrived, instead of feeling better, we ended up feeling the full brunt of all the feelings of 2020 that we had not fully processed.

Too much fight or flight: During this past year, most of us have spent more time than usual in crisis management, stress and fear.  Our bodies are responding like we’re gazelles being chased by hungry lions.  Unfortunately, our systems aren’t designed for non-stop stress response.  For a wonderful description of the cost of unresolved and unrelenting stress reactions, I recommend Burnout by Emily and Amelia Nagoski, which has inspired some of this discussion. 

When we enter the sympathetic nervous system (fight-flight-freeze), our body responds beautifully, increasing blood flow, slowing digestion, and it prepares our bodies to fight for our lives.  However, this system is designed for short-term stress (chased by a predator), not long term chronic stress (fear about job security, non-stop stressful videoconference meetings, children struggling with distance learning), and presupposes that either we die, or we escape the threat to recover with our tribes, and enter the parasympathetic nervous system (rest and digest). 

Instead, we just go to bed, wake up, and start the cycle of work, familial, societal, interpersonal, financial, and health stressors again, with little or no resolutionor recovery. The accumulated stress eventually becomes too much, and we experience burnout, exhaustion, irritability, depression—all signs that we have spent way too much time in the stress systems without recovery or relief.

I assume it goes without saying that, if you can change some of your circumstances that are causing stress, I would encourage you to do so.  However, if you’re dealing with stresses that you cannot change, what can we do to help you survive and feel a little bit better?

1)   Get your body out of fight or flight: For our ancestors, after they dealt with evolutionary threat (usually someone or something trying to kill them), they either died or escaped. Either way, it was short term stress.  In our never-ending Groundhog’s Day of stressors, we often remain stuck in the threat.  We need to find a way to help our body relax. 

a.     Breathe: Breathing is one of the quickest ways to let our body know that it is not under threat.  The marvelous book Breath by James Nestor has numerous examples of breath exercises and the data that support them.  A few easy breathing exercises are listed below. Breathe through your nose if you can.

                                               i.     Inhale and then exhale for double the length of your inhalation. For instance, if you inhale for a count of four, exhale for a count of eight.  Repeat as long as you like. 

                                              ii.     Inhale for a count of four, hold for a count of four, exhale for a count of four, hold for a count of four. Repeat as long as you like.

b.     Exercise: The data are compelling on this topic.  Exercise reduces levels of stress hormones in your system, and it releases endorphins that make you feel good. Clinical research has shown exercise to be a tool that can reduce anxiety and depression.  Aerobic exercise of twenty minutes or more is ideal, but the best kind of exercise is whatever you are willing and able to do regularly.

c.      Connect: There’s a saying that a lonely Neanderthal was a dead Neanderthal—we were built to live in community, and required it for physical survival. Now, we need connection for emotional survival. In Burnout, the authors suggest that a 6 second kiss or 20 second hug can be a way to break out of the sympathetic stress reaction.  If humans aren’t available, many people find similar relief from petting a cat or dog.  If physical touch isn’t your thing, spend time with a friend and connect emotionally. 

I hope some of these ideas give you comfort that you are not alone and that your feelings are normal. Try some of these tools and see if they might give you any relief from the challenges you might be experiencing. If these tools aren’t quite enough for the pain you’re experiencing, please reach out to a therapist or trusted advisor to try to find more structured support. These are challenging times, and you deserve support, and I hope brighter days are ahead for us all.

Frame your conversations for greater success

I’m reading an extraordinary book about communication called Say What You Mean, by Oren Jay Sofer.  I highly recommend it to anyone who wants to communicate authentically, directly and kindly, and to anyone who wants to improve their relationships. While I was reading today, Sofer made such a beautiful and elegant suggestion that I put down the book and came to share it with my community.

In couples’ therapy, and, indeed, in all relationships, difficult conversations are sometimes necessary. Sofer raises the concept of how important it is to be thoughtful about how we begin our difficult conversations. Skillful framing of the message is essential.  Sofer states: “framing gives someone a general indication of the territory we’d like to discuss in a neutral or positive way.”

How many times have you tried to start a conversation with someone only to be met with a response that is distracted, irritable, or defensive?  Maybe you entered into the conversation with positive intentions, but your partner reacts as though you were attacking.

Framing avoids these problems by letting your partner know what is coming and asking for permission before proceeding.  If your partner has had a bad day, is in the middle of something, is distracted, is feeling emotionally unsettled, or is otherwise not ready to receive your conversation, you are giving them the opportunity to say “not right now.”

Framing lets the person know what you hope to talk about, and checks in with them as to whether they would be open to that at this time. Sofer gives the example “I wanted to talk about the conversation we had yesterday to see if we could understand where we each were coming from a little better. Would you be up for that?”

Legendary couples’ researcher, John Gottman, states that 94% of the time, “how you start a discussion determines the way it will end.”   So start off your next difficult conversation with wise framing, letting your partner know what you’d like to talk about (in a neutral or positive way) and ask if they would be open to that conversation.  I’d guess that if you start like that, you’ll be much more likely to have the kind of discussion you want.  Give it a try, and let me know how it goes.

Change your goals from agreement to understanding

Often, when we are in an argument, we start out reasonably calm. Then, the argument escalates, and we find ourselves shouting, and no one is listening any more. It’s like both partners have their fingers on the TALK buttons on their walkie talkies, so they can’t hear anything.

 Typically, the escalation is caused by the feeling that our conversation partner hasn’t heard what we are saying. When we feel like someone hasn’t heard us, we tend to say it more forcefully or more loudly. We might get frustrated and resentful and resort to unkind language or tones.  Unfortunately, these changes do the opposite of what we intend. Instead of getting our partner to hear us, we drive them to place their fingers on the TALK button more firmly, and shut down their capacity to hear us.

The magic solution is simple but hard to do.  Stop talking, and listen.  Even if you think your partner is saying things that are inaccurate or unfair, just listen to the story that they are trying to tell you.  Then, say it back to them, without agreeing or disagreeing with the accuracy of their statement. 

For example: “OK, so I hear you saying that you think that I was nice to everyone at the party except for you, and that made you feel angry with me, and hurt.  Did I get that right? Is there anything you would add or adjust so I can be sure to understand?”  Your partner might add or adjust a few things, but you may find that their negative energy dissipates when you are focused on understanding them. 

Then, once you and your partner are satisfied that you have understood their concern, you might ask: “Would you be interested in hearing my side? It’s ok if now isn’t the right time.” It’s important to offer them the chance to not listen at this particular moment.  They may be too wound up or they might be feeling nervous that they will lose this good, connected feeling of being heard if they open the dialogue up. 

For your part, try to use this pattern of explanation: “When you did _______________________ , I felt _____________________________.” Be careful to only use emotion words when describing your feelings.  “I feel like you’re being a controlling jerk” is not a feeling, and it’s not useful.  When in doubt, refer to the feelings wheel to make sure you are naming emotions within yourself, not thoughts about the situation.  I often tell my clients that if you can’t imagine an emoji of the sensation, it might not be a feeling.

Then, ask your partner if they’d be willing to repeat back what they’ve understood you to say.  You can remind them that they don’t have to agree with what you say, just that they understood your side of the story.

If you each can explain the disagreement in non judgmental terms, you’ll find that you may not have to agree in order to feel connected and collaborative.  For instance, you might say: “I understand that you feel really stressed about work, and it hurts that, when you come home, looking for comfort, you experience me as demanding,” and your partner would say: “I understand that, when I’m stressed with work, my silence and absence make you feel really lonely.” 

John Gottman, a long time researcher of couples’ therapy, found that 69% of problems in relationships are unsolvable: e.g., “I’m a night owl, you’re a morning lark;” “I’m a saver, you’re a spender.”  That’s not necessarily a problem. Life would be pretty boring if we were all the same.  The goal is not to agree, it’s to understand. 

So when you find yourself in a disagreement with a partner, remind yourself that the object isn’t to convince your partner of your point, or even to agree. It’s to listen, and, if you disagree, to disagree accurately.  You might be surprised at how much of a difference it can make.

What are your big rocks?

Maybe you’ve heard the story before about the jar of rocks. It’s been told to me like this: a business school professor brings in a large glass jar. He sets it on the table in front of his class, and fills it with large rocks. He asks the class if it is full. They say yes. He says that they are wrong and begins to add smaller rocks until he can add no more. He asks again if it is full. When the students say yes, he again tells them that they are wrong, and begins to add gravel. He repeats the process with sand, and then, finally, with water.  He then tells the students that the jar is now full.

He asks the students what the point of the exercise was. A student confidently raises their hand and states that it was to remind us that, no matter how full we think our lives are, that we can always fit more into our days.  The professor responds by saying no. He says instead that the point is that if we had started with the small rocks, there never would have been room for the big rocks, so always start with the big rocks first. 

The metaphor, of course, is that the big rocks are the most important things in our lives.  The professor of this story is reminding us to put the most important things into our lives first, and then to have the less important things fit in the area that remains.

So often, we become terribly busy, so we aren’t able to make room for changes in our lives that might make us happier.  It can be useful, during these times, to pull out our metaphorical jar of  rocks, to see how much gravel, sand, and water are filling them up. 

I invite my clients (and therefore, invite you) to take stock of your life.  If we imagine that you have an empty jar, what would be your big rocks? For many people, the big rocks tend to be topics like family, health, career, faith, and/or emotional well being , but yours may vary.

Then, look at your life—have you set it up to put your big rocks in first? If family matters most to you in theory, does your life show that? Do your hours of the day reflect a commitment to family first? Or does your life show that other rocks are taking up more space in your jar? Are you working 80 hours a week? There’s no shame in that, if career or financial security/stability are your biggest rocks right now. But if you believe that family is more important than career right now, you might want to adjust your rock placement.

I also want to remind you to be as ruthlessly honest as you possibly can be about evaluating the biggest rocks.  Sometimes, we have idealistic wishes of what our priorities should be, but our actions show different focus. For instance, though many of us say that our health is the most important thing, we might also prioritize our social lives or our careers over the behaviors (such as sleep, healthy eating, and regular exercise) that would maximize our health.  Again, I have no judgment over the choices we all make, but it’s important to be honest.

Once you know what your biggest rocks are, then I encourage you to set up your life in such a way that your big rocks take a priority in your life, and get entered into your schedule first.  Those commitments become the most important, and are the least available for cancellation if there is a conflict.  If you run out of time to do everything, you will handle the big rocks first, and the gravel and sand commitments can fall to the side if required.

Life doesn’t have to be rigidly limited to your rock allocation, but it can be a useful way to check in with yourself when life seems out of balance. Re-evaluating whether your big rocks have changed, or if you’ve drifted away from your values can be a useful way to get your life back on track in a more positive direction.

A crisis isn't a blessing. It's a snowglobe.

One of my pet peeves is when people say cancer (or some other major crisis) is a blessing. Anyone who has lived through a crisis knows it does not feel like a blessing. It’s stressful, saddening, enraging, frightening, and so many other feelings that most people would not typically describe as blessings.

A crisis is more like a snow globe. A snow globe is a clear liquid-filled ball with a scene in it and with lots of confetti that looks like snow inside. When you shake it up, the “snow” floats all around and, as it comes down, it settles in a different location.

A crisis, like a snow globe, shakes up your life, and all the aspects of your life-your work, your friendships, your family relationships, your identity, your medical and mental health all go in the air and then settle a little differently than they were before.

As you recover, you begin to put the pieces of your life back together. You will have choices about where you put all these pieces. You can try to put them back where they were before, though some things will be different or broken or not fit together like they did before. Or you can decide to put them back in a different order, which might be better than before, or it might not feel quite right either.

As a result, after a major life crisis has passed, many people are surprised to find that they do not feel relieved or transformed, they may feel worse, and not like themselves. That’s often the case when people are trying to put the pieces of their lives back the way they were before. The more transformative way to approach it is to take the time to decide what the best way is to take these pieces and make one’s life whole again. The new configurations may be different than you ever would have planned, but it might also be a beautiful and rewarding use of all your different pieces.

For this reason, some people’s lives do become better after a major crisis. It’s not that the crisis itself was a blessing, but that the introspection and readjustment of priorities that followed generated the positive change. Pain can be quite transformative, because it can force you to take stock of all the different pieces of your life. You can decide whether the pieces of your life are being put together in the way that serves you optimally. It’s like when you move—no one likes all the work involved in moving, but in the process of packing and unpacking, you manage to slough off things you no longer need, and you rearrange the items on a fresh canvas.

Why gratitude isn't just for Thanksgiving

Around Thanksgiving, many people reflect upon what they’re grateful for.  Many of us typically by rote the things we know we should be grateful for, such as a roof over our heads, and food on the table. Don’t get me wrong—I think most people should be grateful for those blessings, because not everyone has them. But I want to talk to you about being grateful far beyond the basics that we do once a year around a turkey, stuffing, and mashed potatoes (or whatever you eat to celebrate the fourth Thursday in November).

Our brains are wired to notice what is bad or dangerous. It makes sense, right? From a survival-based perspective, it’s much more important to remember which berries are poisonous, or how slippery the roads get when it rains or snows, or what sets off an already angry loved one, than to notice how delicious your coffee is, how great your last meeting went, or how nice your spouse’s smile is.  We’re hard wired to be much better at noticing what’s wrong rather than what’s right, and it’s probably served us quite well.  I’m not saying we shouldn’t notice dangerous or suboptimal situations, I’m just saying that we want to strengthen our capacity to notice the joys and pleasures too.   

Science backs this up too.  Gratitude improves physical and mental health.  It improves sleep quality, self-esteem and relationships. It even changes the brain. It sends increased blood flow to the hypothalamus, which manages numerous bodily functions, including eating, drinking and sleeping, and also influences metabolism and stress levels. It also is correlated with increased blood flow to areas which release dopamine, which can increase generally good feelings.

 As a side note, many people find the term gratitude practice to be too mushy or touchy-feely, so I sometimes call it “noticing the good.” Call it whatever works for you, but it’s a very simple and easy way to adjust our mind’s tendency to see the world through gray colored glasses, and to shift us towards a more positive (and often more accurate) worldview.

If you’re up to give this practice a try, let me step you through how to start. I like to make it pretty simple. Pick a time of day when you will notice the good.  It usually works best to pick a time that is linked to a behavior you do every day. For instance-some people do it before getting out of bed in the morning, others do it during the few minutes while waiting for their coffee or tea to brew, and others do it while drifting off to sleep.  Whatever time you pick, make it a time that’s easy to protect.  If you pick an arbitrary time, you might find that 4:15pm or 11:20am (or whatever you’ve chosen) lands in the middle of a meeting or appointment, or when you’re just not feeling like it, and you’ll skip it.

Then, select a number of gratitudes you plan to notice.  Selecting one can be an easy place to start, and you can work your way up to more if you like.  You might find that, at first, it’s not easy to find something to appreciate, but with time, you get quite good at noticing many, so you may adjust the number as time passes. 

Then, decide how you want to notice the gratitudes—do you write it down in a journal? Share it via email/text/phone with a gratitude partner? Say it directly to a friend or family member? Just notice it in your mind?  It’s best to know yourself and what sort of ritual will work best for you.  Sharing it with another person can serve a dual purpose. It can both hold you accountable to do it every day, and also you get the double benefit of your own happiness and hearing about the happiness of someone you care about. If you’re the kind of person who prefers being internal and more private in your practice, think about whether writing it down in a journal or on slips of paper that go into a jar might be right for you.  It can be quite affirming and uplifting to review a year’s worth of gratitude and happiness.

So now that we’ve laid the parameters, let’s discuss what you actually do when you sit down.  First, here’s what not  to do.  Never pretend to be grateful for something you don’t authentically feel in that moment.  Gratitude only works when it’s authentic.  So if you don’t actually feel grateful for a roof over your head, don’t worry about it, but also, don’t claim it as a gratitude that day.  Think about what you do feel grateful for. Maybe the light coming through the trees is particularly pretty, or you’re happy you didn’t get stuck in that traffic jam on the other side of the freeway during your commute, or you’re just grateful that this difficult day is almost over and you’ll get to go to bed soon.  If something doesn’t rise to your awareness right away, that’s ok, just relax and see what wants to bubble up.  Gently review the past 24 hours—where did you go, what did you do, with whom did you interact?  There’s likely at least one thing you can find that was nice, or at least, better than the rest of the day.  Even on a bad day, when it’s hard to find something to appreciate, you might find that it was nice that getting your kids to sleep, or finishing up your paperwork, or dealing with a difficulty person in your life, wasn’t quite as bad as you had anticipated. 

You will likely find that, after doing this practice for a while, you will start noticing the good throughout your day and think “this will be a good one to mention tonight/tomorrow morning.”  Noticing what is going well will start to become increasingly automatic, and your effortful observation of one item may start flowing into three or five.

You might not notice the changes right away—like any new habit, it may take a little time for its positive effects to show.  I encourage you to make a commitment to one month of a gratitude practice.  I think you’ll find that it becomes a lovely little sanctuary in your day that you’ll look forward to, and that you’ll start to notice the longer term benefits as well.  Give it a try and let me know how it goes.

Advanced health care directives

I want to talk to you about advanced health care directives. 

Wait, don't go.  Hear me out.  You may think you are too young (or young at heart) to have to think about these topics, but if you are unlikely to get a warning in advance that you or a loved one are about to have a serious health crisis. And if such a crisis emerges, you will need an advanced health care directive which appoints someone to make decisions on your behalf if you are unable to do so, and which advises that person on your wishes.

 If you are over the age of 21, you need to have a nuanced, fully fleshed out advanced health care directive. If you are over the age of 40, you will need to adjust it further to include instructions in case you eventually have a cognitive impairment such as dementia.

Most of us don't want to even think about the possibility of needing someone to make our health care decisions in the case that we become incapacitated. You may assume that your loved ones know what you want, and that it's unlikely and depressing to discuss, especially if you are young and/or healthy right now.  But let me paint you some pictures of what can happen if you don't have clear written instructions.

Here's one scenario: your beloved father has slowly slipped into Alzheimer's Disease.  He has always told you that he didn't want to be a burden to you.  Now, he cannot clean or feed himself, and you and your sibling are spending several hours a day helping him.  You think that he would want to be in a facility so that his children wouldn't experience him as an emotional and physical burden, but your sibling thinks he meant that you should keep him at home to avoid the financial burden. Because you have no way to find out who is right, you and your sibling are fighting more and you are both stressed by the feeling that you're not doing right by your beloved father.

Here's another scenario: you are in a car accident and have a head injury.  Your family doesn't know what to do.  There is no one explicitly designated as your health care agent, so the hospital asks your family to make decisions on your behalf.  This may include a parent you no longer have a relationship with, a sibling you do not trust, or an estranged (but not officially divorced) spouse. 

And even if you have designated your agent(s), do they know your wishes? Do you? Would your wishes be different if you are thirty or eighty? If you have young children and/or are married and/or are living alone? If you have had a lengthy illness? If your condition is curable? If your prognosis is good or poor? If the treatment was extremely costly? If you would likely have a high risk of being paralyzed or in pain or needing help with your daily activities?

We tend not to have these conversations or even let ourselves consider our wishes in such scary and undesired scenarios.

As someone who helps people through the aftermath of not having their wishes in writing, let me assure you that it is far easier to have a conversation now, rather than to have heartache later. 

Having to guess what your loved one would have wanted while you're going through the stress and emotional upheaval of a crisis is something no one ever wants to do.

And you definitely don't want your loved one to guess wrong about what you would have wanted, or put them through the stress of fighting with other family members about your wishes.

Of course this isn't fun, and many people just don't know where to start.  Happily, this is the easy part. There are forms available on the internet, and they're straightforward and have very clear instructions.  

1. The AARP has free Advanced Health Care directives on their website.  https://www.aarp.org/caregiving/financial-legal/free-printable-advance-directives/

Print out a copy for your location and start filling it out. These forms are fairly basic, simply asking whom you would choose as your health care advocate if you are unable to do so, whether you would want life prolonged or not in end of life circumstances, and whether you'd want your organs donated or not.  You can always add more detail later, but please start with this.

2. Get your document notarized.  Don't skip this step.  Notarization will help your health care agent to feel confident that they are accurately representing your wishes, and will also help them to stand their ground if there are members of your family or inner circle who disagree with their choices on your behalf. 

3. While you've still got momentum, go to this website https://dementia-directive.org/ and print out the dementia directive. Basically, it defines mild, moderate and severe stages of dementia, and it asks you to check which of the four levels of intervention you would want, ranging from palliative care only to any intervention that might extend life. 

Of course, with all these decisions, I strongly encourage you to consult with your legal and medical providers, as well as with your loved ones, to confirm that the choices are right for you and your unique circumstances.  In addition, these topics may bring up emotions or thoughts that might be appropriate to explore with a licensed mental health provider. These are important issues, and they deserve your full attention and appropriate consultation.

I have seen too many people in my office, tormented by the family conflicts, or by the uncertainty of what their loved one would have wanted. Please, whether as a gift to your future self, or to the people who care most about you, take the time, and fill out these forms. 

How to apologize, even when you don't think you did anything wrong

I work a lot with couples, and there are often hurt feelings and pain between them, where both feel like they've been wronged, and they are each waiting for the other to apologize.  When they are asked to apologize, they will often say that they didn't do anything wrong and shouldn't have to apologize.

I often advise people to not wait for the other person to change, but rather to change themselves first. In other words, control what you can control (yourself), rather than another person, who is out of your control. 

If you're willing to take the first step to resolve a conflict between you and another person, here's what I'd suggest.

First, make sure you understand where the other person is coming from. Ask this person to explain the pain to you. Ask clarifying questions if necessary.  Try to restate your understanding of their unhappiness, without agreeing or disagreeing to the premise, and ask if you got it right.  

You might say "You are angry with me because didn't feel like I listened to your concerns, and you think I just pushed my own agenda without taking your opinions seriously," or "You're really lonely and hurt because I don't seem interested in physical intimacy with you."  Then follow your summary with "Did I get that right? Is there anything you'd want to correct or add?"

Do not use this time to tell them why they are not accurately perceiving the situation, defend yourself, tell your side, or do anything besides just clarify your comprehension.

Once you have fully understood their point of view, you can try to offer compassion. Again, you are not agreeing with the accuracy of their perceptions, you are only imagining how they might feel if that's how they experienced the situation. You can probably imagine how painful it can be to feel hurt, sad, angry, lonely, or whatever else the other person is feeling.

Now, once you understand their experience, and have some compassion for their pain, you can apologize.  To be clear, you are not accepting blame, and you are not agreeing with their version of reality.  You are being regretful that someone you care about is suffering as a result of your interactions together.

Here are a few examples of what you might say: "You really felt judged by me yesterday. I'm so sorry you felt so hurt," or "I am so sorry that our fight left you feeling so misunderstood," or "It was never my intention to cause you pain, and I am really regretful that our interactions hurt you so deeply."  

Note that this is not "I'm sorry you feel that way, but..." or "sorry, not sorry." It's also not just giving in and apologizing to make the problem go away.  Both of these approaches rarely bring healing or intimacy, but rather increase the distance and resentment.

I invite you to experiment with this approach in a disagreement you're having with someone who is close to you.  See if you can listen openly, imagine their suffering, and offer sorrow, regret and/or compassion for the pain this person is having.  Give it a try, and let me know how it goes.

Preparing for Medical Appointments

Many people don't have a lot of experience preparing for medical appointments.  If all you've ever done is gone for routine physicals and occasional assistance (mole checks, antibiotics for strep, etc.), you may not know how to best use your limited time with your doctor.

Once you've developed a medical diagnosis that needs to be regularly tracked, however, you might have a lot more doctors appointments. You might be going for second opinions, or to learn your treatment options, and you may have only a few minutes with your treatment provider to help you make very important decisions about your future.

So let me help you think about how to prepare for your appointments so you can make the most of the time you have.  

1) Make a comprehensive written list of questions.  Make three copies. If you need help preparing your questions, brainstorm with friends or family about what they would ask. Questions might include clarification of diagnosis, exploration of potential risks and benefits of possible treatments, prognosis and most likely course of disease, or eligibility for clinical trials.  

2) Bring a companion with you, ideally someone who is not overly emotionally involved. Their job will be to make sure all of your questions get asked, and that all of the answers are documented in a way that you will be able to review later.   They may end up doing very little, or they may end up doing all the question asking on your behalf. They are present as your advocate, and they will be available to step in to do as little or as much as you need.

3) Give a copy of your questions to your doctor when you walk in (or email the questions in advance, and then also provide a printed copy when you come in). Then, your doctor will have a sense of what you want to accomplish during the meeting, and your doctor might also be able to combine answers to multiple questions.

4) Block a significant chunk of time after your appointment to debrief, either with your companion, or with someone else that you care about and trust.  You may have emotional responses to the appointment that you need to process, or you might have missed some of what the doctor said and need to fill in the gaps. 

Doctor visits can be a very useful resource, and I hope these simple guidelines help you as you prepare for your next visit. 

Intimacy and Sex

When I ask couples what they most crave in their relationships, one of the most common responses I receive is for "increased intimacy." It makes sense--as humans, we tend to crave connection, and don't we all want to be closer to our partners?

Yet, when I ask what increased intimacy means to each partner, I don't always get clear answers.  They don't always know what it would look like if their goal for increased intimacy was met. Sometimes, the words sex and intimacy are used interchangeably, but they don't mean the same thing.

Of course, sexual connection matters for many couples.  Even when a partner is complaining about wanting more sexual frequency, if we explore more deeply, we may discover that it's about more than the actual physical engagement. It may be about the total focus on each other without distractions; or about being touched with care (not just sexually); or about feeling valued and desirable; or about stress relief, connection, and so much more.

I often see couples who are mismatched in terms of their desires regarding sexual frequency. They often feel stuck. One wants sex more than the other, so one partner feels frustrated and rejected, while the other partner feels harassed and resentful. But if we look more closely, perhaps there are ways to bridge the gap beyond trying to find some magical compromise regarding how sexual encounters per week/month/year.

The way I think about it, when we talk about sex, we have to widen the focus.  For instance, if Partner A says "I want to have more sex, and my partner never seems interested," we could explore what Partner A values about sex, and what s/he is missing when the frequency of sex is lower than desired.  We could talk about all the needs that sex can gratify, and explore what could also meet those needs. We can also explore what Partner B values about sex and intimacy--what fulfills his/her needs and increases connection? What does s/he like to do--kissing/hugging? intimate conversation? massage and sensual touch? Sex that is initiated by Partner B?

We might also learn about what the requests for sex feel like for both partners. Perhaps there are feelings of unequal power, rejection, guilt, anxiety, or anger. Do those feelings occur in other parts of the relationship? In working through those feelings about sex, we might be able to work through those dynamic patterns in other parts of the relationship. 

Then, if we can find ways in which each partner can get some needs met, and where the communication patterns can be improved, we will also increase goodwill, connection, and intimacy.  With this improvement, we might find that there is more common ground for negotiation about sex than we previously thought.  

Of course, these ideas don't just apply to the therapeutic office. They may also be useful in your own conversations with your partner. I invite you to consider what would happen if you simply asked your own partner what sex means to him/her, beyond the actual physical sensations of the act. You might learn something you didn't know before, and it might open up new ways you can satisfy and fulfill each other, and it may create some movement and openings in conversations about sex that had been stuck. Give it a try, and let me know how it goes. 

How to give and take a really great compliment

When I was in third grade, my teacher taught me that we had to use meaningful adjectives, and certain words were no longer allowed. Generic, vague words like nice, good, and fun were no removed from our lexicon. We had to find words that were more descriptive and rich.

I’d like to invite you to consider that you might want to try giving compliments in this way. Try to avoid the basic platitudes you might give the important people in your life. Don’t tell them they’re a good friend, or a helpful spouse(though that’s not bad), tell them how their specific actions make you feel. You can use the format “when you____________,” I feel _____________.“

Here are some examples: "when you give me a hug, I feel safe and protected,” or “the way you listen to me makes me feel like you really care about me,” or “when I think about how hard you work to take care of our family, it makes me feel grateful.”

We all hunger to be noticed and appreciated, and these types of compliments show that you’ve really paid attention to them, and that you value their specific gifts.

Accepting a compliment can also be challenging for some people. When someone says something kind, we might be tempted to deflect it (“No, you’re the pretty one”) deny it (“I’m not really smart, I just got lucky”) or try to minimize it (”oh it’s no big deal"). Let me make this formula very straightforward. Your only job is to appreciate that they said something kind to you. You don’t have to agree or endorse their opinions, just be appreciative that they thought something nice about you and then cared enough to tell you so.  And don’t be tempted to share the compliment either (“I feel the same way about you!” Or “you’re a really caring friend also!”). 

So you can say “thank you,” or “I appreciate it,” or anything else simple like that, but no more. If you’d like to return the compliment, say your thank you, pause, and then come up with a compliment of your own. It will likely be at least a little different, and will be received with so much more warmth and appreciation than if you just piggyback onto their compliment with a “you too!”

It can be really fun to figure out what you like best about the important people in your life, and it can definitely lead to a positively cascading effect, where you share your appreciation, which may lead the other person to share theirs, and everyone starts to feel more appreciated, which leads to more expressed gratitude and generalized good feeling It also feels so much better to focus on what gives you pleasure than what disappoints you.

Give it a try and let me know how it goes.

For difficult conversations, set your goals and intentions

I think a lot about how to have conversations about difficult topics.  Many people can do it within my office, but it can be really hard to do in the real world.

Here’s a quick tip that can be useful.  Before you enter into the conversation, think about what your goal is for the conversation. Is it to share your feelings? Is it to ask your conversation partner to make a change? Is it build intimacy? We often enter into conversation with unclear and tangled ideas of our purpose, which can really increase the potential for unhelpful conversations.

Once you’ve gotten clear about your goal for the conversation, then set an intention for how you want to behave in this conversation.  Would you like to be brave? Honest? A good listener? Compassionate? Pick one or two descriptions of how you want to be in this conversation. You might even choose to write it down somewhere you can see it while you are in the conversation, so you can remind yourself if you drift away from your plan.

Then, once you have set your goals and intentions, you might choose to share them with your conversation partner.  Here’s an example of how you might do it:

****

You: “I’d like to talk with you about our fight last night.  I’d like to share with you what it felt like for me-would you be open to listening to me? Is now an ok time, or should we pick a different time?”

(partner says ok)

You: “Thanks. I appreciate it.  I want you to know that I’m going to do my best to be forthright, but also to be kind in how I say things. I probably won’t be perfect, but I just want to let you know that’s what I’m trying to do. Is there anything I can support you in how you want to be in this conversation?”

***

My way of speaking may not be your style, so be sure to use your own language and style of speaking. The important thing is to be clear on what you’re trying to do before you open the conversation. When you have a framework for the conversation, I think you’ll be surprised at how much cleaner and more productive the conversation can be.

Forget about the facts--focus on the feelings

Many couples, when they try to tell me about an emotionally charged event, each tell me, with great confidence, completely different stories.  It’s astonishing. I work with bright, honest, perceptive people, and each would swear on their lives that their version of the truth is accurate, and their partner must be inaccurately remembering the event.  They will tell me what they were wearing, where they were standing, how those specific words and tones struck their hearts, and they can get really stuck arguing about whose recollection was correct.

Maybe this has happened to you with a loved one.  Have you ever gotten in a disagreement and ended up fighting about who said what to whom, never actually getting to discuss the actual point of contention?

We know that when emotions rise, our ability to accurately recall data is significantly impaired.  However, even if you’ve read the research studies on this topic, it may still be hard to believe that your confidently-held memory might not be exactly accurate.  

So let me tell you what I suggest.  

Let go of figuring out what actually happened.  It’s not particularly useful information.  Focus on what it felt like for you, and felt like for your partner-that’s what really matters most. Here are some examples of ways you might shift from who said what into connecting around the feelings.

You might say this:  “You know, we are not likely to agree about what happened at the party.  But it seems like you’re feeling really hurt. And maybe that’s more important than figuring out who said what.  Whatever I said, I never meant to hurt you.”

Or, you might say: “I am really angry about what happened between us.  I feel like I remember it correctly, but it seems like you remember it differently.  So regardless of what you said or didn’t say, I am feeling really upset.”

You and your partner may still fall back into insisting that your version of the truth is more accurate, but every time you can catch yourself and return to the conversation about your feelings, you’ll be having a much richer and useful dialogue.  You may still disagree, there may still be strong and painful feelings, but at least your conversation will be on an agreed upon reality (you can’t really argue about how someone feels), and it has potential for shared understanding and the growth of empathy.

"Just like me"-a tool to build empathy in challenging relationships

I do a lot of work with couples, and I notice that a common wish is for increased intimacy. Intimacy is sometimes a code word for sexual and romantic engagement, but often, people are referencing a genuine, heartfelt desire to feel more emotional and relational connection with their partners.

So what do I prescribe? Bubble baths a deux? Romantic weekends away? Sure, those are good, but the real need is to find a deeper and truer connection.  The challenge is to build a feeling of empathy for your partner, when you may be feeling that he or she is the reason that you are feeling so disconnected.

We cannot directly control others' behavior, so I always advise people to look for ways that they can change to create the relationship they want, rather than waiting for their partner to change.  I'd like to share a tool you can use to try to generate an increased sense of compassion and empathy for your partner. I've borrowed it from the meditation world, which has so many useful tools to help us stay calm and connected, even during challenging moments.

I call it "just like me."

First, reflect upon what you want out of a positive relationship. You might want to feel valued, loved, connected, supported, and safe in your relationship.  

Now, try to guess what your partner wants out of a relationship. You might have all kinds of ideas that don't sound quite as nice as your wishes. Maybe you think your partner wants to dominate you, or just wants your paycheck. Maybe you think they don't want to connect to you at all and just want to stare at their phone.

Let me tell you something that may surprise you.  Your partner is just like you.  Your partner wants to feel valued, loved, connected, supported, and safe in your relationship.  I know this because it's what we all want.  All people want to feel valued, loved, connected, supported, and safe.  Sometimes we don't act like it, but we all want it.

So when you're feeling distanced from your partner, think about what you want from the relationship at that moment and remind yourself that "just like me, my partner wants ______." You can use this tool when you're together, or when you're thinking about the relationship.  Just say to yourself "just like me, my partner wants to feel loved," or "just like me, my partner wants to feel connected." You don't have to forgive behavior that you don't like, or explain away past pains. Just acknowledge that just like you, your partner is a person who wants many of the same things as you do.

This can be very hard to do, but if you are able to find moments where you can remind yourself that you and your partner share the same basic needs. It isn't a magic bullet that solves all pain, but it does begin to create tiny moments of increased connection and empathy, and I believe it can be a tool to help rebuild connection in difficult relationships.

Give it a try, and let me know how it goes.

Why bad feelings aren't always bad

When an unpleasant feeling surfaces, most people aren't too happy about it.  It's natural to want to maximize pleasure and minimize pain. You wouldn't leave your hand on a hot stove-you would pull it back as quickly as possible and try to soothe any burns. It can feel the same with unpleasant feelings like sadness, anxiety, anger, shame, or jealousy. 

When these moments do come, they can cause many different reactions.

You might fall into the feeling and be completely absorbed by it- like nothing else in your world exists besides that feeling The feeling may take over your internal world, and all the other parts of you become small or even invisible to you. In doing so, you may also feel like you can't control your reactions (e.g., lashing out in anger, falling into a ruminative funk).

Or, you might try to avoid the feeling. You might attempt to distract yourself with busyness. The internet, TV, books, work, mindless websurfing, and alcohol/drug/food all might be used to try to take the attention away from your suffering.

Or, you might react against the feeling or against the person who is most associated with the feeling. For instance, if your supervisor gave you critical feedback that made you feel ashamed, you might lash out against him/her, whether silently or out loud. If a friend achieves something that you wanted, and you feel envious, you might minimize their accomplishment or push them away.

Unfortunately, while these coping strategies may feel useful in the moment, in that they draw attention away from suffering, they actually do not help you in the longer term. In fact, these strategies often decrease overall well-being and resiliency. It's my experience that when feelings are not acknowledged and/or processed, they can grow and even sometimes morph into what I call the unseen hands that push us around. They become the stories that we tell ourselves-the limits we perceive, the general feelings or irritability, anxiety or malaise. There's the general benefit of listening to ourselves, but there's a secondary and really important learning that can also come when we have an unpleasant feeling--it's information.

An unpleasant feeling can be a signifier that something might require change or attention. It can be an opportunity to improve yourself and make your life easier and more pleasant than it was before. 

Here is a way that I find useful to approach dealing with negative emotions so they can be tools for improvement in your life. These ideas come from teachers like Tara Brach (RAIN method), Chade-Meng Tan (Siberian North Railroad method), as well as from my own experiences helping people work through challenging experiences and feelings.

First, you must notice the negative feelings. It may sound obvious, but it can be very easy to go through daily life, not fully noticing your general sense of discomfort because it's so familiar. You may need to use physical sensations to guide you if it's hard to notice the emotional states. Watch for head or neck aches, digestive problems, clenched jaw, or shallow breathing (obviously, ruling out medical causes of these symptoms and seeking medical care if required). If you observe these symptoms, you might explore if they are signals of some unpleasant feelings or thoughts.

Once you've noticed the feelings (whether physical, mental, or emotional) congratulate yourself for noticing your feelings and treating the feelings (and yourself) with value and importance. That may sound obvious, but it's hard to do.  All people like to be treated like they are seen, worthy, and valued, and most people don't get enough of that feeling--both from themselves and from others. So give yourself a healthy pat on the back for caring enough about yourself to pay attention to your suffering.

Then, as simple as it sounds, pause and breathe. Take at least two slow, full breaths to calm down and get a little space from the sensations.

Now, get curious. Investigate what is happening. Get as interested as you can. Often, we think we know what the feeling is, but we're actually underestimating the complexity of the feelings. You might first notice one feeling, but try to discover what else is in there. Notice thoughts, feelings, and bodily sensations, and, if they change as you observe, notice that too (e.g., "I feel sad, and my throat feels really tight. I feel like everyone is happy except me. Now, I'm starting to also feel envious and a little bit angry at all the other people that seem happier than I am. Now I'm mad at myself for wallowing in feelings...") Take your time in this step. Be as kind and gentle and interested as you can, and try not to assume that you already know. You might discover thoughts or feelings you didn't realize were there.

After you complete your reflection, pause and breathe again, at least two breaths.  And then, this is your moment to learn. Did you learn something about yourself? Was there information in that bad feeling. Do you need to take an action? Is there something you need or want to say to someone (e.g., an apology, letting someone know that they hurt you, clarifying something that you might have misunderstood).? Is there a change you want to make (e.g., is it time to start looking for a new job? Do you want to get help in establishing or eradicating a habit that hurts you?) If you're not ready to take action, do you have ideas about what a future action might be? Even if you're not ready right now, it's good to have a vision of where you would like to get in your future.

**At any point in this process, if you cannot do any more, or need to pause, that's fine. This work sounds simple, but it can be very challenging to change lifelong habits. Even doing the seemingly small act of noticing (e.g., "my teeth are gritted, I think I'm angry about something.") is really useful in building a foundation of being aware and interested in your internal world**

It may feel initially painful to have to spend so much time focusing on a painful feeling or experience. However, as you begin to figure out what the negative experience has to teach you, you may find yourself feeling uplifted or excited by the possibilities for change. By more fully experiencing the problem, you may be able to think more clearly about possible solutions.

Feel the feelings, and then choose your actions

I was sitting next to a child on the plane recently. Our flight had been repeatedly delayed, and after we had finally boarded, we experienced further delays before takeoff. She was becoming increasingly agitated-getting an air sickness bag from the flight attendants, pacing, and talking tearfully with her mother, so I decided to see if I could help her.

I asked her what was wrong, and she said she wasn't nauseous, she was anxious. She said she didn't want to be on the plane, she wanted to be home. I told her I felt the same, and probably most people on the plane did as well. She told me that she was tired of waiting, and again, I agreed that I felt the same. She went through her list of unhappy feelings, and they were all very appropriate feelings- we were in an unpleasant situation, and it's quite understandable to not be happy when your flight is three hours delayed, with no clarity regarding when we would actually get home. She said she thought the plane should be turned around. She said she felt like she couldn't bear how frustrated she felt, and like she had to have relief right now. 

After she told me all of her feelings, and felt like I really understood how bad she felt, we were able to have a really rich conversation about how hard it was to tolerate how bad she felt. She felt like her pain had to be resolved immediately. She couldn't name what would happen if it wasn't resolved, but it felt quite urgent to her, and her anxiety was overwhelming.

So we talked about how it felt unpleasant and inconvenient and uncomfortable for many people on the plane. We talked about how it felt like this misery would last forever, but that it would pass soon enough, and that she would barely be able to remember this miserable feeling tomorrow. We explored if there was anything to be done (if the plane were turned around, she'd just have to go through this process again with a later flight, and many people would be very inconvenienced, including her). Since there was nothing we could do to change the current situation, we decided to talk about other things to pass the time until we were in the air on the way home. We talked about her dance competition, looked at YouTube videos, and chatted with her mother. Soon enough, we were in the air, and she fell asleep almost immediately and slept through the entire flight. Sure enough, when we landed, she barely could remember how bad she had felt before the plane took off.

I tell you this story because I think our experience on the plane is a great example of a common experience. We all have unpleasant feelings, and they probably happen more frequently and more unpredictably than we would like. My flight companion imagined a smooth and quick flight home. She was tired and craving the comforts of home, and probably had already planned out her peaceful evening at home. But sometimes life doesn't match up with our plans. I'd guess you can remember similarly frustrating or painful experiences that have happened to you in the past week. Life can be filled with ups and downs, and our feelings often are similarly volatile. 

When these challenges present themselves, tell yourself the full truth about how you feel, even if it seems unreasonable. For example, you can think "All these cars on the road need to get out of my way! I'm tired of traffic and I'm in a rush! I wish I could drive over all the cars so I could get home." Or "that other person won the prize/deal/promotion that I had really wanted for myself. It's not fair and it should have been mine!"  Your thoughts and feelings do not cause harm, and often just giving yourself permission to feel whatever you feel can release some of the tension. 

Try to be totally free in your mind to think or feel whatever you want.  Treat your thoughts and feelings as really important.  Listen to yourself thoughtfully and compassionately ("Oh, that line was too long and the people in front of you were rude? I'm so sorry that happened to you!" or "Your spouse was short-tempered with you when you needed a hug? That must have been hard!") Do not cut yourself off or talk yourself out of your feelings. Your feelings do not require action, so just try to notice them with interest and care.

Eventually you will notice that you're starting to repeat yourself, or that you have nothing new to say, or even that you are tired of thinking these thoughts.  At that point, you can take a deep breath, and make a choice about what to do next. Just because you feel a certain way doesn't mean you have to act upon it. You might feel hurt, angry, stressed, jealous, or sad. You might want to punch someone in the nose or run away crying. Those are all perfectly fine feelings and desires--but by acknowledging the feeling, you have the freedom to decide if you want to act on it.  And remember--feelings and situations often feel permanent, but often are temporary, so often, the only action required is to wait for it to pass and try to be as calm and patient as you can while you wait.

Quite often, when we give ourselves a little compassion and space to experience our feelings, we decide that the best choice is not to act on our feelings. It might be to take a deep breath; it might be to walk away from a conflictual situation, or to ask for some support from a friend or colleague. You may choose to let someone know that their actions have caused you pain or ask them to clarify the meaning behind their actions towards you. Or you may choose to just wait for the feeling and/or situation to pass, as my traveling companion and I did. If you do decide not to take action at this time, you may choose to explore ways to help provide comfort while you wait-perhaps a nap, deep breathing, chatting with a friend, watching a favorite show or exercising. 

If you do try this process, be patient with yourself. It can be difficult to be compassionate and curious while you're in distress.  After the situation has passed, you can reflect on what worked and what didn't work for you, and how you might modify your approach in future events. I look forward to hearing how it works for you.

Priorities and happiness

I think a lot about self-care.  A lot of people know that they should take care of themselves, but don't know exactly what that means other than some vague images of bubble baths and massages. There's no exact prescription for self-care, because each person's needs and desires are different. However, I can offer some ideas for how anyone can determine their own self-care plan.

First, you have to get to know yourself a little better.  You have to learn about your priorities. There are lots of things in this world that might be enjoyable, but we really want to learn what matters most to you. Take some time and reflect (or talk it through with someone who knows you well)--what would you do with your time if you only had five years, two years, one year, six months left to live? Most people answer these questions with things like: spend more time with family and friends, maybe more time in nature (beach or mountains), maybe more travel, or more artistic expression. There may be also things you haven't experienced yet that you don't want to miss.  Make this list good and long-don't worry about whether you can actually do any of them. Think of what makes you happy, but also what makes you feel fulfilled, what gives your life meaning, when you feel engaged and productive.

Then, really consider if any of these items are available to you. Often we cut off options because they might be difficult, expensive, time-consuming, or inconvenient.  But if you prioritize your well-being, you might be more assertive and creative in making some of those things happen.  Think about the idea of bucket lists--when people know they are dying, they often make the time and space to experience what they have dreamed of--swimming with dolphins, seeing Hamilton live on Broadway, or even gathering their friends and loved ones around them to spend time and enjoy each other. Could you possibly make any of these things happen, on a small or large scale, before you have a limited time to live?

It reminds me of when I was selling a home, and beautified it with landscaping, fresh paint, and fixing all the annoying little things that were broken.  It felt unnecessary to fix while I was still living there, because I didn't need the fixes, but then, after I fixed it, I felt kind of sad that I could have been enjoying these improvements while I was living in the home.

Similarly, why wait until you are running out of time to enjoy the things that might make you happier? You don't have to fly to New York to buy incredibly expensive theater tickets (but if you could, why not?), but do you love live theater? Maybe you might explore local theater, or even participate in theater yourself? If you wish you could go to Tahiti, could you go to your local beach more often? Could you save up for a trip to Tahiti, or fly to another wonderful, less expensive beach, or look for discounts on trips (you can put searches on online travel sites for sales on your desired destinations)? Have you always wanted to write a book? Maybe you can start with a blog, or interview people who have written books to find out what it takes, or start a short story, or take a class on how to write a book. There's always some way you can begin to explore your goal.

In summary, I want you to be happy, and I don't want you to wait. I want you to take extra good care of yourself, like you're important. If you prioritize your happiness, then take the time and interest to figure out what you wish you could do, and then explore how you can begin to add it in small or large ways into your life.

Small changes can make a big difference

I’ve been thinking a lot about all the things I’ve learned in my career about how to help people live the best possible lives. A lot of what we do in therapy is very individualized, but there are also some changes that improve quality of life for most people.  The trick is to make change in the right way.

Often, people approach change in one of two ways. Either they put off the change, because it seems too daunting and they’re too busy (or tired or overwhelmed or hopeless or stuck) to figure out how to implement it; or they dive in whole heartedly with a big change, but then lose momentum when it seems too hard.

Instead, let me propose this idea.  Make a small change.  Pick something really small you can change, and then, make it even smaller. You want to make this proposed change so easy that it’s almost embarrassed by how small it is.  With something so small, it’s easy to commit to it. 

Then, tell someone.  Ask them to join you in it, or ask them to check in with you about it. Many people love to encourage others to be happier and feel better.  Think of someone in your life who wants good things for you, or who is generally helpful. Then ask them to be your partner or helper.

Lastly, commit to this change for thirty days. Because we’ve picked something so easy and small, hopefully, it will be no big deal to try it for a month. After a month of trying something, you’ll have a really good sense of how it works for you, and if you want to keep it, modify it, or throw it out and try something new. (Caveat: If making a commitment for thirty days makes it too hard, then do it for a week. After a week, you can reassess.)

Now that I’ve described how to make a change, let me suggest a few changes that I think are helpful for many people.  Maybe one of them will sound like something you want to try. Or maybe one of these will spark an idea of your own.

1) Pick a time to go to sleep every night and commit to it. Ideally, it’s best to go to bed and wake up at the same time each day, but even picking a consistent bedtime makes a huge difference.

2) Sit in quiet reflection (meditation, prayer, breathing) for five minutes at the start or end of your day. 

3) Reflect on five things you are grateful for at the end of your day (I usually recommend doing it as you drift off to sleep). They can be big or small-it can even be gratitude that a difficult day has ended!

4) Spend ten minutes walking outside every day. While exercise is certainly useful in numerous ways, research suggests that doing so in a natural surrounding improves pleasure, vitality, and self-esteem, and decreases fatigue, tension and depression. 

5) Start each meeting with your own version of a three breath practice (originally learned from Chade Meng-Tan, Google’s Chief Happiness Officer). With the first breath, just notice how the breath feels. With the second breath, find something you can relax in your body. With the third breath, open to the possibility of joy (whatever that means to you).  You can modify this to suit your needs. Or even just take three quiet breaths before each meeting.  

So pick one of these changes to make, or pick one of your own.  Make it something easy, that you’re kind of excited to try.  I’ve found that as people begin to feel a little bit better, they have more energy to add more changes.  So don’t worry if your change seems small–each change makes it that much easier to make the next change.

I’d love to hear what small changes you’ve decided to make, and how it works out for you!

The importance of parking lot conversations

As many of you know, I practice psychotherapy with couples. One theme that I’ve been thinking about recently is how many of my clients have productive, painful, and fearless conversations together in my office, but find it hard to do so outside my office. In the safety of my office, they are respectful and brave, and show impressive capacity to stay with very difficult conversations. Often, the conversations are not quite finished when our session is over, and I encourage them to try to continue the conversation sometime before our next session. After all,  I want my clients to be able to talk through their challenges together without me, and I know that’s what they want too. And yet, these conversations often don’t happen unless they’re in my office.

There are lots of good reasons for this phenomenon, of course. It’s scary to talk about contentious topics, and having an impartial and trained mediator can make it feel safer. Life can get busy, and there often seems like there’s no good time when both parties can sit down together and calmly discuss hard issues. 

What I have noticed is that occasionally, my clients will stand outside my office door, in front of the building, or in front of their cars, continuing their conversations, following our sessions.  They’re able to hold on to the feelings they’re having, they’re able to keep going with the risk-taking and the trust. And even if it’s just for a few minutes, it’s such an important building block to having more and more of these kinds of interactions.

So if you’re in couple’s therapy with me, or with someone else, let me make this humble suggestion.  If you can’t have a big conversation outside of therapy, that’s ok.  You might have good reasons that you’re just not quite ready yet. Building new habits can be hard, so take the opportunity given by your therapy session and practice the skill of taking the conversation out of the therapy room, and bring it with you outside the door, or in the parking lot. Even just a few minutes spent practicing honesty and vulnerability and respectful conversation with your partner will build the capacity to continue having more and more of them.

You might be surprised to find out that the parking lot conversations will build in length or in depth, or that you might have similar, brief conversations the night before therapy or other times throughout your week. Like anything else, new skills take practice, and the best way to do it is little by little, building confidence and experience. 

So, give it a try. Before leaving your couple’s session and rushing off to your next commitment, take a few minutes and keep talking to your partner. Tell your partner the truth, or ask your partner what he or she still wants to say to you. Try to talk and listen (even if just for a few minutes–you can even set a timer for five or ten minutes, so you know it won’t drag on forever) with respect and honesty, and let me know how it goes!

Priorities

Around here, it seems like the most common answer to the question of “how are you?” is “Busy!” followed by a laundry list of the many, many things the person is doing. It can involve professional responsibilities, social engagements, volunteer commitments, athletic involvement and hobbies, but it seems like most of us have schedules that are really, really full to the brim.

Often, these commitments sound fulfilling, interesting, and even fun, and yet it doesn’t seem to make people happy.  All this activity seems to make people feel tired, overstressed, and like they are in constant danger of falling off the back of the treadmill of life.

In addition, it makes it really hard for people to make room for positive changes they’d like to add to their lives. Maybe they’d like to have more time for friendships, or make time to meditate, or exercise more. In addition, it can often get in the way of deepening relationships, like working through conflictual issues with a partner, or spending more time (not just quality time, but quantity too) with their children. 

Those are all very real concerns, but I would even add one more issue that happens when we are very busy. It is very difficult to spend time getting to know ourselves.  Being busy can distract us from our feelings and reactions to how our life is developing.

My sister, who is one of the smartest and busiest people I know, tells me that “we all have the same 24 hours in a day, and we all choose how we want to spend it.” That’s true, and while it sounds simple, it’s actually a very complex and rich concept.  We each have 24 hours in a day, and the way we choose to spend it should reflect our priorities.

Unfortunately, if we really sit down and take a hard look at how we spend our days, we might find out that it doesn’t really reflect current priorities. Often, our time is spent doing things that other people want us to do, or what we think a good person would do, or what feels most urgent, but not necessarily what we would actually choose, if we were trying to build a life from scratch.

I’m not advocating that you should turn your life upside down in order to create your own personal pleasure party, far from it. I understand that there are real life commitments that are serious and real–if you need to work a job you hate in order to pay necessary bills, then that would likely reflect your priorities (making sure necessities are covered).

But many people, if they really stopped and looked at how they spend each day, would be disappointed to see how different it is from what their priorities are.  How much time is spent doing things you don’t like? How much time is frittered away doing things to distract yourself or recover from the hardship of feeling stressed or burdened?

I often use the tool of asking someone “if you knew you had five years left to live, would you change anything?” With five years left, you will likely continue to want to live a productive life (such as employment, creative expression, and/or volunteerism), but also will understand that personal meaning and relationships cannot be postponed.  

In my work, I often work with people who received an unexpected and devastating medical change. When their health status changes (such as dementia, cancer, spinal cord injuries), one of the most challenging and important tasks is to reassess priorities.  Most people find that they had been spending time on things that didn’t matter to them (people they didn’t care for, unrewarding jobs, commitments that were not meaningful), and readjusted their time to reflect it.

But for those people who do not have a big moment force a shift in priorities, it’s easy to let time pass without examining how you spend your time. I am inviting you to take an opportunity to reflect. You can do this in a focused way, by spending a week documenting the usage of your time, or you can do this in a more qualitative way, just noticing how much time you’re spending doing things, and wondering to yourself if you wish you could make changes.  What’s missing? What is there too much of?

You don’t have to make any changes at all. Just noticing is really important.  But you will probably want to change something, and if you do, I advise to make just one small change.  See how it feels to carve out ten minutes a day to meditate, or to not check email after dinner. Do you like it? Does it make you anxious? Was there a priority or meaning that you hadn’t seen before? You might be surprised by how attached we can be to familiar patterns and habits. So be gentle, and try just one small change.  Get used to it, modify it as needed, and once that feels like a stable part of your life, consider making another small change.

It may seem slow, and you may feel impatient–after all you’ve just noticed that your life doesn’t reflect your priorities!  You might want to change everything all at once. Try to take your time with this–you’re actually hypothesizing about who you are and what you want, and then checking out whether your ideas were correct or if they need modifications.

As you keep shifting and adjusting your prioritization, you will keep shifting how you spend your time. Hopefully, if you’re paying attention to how you feel in response to these shifts, you will begin to experience your life as more and more fulfilling.  You may still answer the question of “how are you?” with “busy,” if being busy feels meaningful to you, but it is my hope that you will also say “happy” or “fulfilled” too.

Let me know if you begin to experiment with exploring your priorities and how you spend your time and energy. I’d love to hear what you find out about yourself.