A major part of therapy is increasing your awareness, not just of your surroundings and other people, but also of yourself. Self-awareness is a process centered on gaining insight into how your thoughts and feelings impact you, others, and relationships. In this post I want to take a tangible turn and focus on listening to your body, literally.

The idea of becoming more aware of your physical experience and signals is grounded in the mindfulness process. I’ll write more about that at a later time but if you are interested, just do a quick search of mindfulness.

It’s my belief that the majority of mental health issues come down to a combination of feeling depressed, anxious, or both and struggling with how to cope with these feelings. This is a gross simplification, but in the end most conditions have an anxious or depressed underpinning. I often ask patients how you know you are depressed, anxious, or both. How do you know? Most describe an event (or many) that explains a change in their emotions and behaviors. This is an appropriate response, but it usually doesn't include a description of how their body is reacting during times of duress.

About those body signals. I start with fairly easy, straightforward questions. How do you know you are hungry or thirsty? How do you know you are hot? The answers are obvious: stomach growls, throat is dry, you sweat or feel warm. The same rationale applies to depression and anxiety or any emotion for that matter. Your body almost always tells you when you are happy, sad, angry, etc.

Even when feeling depressed your body sends you signals. Common symptoms include but are not limited to lack of energy, somatic complaints (aches and pains), decreased appetite, and tears from eyes (also known as crying). As for cognitive issues, symptoms include poor concentration, negativistic thinking, and memory problems.

For anxiety, common cognitive symptoms include but are not limited to excessive worrying, difficulty concentrating, and attention issues. Physical symptoms include sweating, tremors and shakes, chest pain, fatigue, and nausea.

Increase your body awareness when in an emotional state. Specifically, ask yourself what is physically happening when you are happy, sad, etc. Making connections between bodily cues and emotions will lead to an improved quality of life. For example, if you know you have trouble paying attention when anxious, by identifying the anxiety you can then intervene with relaxation techniques before the anxiety impacts your thinking. If you have unhealthy conversations when feeling hurt, recognizing your emotions will assist you in coping with your hurt feelings until you are in a psychological state where you can have a healthy conversation.

A good exercise is to reflect on the lowest and highest moments of your day (or any memorable experience), how you felt, and what if anything was happening with your body. As you do this more often, you will become efficient in identifying the body-emotion connections. Soon you’ll be able to recognize how you feel during that emotional experience instead of afterwards. I’ll write much more about how to become more mindful of your body and experience in the coming weeks.

As usual, feel free to share via facebook, twitter, etc. Comments are welcomed!

First of all, it’s not common for patients to add me on facebook. However, it happens enough that I feel a need to comment on it. There is nothing special about me, and it’s actually natural and sensible to add someone that you are associated with, even if it is only for correspondence.

With that said, I can’t be your facebook friend for primarily one reason: it’s a boundary issue. Some might be thinking, “Calm down, it’s only facebook, it’s not a big deal.” This isn’t about being a clinical psychologist and not sharing personal things with the patient. This isn’t about me wanting to keep patients from seeing that I’m a passionate Tennessee alum (go Vols!). It’s about you, and why you are seeking out therapy. Let me say more.

The vast majority of patients seek my services because there have been boundary issues in their lives, past and present. What’s a boundary issue? It can be many things: from being in an abusive relationship to always doing whatever your partner/friends want to do on a night out. It can be parents treating you like a child when you are in your 30s and beyond. It can be your boss putting inappropriate work demands on you. Lastly, it can be boundaries within you; whether it’s poor eating habits or making the same unhealthy life decisions time and time again. Poor boundaries lead to mental health issues like depression and anxiety.

Therapy is your space to improve yourself. One of the ways to work on yourself is to have an appropriate, healthy relationship with your therapist. This type of relationship is defined by mutual respect and honesty. A hallmark of respect and honesty is to have potentially uncomfortable conversations and still know the other cares and wants what’s best for you.

So yes, it’s uncomfortable to sit with someone and say that we can’t be facebook friends. The degree of discomfort increases when you follow the facebook conversation with the continuation of your session. However, by openly talking about the friend invitation, you learn how to have a difficult conversation and still maintain a strong connection with the person. These conversations strengthen the relationship. You will realize a relationship isn't defined by agreeing all the time.  A healthy relationship is defined by how you connect with one another, not necessarily what connects you.

This all applies to your relationships outside of the therapy room. That uncomfortable conversation actually gives you confidence and strength going into other relationships. If you can have an uncomfortable conversation with your therapist (and survive), then maybe you can have that conversation that you've been meaning to have in other relationships (and survive). Feeling comfortable with uncomfortable conversations will help you define and maintain boundaries in your relationships. Those boundaries are ways of taking care of your needs. In any relationship it’s important to find balance between the needs of each individual.

I can see myself having friendships with the vast majority of my patients. At times, the session has a friendly feel. I am fortunate to have the opportunity to work with unique individuals. Part of my responsibility is taking care of the needs of my patients, even if it means a friendship is confined to moments in my office.

As usual, feel free to share via facebook, twitter, etc. Comments are welcomed! 

When it comes to parenting, I certainly do not have all the answers, but I've learned a few things I wish I knew when expecting our first child. Most everyone congratulates you and says, “You’ll love it!” I had one friend that gave it to me straight, “It’s awesome and amazing, but being a parent is the most challenging thing you’ll ever do.” That conversation helped immensely. Let’s get on with the tips:

1) Read books if you want, but they won’t fully prepare you to be a parent. Go ahead and read books, it’ll help with the anxiety. When it comes down to it, something from within you comes out (no, not the baby) and your natural parenting skills kick in. Books prepare you intellectually, but the parenting experience is a largely emotional one.

2) You are entering the most rewarding and challenging job you’ll ever have. It’s that simple, within minutes you can go from tears of joy to tears of frustration. Parents who previously considered themselves unemotional find themselves wiping away tears when asked about the birth of their child. For the challenging moments, take a step back, get perspective, and get back in there.

3) Accept that you’re going to make mistakes, a lot of mistakes. Parenting definitely fits the “learn on the job” description. No parent is perfect. When you make a mistake, learn from it. When you make that same mistake for the hundredth time, keep learning.

4) The first few months are a blur, just survive and advance. For sports fans, I compare the first few months to March Madness. It doesn't matter if you win by 1 or 30; just make it to the next day. Keep advancing. If you are fortunate enough to have a child that sleeps through the night just weeks after birth, just be happy. Most parents experience sleep deprivation the first few months. It’s part of the game.

You will hear the funniest stories from the first few months. In our case, one morning the alarm went off and I cradled the alarm clock like a baby. My wife appropriately asked what I was doing and I responded with, “Ssshhhh, I think she’ll go back to sleep.”

5) Sleep when your little one sleeps. I can’t emphasize this enough. Your sleep pattern will already be screwy. If you are sleep deprived and your little one takes a nap, take a nap as well. Yes, there are things to do around the house. You will have to decide what's more important, sleep or household chores.

6) Taking a break from your infant doesn’t make you a bad parent. It’s okay to take a break; everyone needs a little time for themselves. As a matter of fact, if you acknowledge that you might need a break, it will make you a better parent in the long run.

7) Welcome help and support from family and friends with open arms. Don’t be a hero. If someone offers to cook a meal or clean the house, take them up on it if you feel you need the support. If family/friends offer to change a diaper, get them to sign a written contract. Then present it to them if they say they were only joking when the time comes for a diaper change. Having legal counsel present at that moment is optional.

8) You’re going to be one of those parents that put up pictures of your baby on facebook all the time. We all do it. Your kid is undoubtedly the cutest baby to ever wear a onesie with a funny message.

9) It’s okay if your child doesn’t eat, they’ll eat later. The baby’s weight will be the focus of many conversations. Just like adults, babies will tell you when they are hungry. It’s okay if he hasn’t fed for a couple of hours, he won’t shrink.

10) Comparisons to other babies are inevitable. Almost all conversations with other parents will start with two questions: 1) What is your baby’s name? 2) How many weeks/months old is he? You will then privately compare your baby to the other. This will happen for about a year, maybe thirty. Try to let that go; all kids mature at their own pace.

11) Once you have a rhythm and schedule, something will happen that will flip your schedule upside down. Just accept it. Learn to go with the flow or your head will explode.

As usual, feel free to share via facebook, twitter, etc. Comments welcomed and thanks for reading!

In last week’s Part I post, I presented a parallel between Newton’s first law of physics and interpersonal relationships: the idea that each social interaction has an impact on our emotional state, and how the emotional impact is a product of the person and the content/delivery of the message. If you missed last week’s post, you can read it HERE.  

In this week’s post, let’s focus on what happens after the emotional impact. That is, what you are thinking and feeling after an emotional experience. The emotional aftermath is usually lost on what happened to cause the aftermath. So think about what happens to you after your parent/boss expresses disappointment in your performance, or when your spouse/family member praises you, or when your favorite TV show is cancelled?

There is no right or wrong answer to any or all of these questions. They may seem rhetorical but it’s worth asking yourself, “How do I feel?” after a situation. It doesn’t have to be a traumatic or highly emotional experience, it can be any experience. Sometimes I encourage patients to emotionally “check-in” with themselves at random times during the day. Why do this?

Good question, well for a few reasons:

1)  You will actually learn about your emotional world. 
     What impacts you, how, and for how long.

2)  Recognizing and identifying your emotions will help in 
    understanding and empathizing with others’ emotions. 
    It’s difficult to empathize or even emotionally connect 
    with others if your own emotional world is unclear.

3)  Introspective questions (e.g., How do I feel?)                    increase self-awareness and help you gain personal          insight. This comes in very handy, especially in              relationships.

4)  Sometimes asking yourself a simple question like     
     “How do I feel?” or “What just happened?” can slow 
     things enough to calm yourself and keep your 
     composure in a stressful situation. Think of how 
     many times you've reacted in a situation and then 
     reflected and wished you had a moment to think 
     before doing or saying what you did.

Gaining insight and awareness into how experiences influence your emotions will allow you to better prepare for similar situations that arise in the future. For example, if you get defensive or flustered during stressful situations, you can practice relaxation techniques when you are entering a stressful period of your life. Increasing self-awareness will allow for you to manage your feelings in a healthy, pro-social manner. So if you are aware that you are feeling defensive or flustered, then you could utilize a strategy that helps you return to a more relaxed, calm state.

How an experience affects you is as important as the experience itself. Everyone is busy, but I encourage you to take time during the day and reflect on the high, low, and average experiences of your day. Tap in to your emotional world; you’ll be glad you did.

As usual, feel free to share via facebook, twitter, etc.

Isaac Newton’s first law states an object is at rest or moves at a constant velocity unless acted upon by a force. The images that come to mind are probably two objects that act toward or upon one another: a baseball and a bat, two cars colliding, swirling your drink with a straw. Here, I’ll lay out how several aspects of the law of motion also apply to interpersonal relationships. 

A relationship is fluid. It evolves, shifts, and changes based on the interactions of the individuals. Relationships can vacillate from strong and sound to weak and tenuous as a result of the actions of one or both individuals. Newton theorized outside factors can impact the relationship between two objects; the same applies to relationships between people.

Thinking about the bat hitting the ball, there are two factors regarding the impact (Force): specifically the size of the bat (mass) and the speed at which the bat is swung (acceleration). Hopefully the F = ma equation came to mind (thanks, Dad). Now applying that equation to a relationship, think of the F as the emotional impact, the m as the person, and the a as the content and delivery of a feeling. The Emotional Impact is the product of a Person and the Feeling Delivered by that person. Emotions are certainly much more complicated than these two variables, but for now let’s keep it simple. I’ll discuss other factors in future posts.

For an illustration of m (the person), think about how you would feel if a loved one praised you compared to someone you had just met. More than likely, the praise from the loved one will have a larger emotional impact. How strongly you feel something is linked to who is delivering the message. In many instances, two different people give the same advice, but you might listen to one and dismiss the other. Why is that? Reflect on that question. Parents are driven batty by teens who ignore a parental suggestion and then respond “Great idea!”, when a friend makes the same suggestion.

As for the delivery and content of the message, a, the analogy I always use is your birthday and receiving a present. If someone presents a nicely wrapped gift with a “happy birthday!”, your experience is going to be different than someone giving you the same gift wrapped in a plastic bag with a “here”. The difference is clear, but it’s not always clear in relationships. In therapy, especially couples and family therapy, a constant theme is how to gift wrap feelings, both negative and positive. Just because the feeling is anger, sadness, or frustration doesn't mean it has to be expressed in a hurtful way.

Newton’s first law of motion focuses on being acted upon; the second part is how the object is affected by the act. I’ll touch on the second part here, and say more in next week’s post.

In relationships, this second stage is largely ignored in everyday life and consequently is a significant part of therapy. How do you respond after an emotionally-charged experience? People are more focused on what happened than on what happened after. Part of a relationship is increasing your emotional awareness. 

A complexity arises as an experience in one relationship can impact (positively or negatively) how you perceive and engage in other relationships. This is very evident in couples and family therapy where you have multiple individuals acting upon one another. I’ll write more about this later, but for now think about the solar system and what would happen if one planet suddenly shifted.

This is what makes relationships fluid and why laws and principles can’t completely capture relationships like it can with the sciences and math. Maybe it was serendipity, but Newton was on to something in regards to interpersonal relationships. Ironically, some psychologists argue that Newton would have been diagnosed with Asperger’s disorder in present day.

As usual, feel free to share. Part II, next week!

James Holmes, Adam Lanza, Tamerlan Tsarnaev. Why do people commit extreme acts? More specifically, why do people commit extreme negative acts? As a society, we aren’t usually concerned with the root causes of altruism, care, or charity. We appreciated, maybe just expected. The altruism research is extensive, but it does not compare to the volumes of research on violence and aggression.

Extremism comes in two forms: behavior (terrorism, crime, cruelty, etc.) and beliefs (morality, politics, attitudes, stereotypes, etc.). Why do people hold such rigid views, why are people constantly committing acts of violence? The vast majority of us are left puzzled and scratching heads when acts of violence are committed. In this post, I’m going to focus on negative behavior as most wonder why people do terrible things.

I haven’t researched every extremist act, but it’s safe to say that there are common themes with most extremists. First, the person has experienced rejection from another, group, or society. Second, there is an overwhelming sense of inadequacy, impotence, and sadness. Third, the individual externalizes personal issues such that blame is placed on the other or world. Next, the extremist loses the capacity for empathy. Lastly, the person goes all in: the extreme belief becomes their identity.

Experience of rejection.  Rejection is where it starts. Almost all high-profile (and low-profile for that matter) cases have some degree of rejection. Feeling out of place, being bullied, social isolation, trouble in relationships, and personal (academic, occupational, social) failures are all forms of rejection. Now of course every person has experienced rejection, everyone. This is just one of the components of the process. However, it is rare to see extremists who are successful, happy, and integrated in society.

Overwhelming feelings of inadequacy, impotence, and sadness.  These are common feelings after an experience of rejection. Rejection represents not being good enough, being unimportant, and unworthy. This is the perception of the rejected, not necessarily the intent of the rejector (though sometimes it is). 

So how does one go from feelings of worthlessness and sadness to extreme, violent behavior?  I haven’t written extensively about it, but I view anger as the byproduct of sadness. When you are angry or have angered another, usually you or someone else is feeling hurt.  

For example, if someone steals your wallet, you will be angry.  If you take a step back to analyze why you are angry, yes it’s because something was taken from you, but at a deeper level there is a sense of loss. Something of yours was taken away and you no longer have it.  In this example, we are talking about a material object.  Now imagine if a part of you was taken: your confidence, self-esteem, trust, or hope.  That sadness and disappointment can quickly turn to anger and rage.

Externalization.  Most healthy individuals consider multiple aspects of a situation.  If you fail a test, you can externalize the failure by blaming the incompetent teacher or you can internalize the failure and believe you are a student with poor study habits.  In the process of extremism, the individual blames the other, a group, or society as a whole.  Combine that blame with anger, and it’s a dangerous cocktail.

Void of empathy.  This is where it gets scary. Some believe that laws keep order in society. I would argue that our ability to empathize is the fabric of society. Empathy plays a part in any relationship. When empathy is absent, societal and moral codes are compromised. There is now unconcern for members of society and how potential actions can impact other individuals. A person lacking empathy does not consider or care how his actions impact others. Thinking is irrational and rigid; the ability to reason is gone. The extremist dehumanizes others.

Identity.  People are multidimensional. If you ask someone for a self-description you will get a number of identities in a reply: student, family member, spouse, religious affiliation, hobby of choice, musician, etc. Extremists usually have a limited number of identities. All of their chickens are in one basket. They start to believe in a “cause”, and are consumed with the one identity. They may appear to be interested in a number of things, but interest is genuinely dedicated to one or two things. Again, when your viewpoint narrows, your ability to reason and think logically breaks down. When our thinking is compromised, poor choices are made.

The extremists mentioned at the beginning are some of the most notorious of the last few years. It’s important to remember that not all extremists are mass murders or even violent. If you find someone whom you may think fits the profile I have outlined above, think about how to help that person or at least how to think about that person’s extreme views.

As a society, we jump quickly to explain a person’s behavior based on their beliefs, identifying characteristics (e.g., race, age, sex), and even location of residence. I argue there needs to be a shift to a deeper understanding. Questions like, “Why did this person adhere to such a rigid belief system?” and “Why now (instead of years ago)?” are questions that need to be addressed. Considering the context is much more exhausting and time consuming than generalizing, but if we truly want to understand human behavior, it’s necessary.



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