It's not the river, it's your boat

Dateline, Portland, Oregon, June 4, 2019: “Life is like a river, and we are like a boat on the river.” Pritam

Many years ago, I saw a young woman in therapy who was having difficulty feeling it was okay to wrap up our work together. “How can I leave when things still happen?” she worried. “Of course things happen, you are a living, breathing human being. It is the nature of life—things happen all the time,” I replied. “It’s not that stuff happens, it’s how you respond that’s changed.”

This moment in time came back to me last semester in my classroom. I was talking with my students about resilience, and about how the task of therapy is not to create a patient, rather it is to help a person develop skills to take into their world.

And I recalled what I told my patient so many years ago: If you think of life as a river, then you might consider how rivers change. Rivers have beautiful and tranquil spots you may never want to leave, they have eddies you might feel you’ll never find your way out of. There are rapids and the occasional harrowing waterfall. And sometimes a big rain comes along and changes the course of your river entirely.

The fact is, while we don’t have control over every aspect of the river we navigate, we can alter the nature of the boat we are in. And I believe the skills gained in therapy are skills that help us build stronger, more water-worthy vessels. These skills—anxiety management tools, effective methods for distress tolerance, the development of our capacity to mindfully and compassionately observe ourselves in action and consider the choices we are making, to name a few—fundamentally alter how we navigate our personal rivers.

When we have new tools at our disposal, life challenges don’t melt away. We still have times of anxiety, periods of doubt and the occasional dark night of the soul. The difference is, we manage these things in new ways.

I wrapped up my talk in class by reminding students that if someone’s goal for going to therapy is to never feel anxious or sad or angry again, then they are bound to be disappointed. Our feelings are an evolutionary necessity. Each of them, the comfortable and the uncomfortable, serves a purpose in life, and room inside of us must be made for that purpose. In essence, we benefit from crafting vessels that can carry us through clear waters and support us as we navigate those time when the waters are rocky.

My patient finished the journey of therapy with a new understanding of herself and resiliency skills that helped her navigate inevitable life challenges in new ways. If you are considering how you might benefit from such a journey, feel free to call em at 503-490-5793.

When you can't count on sleep

Dateline, Portland, Oregon: We sleep to dream. We sleep to refresh and we sleep to unwind. When we can’t count on sleep, it colors every aspect of our lives.

I answer my office phone, and on the other end of the line is another person struggling with sleep. They are at their wit’s end, not sure where to turn. Medications aren’t cutting it. Their own attempts to solve the problem may well be making things worse. The sleep study is scheduled, and they are, to put it in stark terms, scared to climb into bed tonight.

Nighttime sleep may have been biologically intended to keep us from wandering in to danger in eons past, but it has always served other purposes as well. In short, there are many reasons why we feel better after a good night’s sleep. During sleep glial cells in our brains clean out the debris of the day. We also consolidate new information, storing it in our long-term memory. Dreams help us sort out our thoughts and feelings. Sleep helps us regulate mood and the intricate chemistry of our bodies. Many people find that they wake after a good night’s sleep with solutions to thorny problems.

Insomnia makes it impossible for people to go to bed at the end of the day and trust that nature will take its course. As a consequence, those with insomnia often become conditioned to experience their beds as negative and unpleasant spaces, and bedtime as highly anxiety provoking. CBI-I helps turn these automatic reactions around so bedtime can be a pleasant experience again.

When I work with a new sleep patient, I generally assure them that somewhere along the way they will come to hate me. It’s a joke. And it’s not a joke. Part of what therapists who work with insomnia do is help their patients tolerate sleep debt. Sleep debt is a patient’s friend, but for many with insomnia sleep debt is an antecedent to a variety of negative thoughts and beliefs, and consequently some less than helpful behaviors.

Insomnia therapy can help people view their bedtime routine with clarity. It provides an opportunity to objectively review what helps and what doesn’t help you get the rest you need. For example, you may not want to believe that the blue range light emitted from your phone or tablet causes you problems, and maybe you are right. The CBT-I protocol will help us know--and we will work together to decide what to do with that information.

Feel free to call me if you are wondering whether CBT-I might help with your disrupted sleep. I would be happy to tell you a little bit about the ways in which insomnia treatment might be helpful to you. I can be reached at 503-490-5793.

What we get from forgiveness

Dateline: Portland, Oregon. Forgiveness is a skill worth cultivating. Do you have a grudge, past hurt or an ax to grind? Consider the following.

Why are the words “I am sorry” for some, the three most difficult words in the English language? Today I am thinking about the role of forgiveness, and why forgiving can be equally as difficult, and every bit as important as apologizing. Here are some common questions about holding a grudge or past hurt.

Is forgiving telling someone what they did is okay with me? Forgiveness ideally comes when the person who has hurt you acknowledges the impact of their behavior and the pain they have caused you. It is not telling them what they did was okay and hoping for the best, rather it is an opportunity to acknowledge pain and reset expectations.

What happens if I need to let go of something when the person who has hurt me has not or cannot apologize? I walk through this process again and again in my practice. People carry the burden of anger and disappointment, often for years. They struggle with how to let go when people have gone from their lives—the deceased parent, the high school bully who somehow still holds power, the former spouse.

And it can be more difficult when the transgressor is present and unwilling or unable to acknowledge their behavior. This can set up a pattern of hurtful behavior followed by apology followed by more hurtful behavior—a kind of Groundhog Day scenario some people are all too familiar with. Therapy can help dislodge maladaptive patterns in a couple or family, or can help an individual examine their approach to difficult relationships.

Some people think of therapy as an archaeological dig focused on finding who to blame for what. But that is not the goal. The true goal of treatment is to learn our strengths, develop new skills and figure out what ails us. Then we use our strengths and skills to find solutions to those things. Blame is not a solution. Blame can sometimes stick us firmly to a difficult past.

When you think about forgiveness and blame, it is important to consider whether choosing not to forgive might be your way of hanging on to the past. And returning to those with whom you share a cycle of anger and blame may be a sign of many things, including the belief that this is what you deserve out of life. If you are caught in a cycle of anger and blame with someone who is important to you, it is worth considering the implications of anger, blame and resentment on your emotional and physical health.  It can help to remember you have plenty to gain from letting go. In other words, there are health advantages to finding your way to forgiveness.

What are the health implications associated with holding a grudge? Allowing negative experiences to overshadow more positive life events is not uncommon, in fact we are biologically predisposed to focus on the negative, a survival skill brought to us by our pre-ancestors. But doing so may short change us in a variety of ways, and may be implicated in many ailments including depression and hypertension. For example, vanOyen Witvliet found that ruminating on those who have wronged us causes elevated blood pressure and a variety of physical markers of stress, while actively trying to think of empathy toward a transgressor reduces these markers. And Luskin (2002) writes that active hope and gratitude, educating the self, and thinking about the future can redirect you toward forgiveness.

There is good evidence to suggest we can change ourselves by forgiving others—in fact, it helps many people forgive when they know the goal is not to change the other person, but to improve the quality of their own life.

Luskin, F. (2002) Forgive for Good: A Proven Prescription for Health and Happiness. Harper Collins.

Four Components of Effective Apologies

Dateline, Portland, Oregon: For many people, ‘I am sorry” are the most difficult three words in the English language. Why?

Each of us hurts other people from time to time. Each of us has things to apologize for, and the ability to apologize well is a critical skill in life. Unfortunately, we often falter in our resolve to take responsibility for our actions. For most of us, learning the essential components of a good apology can pave the way to making this difficult task a little easier.

Research by Lewicki, Ploin and Lount (2016) suggests there are several important components of an apology, one that makes it clear we are taking responsibility for our actions, and that we care about the impact of our behavior on the person we are apologizing to. These researchers found that the most important qualities in an effective apology include acceptance of responsibility and an offer of repair. There are other qualities present in apology—these essentially assure we express our clear understanding of what went wrong, and make it clear we are sorry for our behavior. Interestingly, the researchers found the least important factor in a good apology is a request for forgiveness. In my judgment, this is because asking for forgiveness is a request centered on making ourselves feel better, which is not the goal of a sincere apology.

The following tool may help you the next time you need to organize your thoughts around an apology. If this is a problem for you, practicing with a friend, loved one or a professional can often be helpful. Doing so may provide important feedback on the clarity and sincerity of your message. You may choose to apologize in person, but sometimes a letter will be less uncomfortable. Keep in mind, though, direct communication can be much more powerful in clearing the air, so following up a letter with an offer to get together and talk is generally a good idea.

The components of a complete apology include: (the critical two are in italics)
1. Acknowledgement: Take responsibility for your actions and the way in which your behavior harmed the other. “I understand I hurt you by telling Cindy news you gave me in confidence.”
2. Explanation: Make it clear it was not your intent to harm the other person, and that it will not happen again. “I never meant to hurt you, and I will never do such a thing again.”
3. Express Remorse: Express how you feel about your transgression. Shame, embarrassment and humiliation are all common, and though it may be difficult to make yourself vulnerable by acknowledging them, doing so helps the person you hurt understand how seriously you take your behavior. “I feel terrible about gossiping, and am ashamed of my behavior.”
4. Make Amends: Taking responsibility for your behavior requires you to acknowledge its impact—and offering to repair. But it is critical to find out if the person you are apologizing to wants this, and to learn what a reparation may look like to them. To restore relationships, one must be acting in the interests of the other, not in the interest of alleviating our own guilt.

Rather than a vague statement of remorse, the primary goal of an effective apology is to take full responsibility for a specific event or transgression. If apologies are somewhat difficult for you, you are not alone. Acknowledging disappointment in yourself and the impact of your behavior is hard. Sometimes this is because of a deep-seated sense of shame that may have nothing to do with the present circumstance. I often remind my clients that our emotions do not know time—and because of this, it is easy to mistake feelings from the past for feelings about the present. If you think this may be true for you, it can be helpful to talk with a psychotherapist. Please feel free to call me if you would like to know more about how that might be of use in your life. I can be reached at 503-490-5793.

When your college student comes home for break

When your college student comes home for break

Many of you have recently experienced the second college rite of passage with your teen—their first visit home. And you may be looking forward to spring break now. How can you make this a positive experience for everyone?

Know they will be more independent: When my daughter arrived home for the first time, her greatest concern after our joyous reunion at the airport and a lunch date was how to squeeze visits in with a host of old friends, each of whom also had busy and demanding schedules. She spent the first afternoon settling into her room, and by the time evening rolled around it was clear she was itching to get out of Dodge for a while. It’s understandable—she’d been on her own for over three months, and she wanted and deserved to see her old world from the vantage point of her budding independence. Was there a perfect answer to this tension—nope. But we all knew she needed to get out and try her wings at home, and so off she went. The best solution—her friends often found their way to our kitchen so when I arrived home from work, it was to the happy chaos of people who loved each other’s company.

Recognize that everyone is dreaming of a perfect reunion—and that there is no such thing: Visits home are often around holidays, and because of this they can accidentally get wrapped up in the expectations of perfection that many holiday-makers have. The perfect Latkes, the best Christmas tree ever—whatever your holiday is, know this will be a potential pitfall. So, remember that decorating the tree is not about making perfect memories, it is actually a vehicle for having a bit of time together right now. And if your teen is grumpy about the thought of family time, know they are likely struggling with the same concerns you are—but with an added stress. Decorating the tree reminds everyone of Christmas past, and those memories may make your newly independent teen feel uncomfortably childlike.

Consider setting boundaries and expectations in advance—it may save some challenges in the moment: One family I know wrote a letter to their college freshman in advance of her first visit home. That letter covered many things—how proud of her they were that she was working hard, playing well and embracing this new stage of her life, and how impressed they were with how she was handling her budding independence. Sandwiched in between all the praise was a question—how shall we all handle being back together under the same roof again?

This provided an opportunity for the family to talk about transitions, hopes and dreams. Their daughter shared her concern that being home would be “like being in high school again.” When they unpacked what this meant to her, they learned she was fearful of curfews, rules and expectations that might make her feel guilty about leaving her parents alone. She worried she would somehow disappoint them by wanting to be with her other people much of the time.

This started a great conversation—and an opportunity to clarify family expectations. Planning was not about disappointing or not disappointing parents, rather it was an opportunity to sort out how a bunch of adults and budding adults can respectfully share life under the same roof. Sure, mom and dad were looking forward to Scrabble in front of the fire, but not for hours on end! And the expectation of keeping reasonable hours was not about trust—their daughter had earned their trust and then some. Instead, it was about managing a teenaged vacation schedule around the schedules of busy professionals. If she were to come in at 2:00 am routinely, that would disrupt the sleep of people who were accustomed to arising at 6:00. Seen from that perspective, it made much more sense to her that a conversation was warranted.

Rest assured, there will be bumps along the way: It is inevitable that your teen will chafe at feeling his or her wings have been clipped. And frankly, so might you! If this college transition has gone well, there has been growth all around. Particularly if this is your last child at home, you may find yourself excited at the prospect of a visit, and somewhat concerned about the limits having a kid home again will set on your time. This is natural—it doesn’t make you a bad parent!

 So my advice as you anticipate an airport reunion and weeks under the same roof is to stay flexible, celebrate growth and remember that your goal is to snatch time here and there with your young adult.