Have you ever felt like the same things keep happening to you in your relationships? Do you have trouble making, or maintaining relaxed, consistent connection with friends, romantic partners, or other loved ones? It’s possible that what feels like a pattern in your relationships really is one, because we tend to see similarities and seek out similar relationships to those we have had in the past, particularly if we have been disappointed in our earliest relationships. If you keep getting stuck in what feels like the same old patterns with people that leave you ultimately feeling disappointed all over again, there is a way out of this cycle.
Children are born dependent upon others and undeveloped, including in the ability to understand and function in relationships with others. The first and most significant influence on our social development comes from our primary caregivers as children. As we grow up, we internalize the way we are treated by our caregivers, as well as the way that our caregivers interact with each other and the world, creating a mental model. This mental model informs us, largely unconsciously, about who we are and how other people are likely to interact with us. Our mental model, although based in a real experience, can be projected onto future relationships, making the present look like the past, even when the present is in reality quite different. For example, if we received a lot of criticism growing up, we may feel criticized at every turn by those we are close to, when in reality we are being given reasonable feedback. Minor mistakes, misunderstandings, or limited availability may seem like fundamental rejection or betrayal.
Sometimes, we may find ourselves drawn to choosing people in our lives who are similar to our mental model, or interacting with people in ways that would influence them to conform to these models. If we have been hurt or disappointed in the past, why would we want to go through this again? On the surface, it doesn’t seem to make sense, however, if we look below the surface, people often repeat painful patterns in their relationships because they had to adapt relationally to a difficult situation and they are not aware of it. In other words, children will do just about anything to try and get as much safety and connection as they can from their caregivers, even if to do so means to act in ways that carry significant costs and are maladaptive in adulthood. People carry what they learned about relating as children into their relationships as adults.
Changing the ways that we relate as an adult is difficult because these adaptations are usually not totally conscious and there is often pain involved in recognizing and letting go of these strategies. The cost of not changing them, however, is continued dissatisfaction and disconnect in one’s relationships. As a therapist, I consider it an important part of my role to help people to identify these patterns in their lives, as they are often major contributors to whatever challenges brought them into therapy in the first place. Psychotherapy can be very effective for doing this kind of work not only because it provides a safe space to explore difficult relational experiences in the past and present, but also because therapy is a relationship and the patterns that one tends to bring to other relationships often are played out with the therapist, where they can be mutually explored curiosity, and compassion. As we become aware of our relational patterns, understand their function and roots, and learn to tolerate the difficult emotions, we start to free ourselves of these patterns; establishing relationships that are more secure, authentic, and pleasurable.
As a therapist, I am much more concerned about a person's experience of depression, rather than the chemical make-up of one's brain. While I am sure that there are differences between the brains of a depressed individual and a non-depressed individual, just as there are brain differences between all differing mental states, it is in the person's experience of depression where we may find a way out of the darkness. When we look at depression, or any other challenging mental state, as some kind of "mental illness" or chemical imbalance, we take the person out of the context of their life and instead of helping that person work their way through this challenge and into a way of experiencing themselves and the world that is powerful, authentic, and alive, we leave them at the mercy of chemistry.
I have worked with many depressed individuals and while each person's struggle with depression is unique, there are some common elements. A common element in the experience of depression is constriction. Constriction can come in many forms: constriction of feeling, constriction in the form of physical tension in the body, constriction in motivation... When depressed, people often lose connection with their sense of joy or pleasure in themselves, others, and the activities of life. Often, there is a sense of inertia, of being held down by a weight and a sense of pointlessness and/or hopelessness. What is the point in doing anything, if one cannot even imagine it being enjoyable or leading to a better life in any way? Another frequent aspect of depression is intrusive negative thoughts - criticizing, deflating, and reminding us of old hurts. In depression, these thoughts overwhelm our mental space, running on loops that seem endless.
To escape the constriction and the rumination, we may employ a variety of strategies: isolating ourselves, sleeping all the time, abusing drugs and/or alcohol, comforting with food, binging on shows, video-games, or porn. These strategies, while understandable and perhaps even relieving in the short-run, don't alleviate the depression in the long-run because they avoid, rather than address, the roots of the constrictions at the heart of depression. To get through depression, one must turn into their experience so that one can reconnect with those aspects of themselves which have become choked-off. Often, the process of reconnecting with one's self involves facing things which may be painful or scary, but doing so is often a key part of freeing one's self from depression and creating a life that is vital and authentic.
Doing combat with depression can be difficult and can have its ups-and-downs, but it does not have to be a lonely battle. A competent therapist can be a powerful ally in the fight against depression, by helping you to untangle yourself from and make sense of your experience, begin to establish more of the life that you want, and develop strategies to help you deal with any sense of overwhelm. In the grip of depression, it may be hard to see a way out, or to even remember what it was like to feel differently, but there is hope. Sometimes, the best way to get out of depression is to find an ally who can help you find your way through by getting more into it.
When we feel anxious, staying with our experience is usually the last thing that we want to do, but practicing doing so even just a little bit on a regular basis can be huge for reducing anxiety in the long run and getting more out of life. Such a practice that many people, with and without anxiety, have found helpful is to do with mindfulness. There are a vast number of ways to practice mindfulness, from formal meditation to simple tricks that you can do just about anywhere, but common to all of them is a striving toward awareness of your experience in the present moment with an attitude of acceptance.
In this case, acceptance does not necessarily mean liking what you notice, rather it means without trying to judge or deny it. Mindfulness also does not mean stopping your thoughts, "rising above", or making anything in your experience go away. Mindfulness is a practice that everyone finds difficult, but many find rewarding; it’s a skill that you practice, attempting again and again to notice your experience in the present moment with acceptance. Some people attribute spiritual and/or religious meaning to mindfulness practice, but this is not necessary, and if you are skeptical, I’d recommend considering the vast empirical research demonstrating the many health and psychological benefits of mindfulness practice, including in the treatment of anxiety.
I’d like to share with you one of my favorite ways to practice mindfulness. What I do is I set an alarm for a predetermined amount of time (so I don’t have to think about how long I have been meditating), I sit on a cushion in a quiet room, staring at a blank spot on the wall and breathing steadily until the timer goes off. While I am sitting like this, my mind may go many places and I may become aware of many things and when I notice that I am getting caught up in something I focus my attention on my posture and my breathing. I do this over and over again throughout my time sitting and while I get practice paying attention to the present moment, I also inevitably notice thoughts, feelings, and sensations that are meaningful to me. Something else that I have noticed since starting this practice a few years ago is that my ability to be more aware of my experiences in the present moment has not only increased when I am sitting, but it has spilled over to other moments in my life, which has led me to a much richer experience overall.
If you struggle with anxiety, or you would just like to have more presence in your life, consider starting a mindfulness practice. The exercise that I described may not be for you, and that’s OK, a Google search will reveal so many different ways to practice mindfulness, there is bound to be some approach that will be a good fit. If you do try mindfulness 1) know that it is hard and everyone struggles to be mindful 2) take it slow, even a little bit of regular practice has long term benefits and there’s no reason to overwhelm yourself and 3) give yourself credit for taking the time to be with yourself and invest in this fruitful skill!
If you have insurance, you may be wondering, how could I possibly benefit by paying out of pocket for therapy? While this perspective is totally understandable – why pay more for something than you have to – there are several benefits to paying out of pocket instead of using insurance for therapy.
Work with the therapist you want. Insurance companies have a limited number of therapists who they will reimburse as “in network” providers, a limited number who will be reimbursed “out of network” at a lower rate, and then some who they will not reimburse at all. Finding the right therapist for you is key to your getting what you want out of therapy and if you are willing to pay out of pocket, then you can choose from a wider ray of potential therapists to work with.
Get the treatment you want. Many insurance plans come with specific guidelines for the types, frequency, and duration of treatment that they will pay for, regardless of your needs and desires as a client. If you are willing to pay out of pocket, you can work with your therapist to determine the kind, frequency, and duration of therapy that makes the most sense for you to achieve your goals.
Work on the issues that you want to work on. Many insurance companies will only pay for treatment of a limited range of pre-defined issues and/or diagnoses. There are near infinite challenges that people can benefit from exploring in therapy, and if you are willing to pay out of pocket, you can address what is truly important to you with your therapist, even if the insurance companies wouldn’t pay for it.
Avoid being labelled. Insurance often requires that clients be given a diagnosis from the DSM (Diagnostic and Statistical Manual) and usually will only fund treatment for a limited number of diagnoses. Many times, the diagnoses which insurance will cover may not fit the person seeking treatment. Additionally, the value of the current diagnostic system in aiding treatment is viewed by many as dubious and at times even detrimental, as there are unfortunately some diagnoses that still carry with them a great deal of stigma and a lack of understanding, even among professionals. When paying out of pocket, no diagnosis is required to be in treatment.
Invest in yourself. When you pay out of pocket, rather than using your insurance, you are making a greater financial investment in yourself. Spending your hard earned money on the difficult and rewarding challenge of personal growth sends a message to yourself that you and your goals matter.
While it is perfectly understandable that saving money by using insurance to pay for therapy is a compelling plus, particularly in these times which can be trying for many economically, there are some limitations to what insurance companies will enable you to do. Because of these limitations, it may be worth considering the positives of paying for therapy out of pocket. When you pay out of pocket, you have the freedom to get the therapy you want, with the therapist you want, while avoiding some of the less than positive requirements of insurance policies. At the same time, when you put your money towards what you really value, you send yourself a powerful message.
There are no bad emotions, though many of us may come to believe that there are. Often if we come to believe that some emotion is bad, it is because growing up the expression of certain emotions was responded to with rejection in one form or another. Society reinforces the notion that certain emotions are bad, for example when we are told to rise above and let go of our anger or when we are hurt and people tell us to get over it already. In men, vulnerability is often shamed as a weakness while women are generally discouraged from expressing their anger in an assertive way.
There are no bad emotions, though some emotions are unpleasant and distressing. It is understandable that we have trouble at times tolerating emotions, that we want them to go away, or that we feel shame for having them because these are the messages about our emotions that we have received from others and discomfort is simply hard to sit with.
Our emotions, much like our physical sensations, are important pieces of information that have something to tell us. When you burn your hand on something hot, the pain is intense and unpleasant, but it serves to protect you by letting you know that continuing to touch the hot surface is bad for your health. Emotions work much the same way, they are responses to our environment meant to help us figure out what supports us and what does not. If a lion is chasing you, fear tells you to get away and if your friend embraces you in a hug, the joy you feel tells you that you are supported and loved.
The examples above demonstrate what happens when our emotions are accurate, but this isn't always the case. Difficult experiences and messages that some emotions are bad distort our emotional system's ability to accurately respond to our environment in the present. We may not notice a reaction when one would make sense because we needed to push certain emotions out of our awareness to be accepted in our social environment. On the other hand, we may have a disproportionately strong emotional reaction to something in the present because it is reminiscent of something distressing that happened to us in the past.
There are no bad emotions, however, there are problematic ways to react to our emotions. When we feel an emotion that we don't like, we may react from that emotion and act in a way that is destructive towards ourselves or others, such as lashing out at someone in anger, avoiding people or activities out of fear, or abusing substances to deal with anxiety. When we are unaware of our emotions or actively work to push them away, we miss an opportunity to find out what they have to tell us about our life in the past and/or the present. If you can take on the challenge of staying with your difficult emotions and opening yourself up to them with curiosity, compassion, and acceptance, you may discover something quite important about yourself, and with this new knowledge become more powerful in choosing the direction of your life.
On a fundamental level, there is no separation between the mind and the body; consciousness is an effect of the brain which is intimately connected to and constantly communicating with the body. What we do with our bodies informs our minds and what we think in our minds informs how we use our bodies. We experience our somatic feelings and emotions in our bodies and don't forget about the wisdom of our "gut" (intuition). However, when we experience trauma, we often attempt to protect ourselves by disconnecting our conscious awareness from the experiences of our bodies.
Trauma involves an event, or set of enduring conditions that overwhelms our ability to cope and one of the ways that we attempt to survive these unbearable experiences is by cutting ourselves off from the feelings of our bodies. We may become disconnected by dissociating, becoming tense, or using drugs. If we learned during traumatic experiences that being aware of and/or using our bodies is dangerous, then we may become frozen and inert and avoid using our bodies in ways that we otherwise would like to. We may become chronically stuck in protective postures that negatively impact our health and reinforce the sense that things are still not OK. In these ways, unprocessed trauma becomes stuck in our bodies.
If we adapted to protect ourselves by disconnecting from the body, then in self-work and therapy we may find ourselves doing the same by unintentionally seeking safety in the intellect. This isn't to say that the intellect isn't an important part of who we are and a vital aspect of how we can heal, however, we can only achieve so much when we engage the intellect alone. When we stay disconnected from our bodies, we are missing a huge part of who we are, cut-off from what it feels like to be us. Incorporating things into our self-work and therapy that help us to re-connect with our bodies is key to allowing us to live in a way that is vital, spontaneous, and integrated.
In addition to re-connecting with our bodies, re-claiming them is an important aspect to healing from trauma. Trauma often involves a lack of control over our bodies, if not an outright violation. By making body-work a conscious part of our healing process, we can begin to change our relationship to our bodies; making autonomous choices with and experiencing efficacy through them. Having personal control over and experiencing efficacy with your body are vital elements of incorporating the body into the healing process and living as a whole human being. There are many different ways to engage the body in our healing process, such as mindfulness, breathing exercises, yoga, and a plethora of body-based therapeutic interventions.
At one time, we may have needed to disconnect from our bodies, because not doing so was unsafe or too overwhelming, and it served us well to adapt in that way. We may still find ourselves avoiding our bodies even during our self-work and therapy, by staying in the safer-seeming zone of our cognitive worlds. Once we are safe, and the overwhelming event(s) is(are) no longer happening, we may not be able to really understand that safety, and feel it in our very bones, by the will of our intellect alone. If we can find a way to engage our body, to experience it more fully, and to sense how we can control it and use it to effect our world, we can truly exist in the world in a more fundamental way.