Looking Beyond Labels: Why Diagnoses Don’t Always Help

a woman sitting on a bench in front of a cloudy sky.

Looking Beyond Labels: Why Diagnoses Don’t Always Help

 

If you’ve ever gone to see a therapist or psychiatrist, especially if it’s been covered by your insurance, you’ve likely received a mental health diagnosis. This type of diagnosis is derived from The Diagnostic and Statistical Manual of Mental Disorders, or DSM. The manual, currently in its 5th edition, is intended to be a means by which mental health professionals can assess an individual’s functioning based on predetermined criteria that are decided upon by a council of medical and mental health professionals. At its best, the DSM offers professionals a way to understand their patients’ needs more clearly, in order to provide targeted and effective clinical care. But the truth is, this diagnostic system often doesn’t function at its best. 

 

Realistically speaking, every diagnosis in the DSM is a snapshot of normal human behavior at a certain degree of intensity and duration. Take Major Depressive Disorder, for example. To meet criteria, a person needs to exhibit at least 5 of 7 specific symptoms over the course of at least 2 weeks. These symptoms include insomnia, depressed mood, loss of interest or pleasure in most activities, poor concentration, and changes in appetite. The truth is, most of us have, at some point or another in our lives, exhibited these “symptoms.” Sure, we may not all go through several of those things at once, or for as long a period of time; but what’s described by that diagnosis is well within the spectrum of the typical human experience. 

 

What tends to happen far too often is that diagnoses become labels that serve as markers of identity. Professionals, if they aren’t mindful, think of their patients as disorders rather than people. They focus so much on symptoms and criteria that they fail to see the unique, dynamic, multidimensional human being in front of them. They fail to consider important and highly relevant factors such as context, culture, and environment; and, most unfortunately, they assume their patients’ experience and needs, rather than being curious about them. For people on the receiving end of these diagnoses, getting labeled as “depressed,” “anxious,” “bipolar,” “ADHD” or “borderline” can feel stigmatizing and damning. It’s not to say that people aren’t helped by getting a clear diagnosis; it can certainly be relieving to put a label on what you’ve been experiencing. But when that label starts to dictate how you see yourself and what you believe to be possible for your life, it’s a problem. 

 

At Evergreen, we take a non-pathologizing approach to therapy. This means that, though we’re knowledgeable about the DSM and have a firm understanding of diagnostic criteria, this isn’t what we lead with in our work with clients. We believe that each person who comes to therapy is a unique individual having a distinctive experience in a specific context. We don’t listen to find out what’s wrong with our clients; we join with them in a state of sincere curiosity about what’s been happening in their lives and what they desire for the future. We listen to identify their strengths and resources, and we collaborate to discover solutions. The way we see it, every diagnosis—just like every part of the human experience—can be broken down into separate pieces. So, instead of working on your depression, we’ll focus on your guilt and explore it in ways that offer clarity and relief. Instead of working on your anxiety disorder, we’ll look at the mental, emotional, and physical dimensions of the anxiety you’ve been experiencing. With that understanding, we’ll collaborate with you to design solutions that will help you feel more grounded and less overwhelmed. Our aim, with each client we meet, is to honor their unique experience and look beyond labels to create new possibilities.

Superego, Take a Seat

The field of psychology has come quite a long way since the time of Sigmund Freud. And though a great deal has changed over time, some of his ideas about human psychology have proved timeless. Take, for example, his model of the human psyche, which consists of three components. First there’s the id, the most primal aspect of ourselves, which contains our most basic instincts. Then there’s the superego, which serves as a moral conscience and operates from a rigid set of constructs about how we should conduct ourselves. Finally, there’s the ego, the reality-based part of ourselves that mediates between the id and superego’s extremes.

While the id is all about fulfilling pleasures and satisfying impulses, the superego drives us toward becoming the most idealized version of ourselves. Our superego is like a strict and rigid parental figure living inside our consciousness; its job is to use morality, pressure, and guilt to get us as close to perfect as possible. And all the while, the ego toggles between the two, trying to create harmony and guide us through life.

I’ve always appreciated the framework Freud laid out; it gives us a way to understand the seemingly disparate parts of ourselves. I, for one, find it incredibly useful to remember that my occasional impulse to dive headfirst into a chocolate cake is not a reflection of who I am, but rather a function of the id that constitutes just one part of me. Similarly, I take great comfort in reminding myself that I don’t need to follow all the demands of my relentless superego. Just as it wouldn’t be socially acceptable (or even safe) to follow the id’s every whim, it also wouldn’t be prudent to put the superego squarely in charge.

See, the superego operates according to a strict set of rules and expectations—a binary set of rights and wrongs, if you will. It deals in extremes and sees things in black and white terms, as either completely good or completely bad. Some of its most commonly used words include should, shouldn’t, must, and can’t. It’s nearly impossible to please. And though it serves a worthy purpose—to maintain our moral nature and keep us working toward a perfected version of ourselves—it can keep us rigid, restricted, and mired in guilt if we aren’t careful.

If you’ve ever worked with me in therapy, you know I’m always on the lookout for the superego’s traps. I commonly catch my clients in superego-driven rigidity and invite them to be more reasonable with themselves. This is not only vital to the therapeutic process, creating valuable space for us to be more flexible and forgiving, it’s also essential to our general wellbeing. It’s unreasonable—and often downright harmful—for us to hold ourselves to an inflexible metric of right and wrong. For starters, there’s ultimately no such thing as right or wrong. Reality is a wholly subjective experience, and each of us defines it differently. We all judge reality, including the rightness and wrongness of things, according to our own personal standards. What for some is acceptable, others find reprehensible.

The superego’s idea that there’s a perfect way to do things is simply unrealistic. More than that, it’s damaging. It sets us up to judge ourselves according to impossible standards and always feel like we’re falling short.

We spend our lives letting our superegos tell us what we should and shouldn’t do; we constantly make ourselves (and others, no doubt) right or wrong about everything. This takes a heavy toll on us. It keeps us from having a clear sense of what we want, since it’s hard to hear the voice of our true selves over the din of the superego’s demands. It prevents us from recognizing how free we are. With the guidance of the thoughtful, integrating ego, we can determine new standards for our behavior. We can think openly and flexibly about how we want to show up in the world, and give ourselves permission to be imperfect.

You can create a lot of powerful change in your life by developing a new relationship with your superego. Whenever you notice it dictating what you should think, say, or do, pause and take a moment to consider other possibilities. For example, if you’re facing a choice between two things, don’t let your superego decide which is right and which is wrong. Instead, explore other standards, and ask yourself different questions. Will what you choose be helpful or unhelpful? Will it have you in or out of alignment with your highest self? Will it be productive or unproductive? Will it promote freedom or constraint for you and the people around you?  Instead of letting your superego dictate what you should or shouldn’t do, ask yourself other, more useful questions. How will doing it make you feel?  How will it affect the people around you? Will it move you closer or further away from the life you most desire?

The more mindful and intentional we are, the more harmony we can create among the various parts of ourselves. We can learn from our instincts and be informed by our internalized rules, without being enslaved by either. We can flow more easily through our lives, trusting ourselves to make decisions that move us toward our highest potential. And, in maintaining this sense of internal harmony and self-awareness, we can let ourselves live both responsibly and freely, with a clear mind and an open heart.

I Don’t Know Any Crazy People

Since becoming a therapist, I’ve lost count of the times I’ve been asked, “What’s it like to spend your day listening to crazy people?” Over time, I’ve learned to be grateful for this question, in spite of the initial reaction it always invites in me. I now see it as a valuable opportunity to share my perspective about my work and what it means to me. The response I give—which never lacks in sincerity, no matter how often I repeat it—is always the same: “Actually, I don’t know any crazy people.”

I mean it.

When I first got on the path toward becoming a therapist, I’ll admit that I believed I was signing on to spend my working hours keeping company with sick and crazy people in need of my help. I believed that with the knowledge I was gaining in school, I was going to have all the answers to teach, guide, and treat the people I encountered in my clinical practice. But as soon as I started working with actual clients, all the thinking that was guiding me got turned on its head. I realized very quickly that the people I was working with had much more to teach me than they could ever learn from me. Above all, the great lesson I learned in that early part of my career was that there’s really no such thing as a crazy person.

For all our many differences, we, humans, are having a shared existential experience; we’re all in this weird and wondrous adventure called life together. Sometimes that adventure gets terrifying; sometimes it’s more painful than we can handle; sometimes we get confused and can’t find our way; sometimes we struggle to connect; sometimes we get tired and need support to keep us going. What I’m getting at is that the stuff we tend to call “sick” and “crazy” is merely a reflection of the struggles inherent in our human existence.

Now, when I sit across from a client, I know that I’m sitting across from an equal. A companion. A teacher. A friend. I know that what they’re sharing—no matter how extreme it might appear from the limited perspective of others—is an expression of something that also lives in me. I acknowledge their pain, see their confusion, make contact with their fear; and as I do, I know that I’m witnessing the realities of life—no more, no less. No matter what my clients share with me, even when it’s radically atypical or marginal by our society’s standards, I hold the space and keep my mind and heart open. Because they aren’t sharing their crazy with me, they’re sharing their world with me. And their world matters. Their perspective matters. Their truth matters. Their lives matter.

My clients are my greatest teachers, and I’m more grateful for them than I can ever express. They show me how to stay curious, stay open, and keeping challenging my certainties. They inspire me to keep leaning in, no matter how scary or painful it can be to witness someone else’s story unfolding. They remind me that truth is always relative, and just because we believe something doesn’t make it true. If these people are crazy, I don’t want to be sane.

What I sometimes add to the response I offer when asked about what it’s like to spend my days with crazy people is that “I can’t imagine myself doing anything else.” And this is really, wholeheartedly my truth. I’ve learned more, expanded more, and challenged myself more through my encounters with clients than through any other experience I’ve had in my life. I’m regularly humbled and consistently awestruck by the work I get to do, and to call it work seems ridiculous, because it’s more of a gift than anything else. I feel fortunate to be in the presence of such giants on a regular basis. Through their vulnerability, their courage, their wisdom, and their grace, my clients teach me how to live. I only wish that everyone could see them, and each other, this way.

If what I’m saying resonates with you in any way, know that don’t have to be a therapist to access the spirit of what I’m sharing. All you have to do is hold space for the people around you, and regard them with curiosity rather than certainty. Challenge your perspectives, and question everything you feel right about. Ask questions, and be present to the answers. Know that everyone on the planet knows at least one thing you don’t. Don’t settle for surface understandings. And never, ever let your heart close.

Meditation and Mental Health—Part 4

It’s time for part four of the five-part series I’ve been exploring on meditation and mental health. So far, I’ve made the case for how meditation can support us by influencing how we relate to our thoughts, our emotions, and the people in our lives. This time, I want to examine the role that meditation plays in supporting our physical health. You see, a healthy body is associated with a healthy mind. That’s because our minds and our bodies are connected; the health of one influences and is influenced by the health of the other. Through our meditation practice, we come to understand and access the mind-body connection in ways that foster and expand our mental health.

One way to define meditation is as a committed practice of transforming the mind and connecting with the body. Through the practice, we learn to consciously follow the bridge of our breath, guiding our attention into the body and connecting with ourselves. Every time we find ourselves getting distracted or lost in our thoughts, we come back into our bodies and anchor our attention in the present moment. This not only serves us during our formal practice, it also aids us in every other area of our lives. Because the more practiced we are at bridging the connection between mind and body, the more aware of our physical selves we become.

With the awareness of meditation practice comes the capacity to mindfully choose how we treat our physical bodies. We start to think more carefully and be more intentional about the foods we eat, the beverages we drink, and the products we put into or onto our bodies. When our bodies are fueled and fortified in ways that support our physical health, we think more clearly, engage in higher levels of productivity, attend to our needs more efficiently, sustain higher levels of energy, and feel more alive. Improved mental health, in this way, becomes a natural byproduct of physical health—and meditation is one way to get us there.

The mindfulness we cultivate through a regular meditation practice gives us the ability to keep an ongoing awareness of our physical bodies. It enables us to be in contact with our hunger cues, so we know when it’s time to eat. It encourages us to eat and drink slowly, so we enjoy the process and realize when we’ve had enough. It let us tune into our intrinsic wisdom, choosing to eat what our bodies need instead of what our minds crave. All of this serves to reinforce the mind-body connection, thereby increasing our self-awareness, self-care, physical wellness, and mental health.

When we learn to connect with the breath and the body, we start to expand what’s physically possible for us. This is something yogis have known for centuries, which is no surprise, considering yoga is ultimately a moving form of meditation. Not only can we reach new levels of physical fitness through the foundations of meditation, we can also become highly intuitive about how we move our bodies. We can listen to the messages our bodies are sending, so we know when it’s time to be active and when it’s time to rest. We know when it’s a good idea to roll on some lavender oil and take an Epsom salt bath, or when a good old doctor’s visit is in order. To be this aware, this connected, requires ongoing attention. It’s a skill that we develop through practice, over time.

One of the coolest things about meditation is that there are endless ways we can use it to support our bodies and sharpen our minds. For example, many swimmers, basketball players, gymnasts, and runners regularly engage in visualization meditation to improve their performance. That’s because studies have shown that athletes who use visualization meditation to imagine themselves performing a certain physical activity improve as much as—or, in some cases, more than—athletes who practice actually performing the activity. How’s that for a testament to the mind-body connection?

Whether your physical health goals include losing weight, overcoming panic attacks, expanding your yoga practice, changing your physique, adopting a cleaner diet, cutting back your alcohol consumption, improving your athletic performance, reducing the intensity of chronic aches and pains, or just generally feeling more connected to your body, meditation practice can support you—and you get to enjoy the fun bonus prize of enhanced mental health!

As long as we’re enjoying this human experience, we’ll do so within the vessels of our beautiful, remarkable, wise, and resilient bodies. It’s a worthy activity, then, to connect with those bodies and treat them with love and respect. Meditation, which gives us entry to the present moment and guides our awareness within, is a gift we give ourselves in the service of our health. I invite you to begin exploring your mind-body connection through meditation, yoga, and any other practices that call to you. And I look forward to coming back to you soon with the final installment of this series!

Meditation and Mental Health – Part 2

a person sitting in a pile of hay.

Hi, everyone. I’m back for the second installment of this five-article series I’ve developed to uncover some of the most valuable ways that meditation can support our mental health. In the last installment, I described how meditation supports the way we relate to our thoughts. (If you missed that article, you can check it out here.) Next, I’ll explore the unique relationship between meditation and emotional health.

As it turns out, meditation and mindfulness can valuably aid us in developing an enhanced relationship with our emotions. They do this in two particular ways. First, they help us learn how to identify rather than identify with our emotions. Second, they help us more effectively regulate our emotions and self-soothe. These are critical skills that, when practiced regularly, can have a meaningful—even life-changing—impact on our emotional health. And it all starts with the fine-tuned awareness that mindfulness and meditation help us cultivate.

As I’ve already mentioned, meditation and mindfulness help us learn how to identify our emotions, rather than identifying with them. This happens as a function of our ability to notice what we’re experiencing in the moment. When we practice meditation and mindfulness, we connect to our experience in the here-and-now, noticing what’s bubbling up within us. We experience our emotions in real time, witnessing their arrival and watching them move through us. This turns out to be a really useful skill—one that can change the way we relate to emotionally charged experiences. You see, research shows that people who can identify their emotions are more capable of coping with them than people who aren’t aware of what they’re feeling. The more understanding we have of our emotional experience, the more effectively we can manage it. When we know what we’re feeling, we’re more capable of being with that feeling and responding to it in ways that support our mental health.

This experience of identifying our emotions is quite different from the experience of identifying with our emotions—something that’s painfully familiar to most of us. Let me use an example to clarify the distinction. Imagine that you’re driving along the highway on your way to work, and another vehicle cuts in front of you unexpectedly. You have to slam on your brakes to avoid a collision, and your treasured morning coffee takes a spill as a result. Instinctively and immediately, anger arises within you. It courses through your body and stirs up a stream of anger-inspired thoughts. You become angry. You are angry. There’s no distinction between the anger and you; you’re identified with the emotion, and it’s taken over your experience. In that moment, your identification with anger might have you react in particular ways. You might curse loudly, scream obscenities, decide that your day is now ruined, or even attempt to seek revenge against the offending driver. With anger in the driver’s seat of your experience, you might say or do a number of things that you might later regret.

When we’re identified with and consumed by an emotion, our thinking is clouded and our actions are limited. We’re in full-on reaction mode, without much consideration for consequences. This is where identifying with our emotions can get dicey—dangerous, even. Where meditation and mindfulness step in and support us is by allowing us to experience our emotions without becoming consumed by them. When we’re present to our in-the-moment experience (a skill we develop through committed and consistent practice), we can lengthen the space between action and reaction. We can deliberately respond to our experiences with a sense of clarity, instead of emotionally reacting based on impulse. When we learn to identify our emotions through meditation and mindfulness, we can notice what we’re feeling, let ourselves experience it, and then intentionally settle ourselves before responding. This challenging practice is remarkably empowering; it can allow us to more masterfully navigate through our lives and manage everything that comes at us.

Meditation and mindfulness have another significant impact on our emotional health: they improve our capacity to manage and regulate what we’re feeling. There’s a common phrase among therapists that you’ve got to feel it to heal it, and there’s a lot of wisdom in that. Denying, resisting, and suppressing emotions is a recipe for disaster. When we refuse to face our emotions, we wreak havoc on our mental, emotional, and physical health. But as I stated earlier, allowing our emotions to consume us is equally unproductive and unhealthy. So how do develop a relationship with our emotions that allows us to feel them without becoming attached to them? Well, that’s where mindfulness and meditation come in. You see, these practices expand our ability to manage our emotions, regulate their expression, and soothe ourselves when we become distressed. But how do they do it?

When we practice meditation and mindfulness, we get present to our experience in the moment. We notice our emotions as they’re coming up, and we allow ourselves to feel them without impulsively reacting to them. We get familiar with the sensations in our bodies associated with certain emotions, and we learn to sit with the discomfort of feeling what we’d rather not feel. This is a remarkably useful practice—one that allows us to more capably manage our emotions. The capacity to self-soothe—in other words, to work through our own difficult emotions and calm ourselves down instead of relying on outside sources (other people, food, substances, etc.) to do it for us—is an important marker of mental health. The more we practice it, the better we become at it; and the better we are at self-soothing, the more capable we are of managing ourselves under even the most difficult of circumstances.

We humans are extraordinarily complex emotional creatures, and our ability to understand what we’re feeling is one of our most adaptive and advantageous features. As you journey through your own meditation and mindfulness practice, consider how you can increase your emotional attunement, thus improving your ability to identify your emotions and self-soothe. Though practice may never make perfect, in this case, it will most certainly boost your mental health and allow you to move through life with more mastery and grace.

I’ll be back soon with the next installment of this five-part series. Be well until then!

Ask a Therapist: How Can I Build My Self-Confidence?

a person's hand holding a green leaf in the woods.

Self-confidence, a cornerstone of personal and professional success, is a theme that comes up often in therapy. Undeniably, the way we feel about ourselves significantly influences how we navigate through our lives. When we lack self-confidence, we have a hard time developing solid, mutually supportive relationships with others and doing what it takes to achieve our goals. It stands to reason, then, that building more self-confidence is a worthwhile pursuit that can support a more fulfilling life. While there are many ways to go about doing this, here are a few that I’ve found to be particularly effective. 

Challenge your self-defeating beliefs. Perhaps unsurprisingly, limiting beliefs are at the core of most self-confidence struggles. From an early age, we all adopt certain beliefs about ourselves that significantly influence how capable and worthy we feel.  Many of us have formed certain self-defeating beliefs that keep us feeling small and limit our capacity to reach our potential. The best way to identify these beliefs is by noticing the thoughts that stem from them. For example, thoughts like, “I never get anything right” or “I’m just not meant to have a healthy, loving relationship” reflect core beliefs about being unworthy or unlovable. Catching belief-derived thoughts and challenging them on the spot is a crucial step in breaking down self-imposed barriers and building more self-confidence.

Pay attention to your surroundings. For a variety of reasons, humans are highly influenced by their environment and the relationships they participate in; and when it comes to self-confidence, this is especially true. If you’re surrounded by people who don’t see or bring out the best in you, you’re not likely to feel good about yourself. On the contrary, it can be incredibly affirming to have relationships with people who hold you to your highest and encourage you to be the best version of yourself. If you think you could stand to feel more confident, look around and make sure your surroundings are supportive.

Prioritize self-care. It’s no secret: When we’re well taken care of, we tend to feel good. And who better to take care of you than you yourself? One of the best ways to boost your self-confidence is to make self-care a priority. Eat foods that nourish your body and give you energy; engage in regular physical exercise to boost your mood; carve out time every week (or every day, if you’re able) to do things you love; pamper yourself in ways that make you feel good about yourself; be intentional about how you spend your time. However you go about it, make sure self-care is an integral part of your routine; because the more cared for you are, the more confident you’ll feel.

Stop comparing. Theodore Roosevelt once famously said that “comparison is the thief of joy.” Well, as it turns out, it’s the thief of self-confidence, too. In our increasingly interconnected world, we get plenty of opportunities to compare ourselves with others and feel like we’re falling short. When we measure what we know about our lives against what we assume about others’, we set ourselves up to feel deflated and defeated. We rob ourselves of the confidence that comes from knowing that we are enough. If you want to build yourself up, spend less time looking around and more time looking within. Base your sense of self-worth on internally designed standards so that nobody else’s appearances or accomplishments can rob you of it.

 Be purpose-driven. Setting and achieving goals is one of the most fulfilling and self-affirming things we can do. There’s something about deciding upon something and seeing it through that builds a sense of self-confidence and self-esteem. Even seemingly small goals, like preparing a meal or making a request at work, can make a big impact. If you’re ready to start feeling better about yourself, start getting intentional about the way you live. Get committed to designing a life that reveals a sense of purpose, and watch your self-confidence soar.

Life can be pretty challenging, but living without self-confidence can make it downright unbearable. If you struggle to feel a sense of self-worth that goes beyond what simple strategies like these can address, reach out to the support that’s available to you. You are worth it.

Ask a Therapist: How Do I Find the Right Therapist for Me?

two glasses of tea with green leaves in them.

In this edition of Ask a Therapist, I’m addressing a question I get asked pretty often. It’s an everyday occurrence for me to receive a phone call or text from someone in my personal network who’s looking for a therapist—and, of course, I regularly have conversations with potential clients of my own. These conversations always center on an essential question: How do I find a therapist who’s a good fit for me? If you’re presently looking for a therapist or think you could benefit from finding one, here are some simple, straightforward steps to get your search moving in the right direction.

1. Start with the end in mind. Therapy doesn’t operate according to a one-size-fits-all model, so it’s important to consider what you want to gain from the experience. Before you start your search, spend some time thinking about what you want to get out of therapy. I recommend doing this by starting with the end of the experience in mind. In other words, imagine that you’ve just completed your last session with your ideal therapist. How will you know that your work with this person had been helpful? What will you be able to do that you struggle to do now? What will be possible for you then that seems impossible for you now? What will be different in your life, and what will you have done in therapy to make that happen? By imagining what you’ll get out of therapy in your best-case-scenario, you can begin to get some ideas about who can best support you in the process.

2. Reflect on what’s most important to you. Many people assume that if they have mental health benefits through their insurance provider, they should start by finding someone who accepts their plan. This is a logical place to start the search process, of course, but it may not lead you to the therapist who’s right for you. If spending as little money as possible on therapy is your primary consideration, then going through your insurance company makes perfect sense. But it may be that other factors are more important to you, like finding someone who has experience working with a particular issue, or working with someone who utilizes a more holistic approach. Think carefully about what matters most to you, and allow that criteria—rather than the cost of services—to guide your search. You can’t put a price on your wellbeing, and your best life is well worth whatever money you’ll spend on your sessions; so before you let your wallet or insurance card make your decision for you, spend some time thinking carefully about what really matters to you. Thoughtfully consider what qualities your ideal therapist will possess. Whether you want someone of a particular gender, age, secondary language, training, location, availability, skill set, theoretical approach, or background experience, there’s someone out there who fits the bill. Get clear about your must-haves, and let these be your guide.

3. Do the research. Once you have a sense of what you want out of therapy and what qualities your ideal therapist will possess, you can begin the actual search process. Therapy is an intimate interpersonal experience, so word-of-mouth referrals and recommendations from people in your network are a good place to start. If you’re comfortable doing so, reach out to people in your life and ask them to share the names of therapists they’ve worked with and would recommend. Start a list of potential therapists based on the responses you get. Then start exploring other avenues, like the Psychology Today online database or even a Google search for therapists or counselors in your area. Keep adding to your list of potential therapists until you’ve got somewhere between 3 and 10 possibilities. Gather as much preliminary information as you can about these therapists, and narrow the list according to the information you gathered in the first two steps of your search process. Use your personal criteria as well as your intuition to come up with the top 3 therapists on your list.

4. Start the audition process. Once you’ve gotten to this point in the process, the trickier, more annoying stuff is out of the way. Now it’s just a matter of picking up the phone! Many of my clients tell me it took them months, sometimes years, to pick up the phone and call me—and they almost always say they wish they’d done it sooner! I know how intimidating it can be to make that first phone call, but if you’ve done the work of generating a list of potential therapists based on your personal search criteria, you’re likely to find that the initial call is a pleasant and encouraging experience. It’s bringing you one step closer to that future you envisioned, where the problems leading you to therapy are no longer problematic! As you carry out this step, remember that you’re essentially auditioning or interviewing your potential therapist. Prepare a short list of questions to ask during your initial phone call, to be sure you’re talking to someone who’s right for you. Make your phone call(s) at a time when you feel relaxed and won’t be interrupted. You want to be as centered and focused as possible, so you can get a sense of whether or not the person is a good fit. Make an appointment with whoever you feel best about, and remember that you don’t have to commit to the process until you’ve found someone who’s right for you.

5. Evaluate honestly. Once you’ve had a session with a therapist (or two, or three, depending on how you choose to go about the audition process), reflect on what you experienced during the session. Did you feel a sense of connection with the therapist? Did he/she show an interest in getting to know you without judging, labeling, or jumping to conclusions? Was the environment somewhere you can feel comfortable accessing deep emotions and getting vulnerable? Did you leave feeling hopeful? Remembering your reasons for seeking therapy in the first place, reflect on your experience and evaluate accordingly. If the session was unpleasant or the therapist wasn’t a god fit, don’t be discouraged! You may not find the therapist who’s right for you on the first go-around, but that doesn’t mean he or she doesn’t exist. Go to the next person on your list, and keep trying. You are worth the effort it takes to find someone who’s right for you—and when you do, you’ll be glad you put in the work and stuck with the process.

Ask a Therapist: How Do I Overcome Fear?

a black and white photo of a woman with her hand over her face.

If you’ve followed my blog for a while, you probably already know that I’ve been working as a therapist for the past 10 years, serving a diversity of clients in a variety of settings. I’ve supported clients in addressing a host of issues, from minor struggles to major life crises. Along the way, I’ve had the opportunity to offer these clients some clarity and understanding about their issues that they can utilize to heal themselves. In hopes of keeping this blog relevant and using it to share practical information, I’ve decided to introduce a new series called Ask A Therapist, in which I’ll pose some of the questions I’ve been asked over the years and offer answers based on my guiding philosophy and therapeutic approach. I’ll start by answering the questions I’m most commonly asked. At the end of each post, I’ll make a request for you to pose questions of your own.

This week, I’m exploring a question I get asked pretty often: How do I overcome fear?

To answer this question, I’ve got to begin by breaking down what fear is and why it exists. Fear is a response to perceived danger or impending threat that occurs in certain types of organisms. In humans, fear manifests as a combination of emotions, thoughts, and physical sensations. Much of what happens when we’re experiencing fear has been hardwired into us for survival purposes. It’s an important response to potential threats in our environment that prepares us to fight, flee, or freeze up in order to stay alive. When we’re in real danger, our fear response enables us to stay alert and proceed with caution. Without it, we’re prey to many things in our environment, with little ability to protect ourselves. But in reality, most of the things that produce a fear response within us are not actual threats to our survival—we just perceive them to be such. This is the kind of fear that most people want to overcome, as experiencing it is unpleasant, at best, and crippling, at worst.

Knowing that there’s a difference between rational fear—the kind we experience when we’re faced with a true and imminent threat to our survival—and irrational fear—the crippling kind we create in our minds—is an important first step. Rational fear is healthy and essential; since we need a little bit of fear to help us act swiftly and protect ourselves, we don’t want to get rid of it. But the irrational fear is the kind we generally want to get past. The crucial first step in doing so is breaking the fear down in your mind. When you’re afraid of something that isn’t posing an imminent threat, it’s largely because of a story you’re telling yourself. For example, if you have a fear of public speaking, you’d begin to overcome that fear by breaking down the fear story you’ve created. It might look something like: “If I give this presentation in front of all these people, I’ll completely choke, everyone will laugh at me, and I’ll never be able to show my face in public again.” Looking closely at this fear story, it’s clear to see how irrational it is. How can you be sure that those things will happen if you speak in public? How likely is it that this story is true? Pretty unlikely. This first step in overcoming this fear, then, would be to break the fear story down and look at it more rationally. Some people do this by asking themselves, “Can I know for sure that the worst-case-scenario I’m creating in my mind will come to pass if I face this fear?” The answer will almost certainly always be “No.” So, then, what comes next?

After you’ve gotten clear about how your mind is working to get you fearful about something irrational and unlikely, you can tell yourself a more rational story and create a plan of action. Continuing with the public speaking example, you would tell yourself the truth—that you’re experiencing fear about something you’re anticipating and making up in your mind—and then create a plan of action for addressing the fear. Here’s where the most important step comes in: To overcome fear, you absolutely must confront whatever it is that’s making you fearful. But in order to not overwhelm yourself, you want to have a plan and do it in a safe way. The best way to do this is to start small, and gradually build up to bigger things. The first bit of movement in the direction of overcoming your public speaking fear would be to create a plan for speaking in front of, say, a couple of your family members, then start working your way up to a more public presentation.

Once you’ve planned for the first action you’ll take to face your fear, you’ll want to start practicing ways to manage the physical symptoms that occur when you’re feeling afraid. The best way to do this is to develop a practice of centered self-awareness and deep breathing. When you confront your first fear-inducing scenario, you’ll likely feel some unpleasant physical sensations. Manage this by learning how to breathe through it, with compassionate awareness of what’s happening in your body. Just because you feel afraid doesn’t mean anything bad is going to happen. Let yourself be with what you’re experiencing, and intentionally send your breath to all the places in your body that are registering fear.

After facing the first item on your fear scenario list, managing the sensations that arise for you in the moment, you’ll inevitably notice that you’ve survived, and that none of the catastrophes your mind made up have come to pass. This will embolden you to take the next step and more confidently confront the next scenario on your list. Repeat the previous steps until you’ve worked your way up to the scenario you’ve been most afraid of facing.

Overcoming fear is possible through simple, actionable steps; but, of course, it isn’t easy. Many people find that working with a therapist can keep them on task and offer them important support through the process. If you’ve been wanting to overcome a certain fear and would like some help, let’s set up a phone consultation to see what possibilities exist. If you want to go about it on your own, here are five steps for you to follow:

1. Break down the fear in your mind.

2. Replace the fear story with a more grounded and rational one.

3. Create a plan for confronting the fear-inducing scenario, starting with something small.

4. Learn and practice ways to manage the physical symptoms of fear.

5. Confront your first scenario and build confidence to work your way up to the one you fear most.

So, there you have it: overcoming fear in a nutshell. Have a question you’d like me to answer? Send it to me in a comment or email, and I’ll answer it in an upcoming post!

Let It Hurt, Let It Heal

a large wave is breaking in the ocean.

On any given day in the US, nearly 700,000 prescriptions are dispensed for pain medications. If this number seems staggering to you, that’s because it is—especially when you consider that rates of opioid addiction and overdose in this country are at an all-time high. What can start as a pill here or there to manage pain can quickly unravel into a debilitating dependence. We don’t tend to (or want to) think about it this way, but many of the people who die from heroin overdoses started out in a doctor’s office. We’ve got a troubling epidemic on our hands in this country, and for the last several years of my career, I’ve been on its harrowing front lines.

I’ve worked with many people suffering from addiction to opioids and other substances; and while I treat each of my clients according to their unique circumstances, I often find that my conversations with them venture into familiar territory. One of the topics that comes up most often when I speak to these clients is a common one that also comes up when I speak to my other, non-addicted clients. That’s because it’s a topic that relates much more to the human experience in general than to the unique experience of becoming an addict.

The topic I’m referring to is pain. Not just physical pain, of course. I’m talking about the pain of everyday living. From momentary sadness to crippling regret; from a broken heart after a breakup to the devastating loss of a close companion. No matter who you are, no matter how fortunate you’ve been, pain is (or surely will be) part of your reality. And the truth is, your mental health and overall capacity to function in your life depend critically on your ability to effectively manage it. When I see the overwhelming numbers of people losing their lives and their loved ones to addiction every day in this country, I can’t help but think about how different things might be if we could all learn more adaptive ways to manage discomfort and cope with the tough stuff. People are suffering—and far too many of them are doing so in an effort to avoid feeling pain.

Though not everyone turns to substances, we all have ways of seeking to numb ourselves and avoid facing the parts of life that feel uncomfortable and unpleasant. We overeat, oversleep, overwork, or otherwise disconnect from our experience in the moment. And, in some ways, this makes sense. Pain avoidance is woven into the fabric of what makes us human, so it’s only natural that we look for ways to make ourselves feel better whenever pain arises. The problem is, instant gratification and immediate relief are terrible long-term strategies. They serve to lower our tolerance to pain so that we’re less equipped (and more afraid) to manage it the next time it comes up. It’s no wonder our society is more obese, addicted, and depressed than ever before. Our efforts to tune out and feel good in the moment only end up harming us in the long-run.

Life transforms dramatically when we learn to let ourselves feel pain. Trust me; I make a living helping people through this process. Many people spend their lives developing strategies—both consciously and unconsciously—to resist and avoid pain. But this is the worst thing we can do with painful emotions once they’ve arisen. The resistance only serves to strengthen the pain, making it harder for us to move through it. Think about how difficult it is to swim upstream. When you resist the current and try to move in the opposite direction of where it’s flowing, you make the journey to your destination much more difficult. You get stuck. You wear yourself out from the effort. When, however, you move in the direction of the current—going with what’s already flowing—you move much more swiftly. This is the way it works with our emotions, too. Though we’re naturally inclined to resist feeling painful emotions like anger, sadness, regret, or loneliness, we can move through them much more quickly and easily when we allow ourselves to feel them—going with the current, so to speak—than when we resist.

Our society compels us to believe that we should always turn that frown upside-down or find the silver lining on every dark cloud. But the truth is, life is as much about the difficulties as it is about the triumphs—as much about the happy feelings as the painful ones. Pain takes on a whole new meaning when we can learn to greet it and keep it company. Once we learn to let it hurt, we’ve taken the first step to letting it heal.

If something hurts for a while, or you experience difficult emotions every time you think about a particular part of your life, it doesn’t mean something’s wrong. Hurting is part of healing, and sometimes the healing process takes longer than we’d want or expect it to. If you find yourself stuck in this process and unsure how to manage it on your own, know that support is available to you. I sometimes think of myself as a tour guide or compassionate companion along the journey through pain; I’d be honored to keep you company. But whether or not you work with someone through this process or go it alone, trust that your efforts to make contact with your pain will lead you down the path toward healing. And not only will you heal, you’ll also strengthen your ability to face life courageously and open-heartedly, knowing you can handle whatever comes your way.

If we choose to see it this way, being in pain can serve as an opportunity for us to be with ourselves, slowing down and tuning in to our experience so we can move through it as gracefully as possible, learning what’s there for us to learn along the way. I invite you to begin the process of letting your painful emotions come and go; allow yourself to flow through them, supported by the knowledge that they will pass, so long as you let them.

The Making of a Mind Master

a silhouette of a bird flying over a palm tree.

In his bestselling book, The Monk Who Sold His Ferrari, author Robin Sharma wisely states: “The mind is a wonderful servant, but a terrible master.” The simple wisdom of these words speaks to the heart of the human experience, for to be human is to be in constant thought. It is to live inside an endless loop of inner chitter chatter about everything that is, was, and ever could be. Without the light of our awareness and the spirit of our conscious intention, we are bound to be the servants of our minds. And most of us know what it feels like to live this way, at the mercy of our own thoughts, consumed by the contents of our minds. But through subtle shifts in attention and the implementation of simple practices, we can enter a new relationship with our minds, becoming their masters and wielding their greatest potential.

Our minds are remarkably powerful, and they’re particularly good at three specific things: storytelling, meaning making, and time traveling. As a therapist and coach, I know all too well how heavily these functions of mind can impact people’s lives. When the mind is the master, the stories it tells, the meanings it makes, and the places it goes can create tremendous suffering. But I also know that while these activities of the mind can be enslaving, they can also serve as the doorways for liberation; they present an opportunity to become the mind’s master.

As storytelling machines, our minds run an ongoing narrative of everything that happens in our lives. The stories they tell us are captivating and distracting, holding our attention and heavily influencing our experience. Our minds can keep us from connecting with the present moment, because instead of attending to what’s happening in that moment, we’re caught up in the stories they tell us—either about what’s happening, or about something else altogether. It’s easy to feel disconnected when the mind is in control; while life unfolds right in front of us, our stories keep us trapped and unable to make contact.

To move from servitude to mastery, we must heighten our awareness of the mind’s propensity for storytelling. Through the development of practices like mindfulness and meditation, we can learn to notice when the stories in our minds are pulling us away from the present moment. The quicker we notice, the quicker and more effectively we can bring our attention back to our experience in the here-and-now. Becoming the master in this way means being more grounded, connected, and present to life.

Our minds are not only great at storytelling, they’re also pretty magnificent meaning-making machines. They interpret everything, filtering information through our personal biases and beliefs, and influencing how we make sense of the world. When we are servants to our minds, the meanings they make can blind and constrict us, keeping us stuck and limiting our perspective. We hold these interpretations—the meaning our minds generate about our experiences—as truths, and we get completely caught up in them. A great example of how this operates is a former client of mine, who came to me after suffering for 30 years from a sense of unworthiness. He shared with me that when he was in the 3rd grade, a couple of boys in his class teased him about his haircut, and a few other kids within earshot laughed along with them. The meaning my client made of that experience was that he was an “unlovable reject,” and he carried that with him throughout the rest of his life, until the point that we met. This example is as common as it is painful; we all know what it’s like to believe what our minds make up about some event or experience, and we know how limiting and damaging that can be.

The shift from servitude to mastery with respect to meaning-making comes with identifying our core beliefs and recognizing the things our minds make up about what we encounter in life. Therapy and coaching are particularly effective ways to develop mind mastery in this area. The more aware we are of the interpretations our minds create—and, most importantly, the ways in which those interpretations affect us—the more we can distinguish the facts from the interpretations, and the less we suffer.

As I mentioned before, our minds are highly sophisticated time-travel machines. At any given moment, we can travel to the near or distant past, the anticipated or imagined future. And while this is, no doubt, a pretty cool thing, it can also get pretty ugly. Because the reality is, our minds let us travel to the past and future, but we have absolutely no control over either one of them. The past is gone, and the future hasn’t happened yet, so dwelling in either one can be an exercise in suffering. When the mind is the master, its time-traveling adventures can cause depression, by dwelling on what’s already happened, and anxiety, by agonizing about what could happen. And that’s not to mention the ways in which all that time-hopping robs us of our ability to be in the present, where life is happening. Many of my clients speak to me about how terrible it can feel when their minds take control and zap them back into an ugly past or zoom them forward into an uncertain future. There’s a reason the Buddha taught so much about being in the present moment; he was wise to the reality that the mind likes to travel, and when it takes us with it, we’re liable to suffer.

To become a master of the mind’s time-traveling nature is to acknowledge that there are some undeniable upsides to this capability. The past is full of rich material; it contains our memories, the lessons we’ve learned, and valuable information that can guide us through life. Thinking about the future can also be advantageous, as we can plan, get excited about upcoming events, and anticipate things on the horizon in order to prepare for them effectively. When we learn how to travel to the past and future with intention and be in the driver’s seat for the voyage, we can use this function of our minds to its greatest capacity and avoiding unnecessary suffering.

The human mind is magnificent. As John Milton so aptly put it, it can “make a heaven of hell, a heal of heaven.” To master the mind is to master life, so why not start moving toward mastery right here and now? As always, I wish you peace and love and am here to keep you company on your journey however it supports you.