Why "Evidence-Based" Therapy is a Straw Man

Misconceptions About Modern Therapeutic Practices

Modern therapeutic practices often face scrutiny and misunderstanding, particularly when it comes to therapy methods and the concept of evidence-based therapy. Many people mistakenly believe that evidence-based therapy is a one-size-fits-all approach, disregarding the nuanced and individualized nature of mental health treatment. This misconception can lead to the erroneous belief that therapies not labeled as "evidence-based" are ineffective or inferior. In reality, the term "evidence-based" is frequently used as a marketing tool rather than a definitive measure of a therapy's efficacy. This oversimplification ignores the complexity of human psychology and the diverse needs of individuals seeking mental health support.

Through large scale studies over decades, it has been observed by researchers that despite the explosion of new methods and diagnostic procedures in therapy, the overall efficacy of psychotherapeutic treatment has not significantly improved (1). In fact, of all factors that impact therapy outcomes, treatment model, technique, or method makes the "smallest percentage size contribution to outcome of any known ingredient," (2). In other words, large scale research suggests that different treatment approaches do not definitively produce better outcomes than others. However, according to Scott D. Miller “Study after study, and studies of studies show that the average client is better off than 80% of untreated sample,” (2).

Limitations of Therapy Labels: A Critical Look at Evidence-Based Practice

The labels used in therapy, particularly "evidence-based practice," often come with significant limitations that can obscure the true efficacy of various therapeutic approaches. While the term "evidence-based practice" suggests a rigorous, scientific foundation, it can also create a misleading hierarchy among therapies. This label may cause individuals to overlook valuable treatments that do not fit neatly into this category but are nonetheless effective for certain conditions or populations. Additionally, the focus on evidence-based therapy can sometimes prioritize short-term outcomes over long-term well-being, neglecting the importance of sustained mental health improvement.

Moreover, the criteria for what constitutes "evidence" can be narrow, often excluding qualitative data and patient experiences that are crucial for understanding the full impact of a therapy. This can result in a skewed perception of what is effective, potentially marginalizing innovative or holistic approaches that do not conform to traditional research methodologies. It is essential to recognize that the therapeutic process is inherently complex and multifaceted, requiring a broader perspective that values both empirical evidence and individual experiences. By critically examining these labels, mental health professionals and patients alike can make more informed decisions that better address the diverse needs of those seeking support.

The Role of Research in Effective Therapy

Research plays a crucial role in developing effective treatments and advancing the field of psychotherapy. It provides a scientific basis for understanding which methods are most beneficial for specific conditions, helping clinicians make informed decisions. However, it is important to recognize that research alone cannot capture the full complexity of human experience and the therapeutic process. While empirical studies offer valuable insights, they often rely on controlled environments that may not reflect real-world scenarios.

Moreover, research can sometimes be influenced by funding sources or publication biases, which may skew the perceived efficacy of certain treatments. This underscores the need for a balanced approach that integrates research findings with clinical expertise and patient preferences. By combining these elements, therapists can tailor their interventions to meet the unique needs of each individual, leading to more personalized and effective care.

Additionally, ongoing research is essential for continually improving therapeutic practices and adapting to new challenges in mental health. It encourages innovation and the development of new techniques that can address emerging issues. Ultimately, the role of research in effective treatment is to provide a foundation of knowledge while remaining flexible and responsive to the evolving landscape of mental health care.

Why Context Matters in Therapeutic Outcomes

Context plays a pivotal role in determining the outcomes of therapeutic interventions. The effectiveness of therapy is not solely dependent on the techniques used but also on the environment in which it is delivered and the unique circumstances of each patient. Factors such as cultural background, socioeconomic status, and personal history can significantly influence how a patient responds to treatment. Ignoring these contextual elements can lead to suboptimal outcomes and a lack of engagement from the patient.

Furthermore, the therapeutic relationship itself is a critical component of successful treatment. Trust, empathy, and mutual understanding between the therapist and patient can greatly enhance the effectiveness of any therapeutic approach. Research has shown that the quality of the therapeutic alliance is often a stronger predictor of positive outcomes than the specific type of therapy used. This highlights the importance of creating a supportive and individualized therapeutic environment.

Additionally, external factors such as family dynamics, social support, and life stressors can impact the progress and sustainability of therapeutic gains. Therapists must consider these elements when designing and implementing treatment plans to ensure they are addressing the whole person, not just the symptoms. By acknowledging and integrating context into therapeutic practice, mental health professionals can provide more comprehensive and effective care, ultimately leading to better long-term outcomes for their patients.

Moving Beyond Simplistic Therapy Debates

The ongoing debates about the superiority of different therapeutic approaches often oversimplify the complexities of mental health treatment. These discussions frequently pit one method against another, creating a false dichotomy that overlooks the multifaceted nature of effective therapy. It is essential to move beyond these simplistic debates and recognize that no single approach holds the key to addressing all mental health issues.

Each therapeutic method has its strengths and limitations, and the effectiveness of any given approach can vary widely depending on the individual and their specific circumstances. For instance, cognitive-behavioral therapy (CBT) may be highly effective for some individuals dealing with anxiety, while others may benefit more from psychodynamic therapy or mindfulness-based interventions. The key is to adopt a flexible, integrative approach that draws on the best practices from various therapeutic models.

Moreover, the focus should shift from arguing about which therapy is superior to understanding how different approaches can complement each other. By fostering collaboration among mental health professionals and encouraging the integration of diverse therapeutic techniques, the field can better serve the complex needs of patients. This holistic perspective acknowledges that mental health is influenced by a myriad of factors, including biological, psychological, and social elements.

Additionally, it is crucial to involve patients in the decision-making process, respecting their preferences and values. Empowering patients to take an active role in their treatment can enhance engagement and improve outcomes. Moving beyond simplistic therapy debates allows for a more nuanced and effective approach to mental health care, ultimately benefiting both practitioners and patients.

(1) Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness. Miller, S.D., Hubble, M.A., & Chow, D. American Psychological Association. (2020).

(2). https://scottdmiller.com/wp-content/uploads/What%20Works%202010.PDF

Why Boundaries Are So Difficult To Practice?

What makes boundaries so difficult to practice in our daily lives? While the concept of boundaries is crucial for mental and emotional well-being, many find it challenging to implement them consistently.

Boundaries are essential for us if we want to experience sustainable mental health and emotional well-being.

Understanding the intricacies of why boundaries pose such a challenge involves examining psychological, social, and cultural factors that deeply influence individual behaviors.

The Importance of Setting Boundaries

Boundaries are fundamental components of healthy relationships, serving as critical markers that define individual limits and mutual respect.

Setting boundaries is not merely a personal pursuit; it’s a necessity that ensures harmony and self-preservation. These defined limits help in maintaining a sense of identity, preventing emotional burnout, and fostering mutual respect in interactions. Without clear boundaries, individuals often find themselves succumbing to unhealthy dynamics.

Moreover, boundaries serve as a protective mechanism against undue stress. By explicitly stating personal limits, individuals can guard against behaviors that overextend them, thereby enhancing both psychological and physical health. The advantages extend to professional environments as well, where defined boundaries help in maintaining productivity and job satisfaction.

However, setting and maintaining boundaries requires practice and courage. It involves articulating needs clearly and confidently, and more significantly, confronting potential resistance or misunderstanding from others. This process, though challenging, is invaluable for personal growth, self-respect, and preserving the quality of relationships.

Cultural Influences on Boundaries

Cultural norms significantly shape how boundaries are perceived and practiced, creating both clarity and conflict around personal limits.

For instance, in more collectivist cultures, the emphasis on community and collective well-being often overrides individual preferences, making it harder for people to establish firm personal boundaries. In such settings, saying "no" is frequently seen as an act of defiance rather than a necessary means of self-care.

Conversely, more individualistic cultures prioritize personal autonomy and self-expression, which can foster a more fluent understanding and practice of setting boundaries. However, even within these cultures, subcultural norms and familial expectations can still pose substantial barriers.

The complexity of cultural influences underscores the necessity for individuals to navigate these social codes thoughtfully and recognize their personal thresholds. As people become more culturally aware, they can better integrate the need for boundaries with their cultural obligations, ultimately leading to healthier interpersonal dynamics. This culturally informed approach can promote a more compassionate and respectful dialogue about personal limits.

Psychological Barriers to Boundaries

Many individuals face significant psychological barriers to setting and maintaining boundaries, stemming from deep-seated fears and insecurities.

They often worry that asserting boundaries will lead to rejection or conflict.

This fear of negative repercussions can be rooted in past experiences, conditioning individuals to prioritize others' needs over their well-being, thereby perpetuating their discomfort.

Moreover, societal expectations and ingrained social roles can make individuals believe it is their duty to comply with others' demands. These internalized beliefs, combined with a lack of "boundary-setting" skills, further complicate the challenge.

Fear of Rejection and Conflict

Fear of rejection and conflict greatly affects boundaries.

People often hesitate to assert their needs out of fear. This fear manifests in worries about facing rejection and the potential for interpersonal conflict, making it challenging to voice personal limits. Consequently, individuals are more likely to acquiesce to others' demands rather than risk jeopardizing their relationships due to perceived insensitivity.

From an evolutionary standpoint, humans are social beings - the innate need for acceptance and belonging makes the prospect of rejection particularly daunting. This primal drive to maintain social harmony often outweighs the necessity of establishing firm boundaries.

Thus, people may find themselves avoiding necessary confrontations, which allows dependency and resentment to build up over time. Understanding this dynamic is crucial for fostering a healthier approach to boundary-setting, where one's emotional and psychological health is prioritized and validated.

Guilt and Obligation

Guilt and obligation significantly impact one's ability to practice boundaries effectively. These feelings often emerge from deep-seated societal and cultural norms that prioritize others' needs and expectations over personal well-being.

Indeed, it's not uncommon for someone to feel that their self-worth is intrinsically tied to their ability to please others, leading to a reluctance to establish clear boundaries and, consequently, perpetuating cycles of resentment and burnout.

Moreover, societal conditioning often reinforces the notion that caring and self-sacrifice are paramount virtues, making it difficult for people to prioritize their personal space and emotional health without experiencing guilt.

Recognizing and addressing these feelings of guilt and obligation can be transformative, fostering environments where both personal well-being and mutual respect coexist harmoniously.

Lack of Role Models

A significant challenge in setting boundaries is the lack of role models.

Many individuals grow up without seeing clear boundaries. This absence creates a gap in their understanding of how to navigate personal and professional relationships effectively, which, in turn, leaves them ill-equipped to enforce their own limits. Observing others' behavior is crucial for learning the importance and techniques of setting boundaries.

Often, families and cultures fail to demonstrate healthy boundaries.

As a result, people may struggle. They lack tangible templates on which to model their behavior, leading to confusion and discomfort.

Without visible examples of boundary-setting, individuals are left to navigate complex social interactions alone, often repeating patterns of boundary-neglect they observed in formative years. This perpetuates a cycle where the inability to set boundaries continues to undermine personal and collective well-being. Recognizing the importance of role models in this context is crucial for fostering healthier interpersonal dynamics.

Personal History and Trauma

Personal history can deeply influence boundaries.

People with traumatic pasts often face additional hurdles. The lack of established or respected boundaries in early life can hinder the development of healthy, self-protective limits, making it exceedingly difficult to set and maintain them as adults. Consequently, trauma survivors may find the practice of boundary-setting exceptionally taxing.

This difficulty breeds perpetual boundary-violations.

It results in a repeated cycle of unhealthy relationships - where past traumas might be unintentionally reenacted - and further complicates the process. Survivors often struggle with post-traumatic stress, which manifests in boundary-related challenges.

They may unknowingly perpetuate behaviors consistent with their trauma, reinforcing an environment where boundaries remain nebulous. Studies from institutions such as the American Psychological Association have shed light on how trauma exposure critically impacts boundary-setting capacity. This intersection of personal history and trauma thus demands compassionate, informed approaches to help individuals establish and honor their boundaries effectively.

Misconceptions About Boundaries

There exists a widespread belief that setting boundaries is inherently selfish, which hinders individuals from establishing them effectively. This misconception leads many to avoid making crucial distinctions between their needs and those of others. Consequently, people might erroneously believe that prioritizing their own well-being is to the detriment of those around them, fostering hesitation.

Another common misunderstanding is that boundaries always create conflict. This fear can discourage individuals from addressing their limits, perpetuating cycles of discomfort and resentment. Effective boundaries, however, often enhance relationships by clarifying expectations and reducing misunderstandings.

Many also confuse boundaries with rigid, inflexible ultimatums, believing that setting them necessitates harshness or severity. In reality, boundaries can be communicated with kindness and empathy, fostering respect and mutual understanding without alienating others.

Additionally, there is the fallacy that boundaries are static and unchanging, failing to recognize that they can and should evolve over time. As personal experiences and circumstances shift, so too should the boundaries that protect an individual's emotional and mental well-being.

This misunderstanding results in reluctance to reassess boundaries, potentially leading to outdated or ineffective limits. By viewing boundaries as dynamic, individuals can adapt to their ongoing needs and better navigate their interpersonal relationships.

Ultimately, these misconceptions contribute significantly to the difficulty of boundary-setting. By addressing and correcting these erroneous beliefs, individuals can better appreciate the necessity and benefits of establishing clear, healthy boundaries.

People-Pleasing Tendencies

People-pleasing tendencies often stem from deep-seated fears of rejection. Many individuals, in their earnest pursuit to maintain harmony and receive validation, find themselves endlessly accommodating the needs and desires of others.

Consequently, this behavioral pattern makes it exceptionally challenging to establish boundaries. A people-pleaser's inclination to prioritize others over themselves can lead to burnout, resentment, and a diminished sense of self-worth. By consistently putting others' needs first, they inadvertently send a message that their own limits and preferences are inconsequential.

More importantly, such individuals may experience profound anxiety at the thought of disappointing someone. This fear can render them hesitant or outright incapable of asserting boundaries, believing that doing so might jeopardize their relationships or cause emotional distress to others.

Despite their good intentions, people-pleasers must recognize that healthy boundaries are essential for their own well-being and for sustaining truly reciprocal relationships. Understanding the importance of self-care and developing the courage to assert personal limits can mitigate the destructive impacts of people-pleasing tendencies, ultimately fostering more balanced and fulfilling interactions.

The Role of Self-Awareness

Self-awareness is a critical factor in understanding and setting boundaries.

Individuals must possess self-awareness to recognize when their limits are being breached.

Such awareness involves an in-depth comprehension of one’s own needs and values, as well as an understanding of how these are impacted by external interactions.

Without sufficient self-awareness, people may find it challenging to articulate or even identify their personal boundaries. This can lead to a cycle of unmet expectations and emotional fatigue, as they constantly respond to external pressures without considering their own well-being. Accurate self-awareness, thus, becomes the cornerstone for the effective and healthy establishment of boundaries.

How to Begin Setting Healthy Boundaries

Setting healthy boundaries starts with self-reflection.

Individuals embarking on this journey must clearly identify their own needs. This requires contemplation to determine what specific interactions or situations cause discomfort. Additionally, taking the time to note any recurring feelings of resentment or exhaustion can reveal crucial insights.

Knowledge is empowering.

Once personal needs are identified, it's essential to communicate them explicitly. Family members, partners, or friends need to understand these new limits to support the boundary-setting process.

Practice is an integral component of sustaining boundaries. Decisively setting and maintaining boundaries over time will help solidify them as part of everyday practice. Maintaining open communication channels nurtures mutual respect and understanding, underscoring the importance of boundaries in personal relationships.

Communicating Boundaries Effectively

Effectively communicating boundaries can be as challenging as understanding and setting them initially.

Getting the message right often requires thoughtful articulation.

Individuals may feel anxious about potential conflicts or misunderstandings when expressing their boundaries. Clear, concise language is paramount, ensuring messages resonate without ambiguity, reducing the risk of misinterpretation. Clarity means being able to set limits regarding very specific behaviors.

Active listening and non-verbal cues also play a crucial role in the effective communication of boundaries. Practicing active listening ensures that both parties feel heard and respected, fostering a more supportive environment. Non-verbal cues such as eye contact, posture, and facial expressions can reinforce the sincerity and seriousness of the conversation, contributing to a more constructive dialogue.

Maintaining Consistent Boundaries

Maintaining consistent boundaries requires a focused, deliberate approach, but many struggle to uphold the rules they set forth, especially in emotionally charged situations.

This inconsistency often leads to confusion.

Consistency reassures those involved and reinforces the significance of the established boundaries.

However, external pressures and internal doubts can frequently complicate matters.

In such cases, individuals benefit from regular reflection and reinforcement of their boundaries, ensuring their personal principles remain intact.

Additionally, the fear of disappointing others often undermines boundary consistency. Regular self-checks and supportive networks can help maintain the necessary resolve.

Codependency and Therapy

What is codependency and how can therapy help with it?

In his best-selling book, John Bradshaw wrote, “Much has been written about codependency. All agree that it is about the loss of selfhood,” (1). While being trained at the former Bay Area affiliate of the John Bradshaw center one of my supervisors would quote Bradshaw as saying that codependency was the ‘disease of the lost self.’ But what does this really mean? In order to understand this, we need to know about the conditions in which codependency forms.

Codependency refers to a pattern or set of patterns wherein we disconnect from the truth or reality of our own embodied experience. Why would one do this? We do this because we have learned that something about our experience is threatening to the stability of our relationship to a significant other.

In the process of disconnecting from ourselves, we experience several trickle-down impacts. These impacts are summarized in this list from Pia Melody:

Codependents have difficulty

1. Experiencing appropriate levels of self-esteem

2. Setting functional boundaries

3. Owning and expressing their own reality

4. Taking care of their adult needs and wants

5. Experiencing and expressing their reality moderately (2)

Many definitions of codependency are vague, misleading, or simply non-existent (3). When I refer to codependency I am referring to an observable internal dynamic that takes shape in external relationships. In other words, the pattern is observable in how we relate to ourselves and how we relate to others. These dynamics are formed through the course of our emotional development, and thus in response to our primary caretakers. This is why Bradshaw goes on to say that codependency is a “disease of the developing self that does not manifest fully until one is in an adult relationship,” (1).

Many people think they had a normal childhood. However when we look deeper, they realize they experienced a lack of emotional support. As adults they now find it difficult to feel and express their true feelings. Furthermore, if they were shamed for having certain feelings, this adds to the difficulty. Now their feelings can also be experienced as threatening to their sense of security.

People-pleasing, fawning, feigning, and other protections.

Codependency is often connected with people-pleasing. Why is that? If we learn that our emotional experience can lead to a threat to our sense of security with a significant other, we need to find a way to mitigate that threat. In trauma-informed practice most people are familiar with the fight, flight, and freeze responses. More recently clinicians have begun to connect “fawning” and “feigning” as a systemic response to threat. People pleasing falls under the category of these two. Each are strategies to to avoid conflict and the potential threat it entails. Each ultimately require us to disconnect from our true needs, desires, and emotions - some may say our true selves.

While the strategies of fawning and feigning are very much a part of the codependency presentation, they are not the only defenses that can operate under this moniker. The truth is each person may rely on defenses a little differently. If we have learned to disconnect from our feelings we may also do so unconsciously through repression, denial, and dissociation. We may rationalize our true feelings away. We may minimize our hurt or anger in order to avoid conflict. All of these processes are meant to mitigate the potential for threat.

The problem with such protective strategies is that over time they erode our ability to experience genuine fulfillment and connection in our relationships. So for this reason, in my work with clients I focus on both practical skills around helping them identify and express feelings when they struggle to do so. I help them learn how their feelings are vital to their relationship to themselves and others. I help clients to connect their feelings to their relational needs, desires, and boundaries. I have seen these practical skills have a transformative effect on my clients time and time again. They help clients develop a healthy sense of self-esteem, competence in setting limits, verbalizing their needs and emotions. This often results in a lessening of internal conflict and a capacity to manage conflicts in relationship with significantly less drama and sense of threat.

At a certain point in our work, I will help the client to start to connect with their inner child. As we learn practical skills to manage our emotions, we can then begin to deepen awareness into how these patterns, or as I call them ‘templates,’ began to develop in the first place. This often brings up feelings of fear, grief, and/or anger that have been disconnected from for a long time. We develop a relationship to the embodied inner child experience so that this part of us can begin to an internalize a compassion, patient, and tolerant relationship. As this part of us begins to develop trust that we can hold it lovingly, they don’t have to rely on other ways to protect themselves which create damaging consequences which could include: low self-esteem, dissociation, dis-satisfying relationships, shame spirals, depression, and anxiety.

The good news is that it is possible to experience significant growth and healing from these patterns. Please don’t hesitate to contact me if you are interested in learning more about how I work with codependency in therapy.

(1) Bradshaw, John. Healing the Shame That Binds You (p. 34).

(2)Mellody, Pia; Wells Miller, Andrea; Miller, J. Keith. Facing Codependence: What It Is, Where It Comes from, How It Sabotages Our Lives . Kindle Edition.

(3) https://en.wikipedia.org/wiki/Codependency

Introduction to Interpersonal Nonduality

Most often when we go to a group, a workshop, a class, or even a meditation we are learning content through some presentation, or in the case of meditation we are being guided into directing our attention in a specific way to try and produce a specific result.

While these modes of working have much utility for too many reasons to list here, from the perspective of Nonduality they all fall within a structure that looks like something like this:

Process = Sense-of-Self + Directed Attention + Content.

Which then culminates in:

Sense-of-Self + Directed Attention + Content = Attempt Towards Intended Outcome

They all operate within a framework that tacitly assumes we need to identify with a sense-of-self and direct our attention towards some object. That is, they all operate within a framework of Subject towards Object with the intention of producing some result (e.g. learning, relaxation, insight).

Again, this does not mean these approaches do not have value, or utility. This kind of learning has been essential for all of us. Also, many different perceptions and experiences can and do arise within this framework, which can include experiences outside of the perceptual habit (e.g. during process of guided meditation, there is an experience of expansiveness of Self, or even selflessness). However, regardless of outcome the process can reinforce this underlying structure of perceptual habit.

Interpersonal Nonduality is a completely different process of interaction through which we are connecting with another or others with the primary intention of embodying Nondual Awareness.

Within the context of interactions in this intentionality, whatever we say, or don’t say, is of little importance. We aren’t trying to direct our attention in any which way, because attention is simply awareness that has been narrowed, and there is no narrowing necessary here as we are connecting with awareness as the backdrop of the entirety of any and all experience.

There is no content being presented, no concept to learn, and while one could argue that the intended outcome is to rest in the effortless experience of Nondual Awareness, we wouldn’t know if we were achieving that outcome because there would be no content of awareness to signal any achievement and nothing to compare achievement or non-achievement to.

Furthermore, the Sense-of-Self that is implicit in other processes is not necessarily a given variable in this context. Meaning, just because in the rest of our lives we assume that our Sense-of-Self may be somewhat concrete, we don’t start with the presupposition in Interpersonal Nonduality. We don’t start with any presupposition. Rather we start with an effortless non-presupposition, or what we might call innate not-knowing.

If we return to the formula I posited earlier of:

Process = Sense-of-Self + Directed Attention + Content

In Interpersonal Nonduality we might render this something like the following:

Process = Innate Not-Knowing = Sense-of-Self (None and/or No Presupposition) + Directed Attention (None and/or Awareness Itself) + Content (No Content) = Outcome-Whatever-It-Is

So in this sense we aren’t doing anything, but there is no pressure. There isn’t some suppressive silence. Rather, the shared recognition is simply that whatever words we have can not or ever capture the profundity and simplicity of awareness itself. We can talk about awareness, but our words are not themselves awareness. And yet somehow, our words are not, not awareness. Yet in this framework there is no work to be done, we simply have the opportunity to share and rest in the awe of the ground of experience itself.

Nonduality and the Psychotherapy of Transcendence

How does nonduality relate to psychotherapy? How might it be distinct? Is nonduality a method or approach to psychotherapy? What does nonduality offer psychotherapy?

In order to answer these questions we must start with how we understand who and what we are and what therapy is. In technical terms (which you can leave aside if you choose) we must try to understand the ontology behind our approach in order to understand the epistemology. That is, we must be differentiate how each approach sees itself in relationship to the process of being human or if you favor redundancy, being a human being.

Encyclopedias could be written about what psychotherapy actually is. Generally speaking, we can think of psychotherapy as an interpersonal methodology applied with the intent of helping the client develop awareness/insight and into their mental, emotional, and behavioral patterns in order to facilitate change. Some schools of therapy may frame therapy more centrally as a process of skill-building also aimed at facilitating change.

In either instance, therapy operates within a primarily secular worldview that is both individual to each therapist, and in the context of the therapeutic interaction intends to stand outside of belief (unless that is we specifically seek out a faith-based therapist) resulting in opaque or inexplicit ontology. Yet, whether or not belief is explicit it is impossible that the therapist and client would not include their respective world-views in the therapy process. Meaning, how the clients understand themselves in relationship to their world and existence must be part of the therapy process and by proxy how their therapist understands themselves in relationship to the world is impossible to eradicate from the therapy process, no matter how client-centered our values are.

Why am I making this point? Well the aim of conventional psychotherapy methods are built upon presuppositions that both client and therapist bring into the room. In the most general, structural sense some of these presuppositions are:

• the client exists as a sense-of-self

• the client is experiencing problems related to that sense-of-self

• those problems are related to one or more areas of dysfunction within the sense-of-self system

• those problems may be explained variably by different epistemological and etiological concepts (i.e. therapeutic theories and methodologies).

• emotional and relational development are emphasized as structurally formative factors in problems with the sense-of-self

• therapy seeks to ameliorate problems of the sense-of-self

These presuppositions are distinct from a nondual orientation to therapy which may respond to each point as such:

• the client sense-of-self exists as a relativity (some schools of psychotherapy may agree) and from another perspective the sense-of-self is non-existent; it is empty of self-nature

• “Problems,” or the roots of mental affliction, arise from the client’s identification with the sense-of-self as being substantial

• investment in remedying the sense-of-self reinforces the belief that the sense-of-self is ultimately existent and important

• Nonconceptual/Nondual Awareness is the ground of all experience

• the experiential revelation of Nonconceptual Awareness naturally divests energy from the identification with the sense-of-self, emphasizing experiential selfless spaciousness

• the conceptual mind may or may not naturally re-assert itself into Nonconceptual space

• The conceptual mind is divested of it’s relevance

• Resting in experiential selfless spaciousness

• Problems can not be constituted; awareness is unstructured; there is no it, there is no that, there is no I, there is no there.

The aims of conventional and nondual psychotherapy are different. Conventional therapy is a useful and important endeavor. It often implies certain presuppositions that are not explicit, however the reality is that most people who go to therapy find it helpful. In therapy we look at how we became who we are identified with today, and how certain patterns of emotion, affect, and thought serve or do not serve us— broadly speaking.

Nondual therapy is a totally transpersonal-consciousness based approach which is based on going beyond identification with the sense-of-self to an innate, experiential ground of being that has nothing to do with who we think we are. This is a psychotherapy of transcendence.

Selling happiness? Not so fast…

Do you ever feel exhausted from the constant influx of advertising? Just how each of us is assaulted by strategies every time we pick up a device. You may even notice that the language I am using here could remind you of that strategy. This is the language people and companies use to try and get you to buy their goods and services. Basically, the goal is to convince you that you are missing something that will improve the quality of your life. That’s the formula. While I’m not necessarily saying that such advertising is ALL bad (services do help people, and so do products); I think it is important to cultivate an awareness of the mental/cognitive structures that this advertising capitalizes on.

Such advertising is dehumanizing because it pits yourself against yourself. It plays on and reinforces your greatest insecurities. It markets to you an ideal version of yourself. It shows you images of happiness so repetitively that you can’t help but question, what if? What if it’s correct? You might think, I can’t take the risk, I’ve got to try! Often depression is talked about as if it is some abnormality as opposed to “mental health.” Yet, we can be marketed products and services that tell us we are missing something tens or hundreds of times a day and we are expected to be “mentally healthy.” Now clinical depression has a lot of potential contributing factors, I’m not saying we can reduce it to this one thing. However, if we just think this through logically, what can we expect to happen to our sense of selves if we are constantly assaulted with the message that we are missing something? Think of a child or teen. What do we expect to happen to a child or teen’s self-esteem if they receive the message 10 times a day, over 365 days per year that they are missing something? I would say that is a conservative estimate as well.

Rather than try to sell you something in this context, I’d like to throw out some radical ideas that maybe you can experiment with inside yourself, reminding your children, or your grandchildren.

·       You are not missing anything

·       There is no “one” way that you are supposed to look

·       There is no ideal life, no matter who tells you there is

·       Hardships are unavoidable, and rather than trying to avoid them we can learn how to use them to grow and connect us to the hardships of all beings

·       Comparing ourselves to others hurts, even though we all do it. The truth is that we can learn how to do it less if we are taught. We all arrive in this universe with different circumstances that are not always comparable.

·       What we have in a material sense has nothing to do with feeling satisfied internally

·       Our greatest capacity as humans lies within our own self-knowledge

·       Happiness is not a commodity, it’s not something we can have or not have, something we can buy or sell. It is a way of relating to self and other.

·       True happiness transcends relating to other as other, instead sees other as self

Suicide Awareness Resources

As some of you may know, May is #MentalHealthAwareness month. I was so saddened to hear about recent teen suicides in our community. While such losses can overwhelm us with confusion and grief, some avenues for further prevention are to continue to educate ourselves, to have the difficult conversations, to make sure that we let others know that they aren't alone and that we are here to provide support. Listed below are links to resources on suicide education and prevention.

Warning Signs: https://suicidepreventionlifel...

Facts and Statistics: https://suicidology.org/facts-...

Teens: https://suicidepreventionlifeline.org/help-yourself/youth/

Resources for Suicide Loss Survivors: https://suicidology.org/resources/suicide-loss-survivors/

Story of Hope & Recovery: https://youmatter.suicidepreve...

National Suicide Prevention Lifeline: 1-800-273-8255 or text CONNECT to 741741. You also can contact them through their website.

There is always someone who can support you.

Affect Tolerance: What Is It, And Why Does It Matter For Your Mental Health?

If there were just one idea you could latch onto when thinking about mental health, “affect tolerance” would take you a long way. I’m not saying it’s the single most important component to mental health, but it’s up there. Before explaining why this idea is so important, let’s first define some terms.

Simply put, affect is your feeling-state—or your feeling-experience in a given moment. While it may be splitting hairs to distinguish affect from emotion, we might think of affect as less personal than emotion; that is, it’s the experience of emotion. While we often use the word “mental health,” our experience of emotion isn’t located somewhere inside of our head or thoughts only. Rather, emotion also includes a bodily experience or an embodied experience. We might call this experience our affectual state.

Now that we’ve got that definition out of the way let’s talk about the idea of affect tolerance. What’s so important about tolerating our embodied emotional experience? Let me give you a concrete example. Everyone knows about the idea of anger management, but what really is the inability to manage anger? If we can not tolerate the embodied experience of being angry, we will likely need to compensate for this somehow. That is, if we can not tolerate the affect of anger, we are going to have to get rid of it somehow.

Most often, we think of people needing anger management when they have an issue with controlling outbursts of anger. They can not tolerate the affect of anger inside themselves, and therefore they express it in ways that are verbally or physically harmful to themselves or others. This is a pretty concrete example of a negative outcome of low affect tolerance.

Another option is that one could suppress or deny their anger. A seemingly good choice, for a period; however, it just so happens that suppressed feelings and feeling-states don’t just disappear into thin air. While we may think this option is “better” than outbursts of anger, both of these approaches come with the potential for severely negative outcomes from a mental health perspective. I won’t go into all the problems that suppressed feelings can cause, but let’s just say they are too many to count.

But affect tolerance does not just apply to anger. It also applies to our ability to tolerate the experience of feelings of sadness, jealousy, shame, fear, and really any emotion. If we cannot tolerate the felt sense of these feelings, then we have to try to get rid of them somehow either by transforming them into something else, acting them out, or suppressing them. Often (but not ALL the time) this difficulty in tolerating affect can then start to show up as one or more mental health symptoms. For example, if I can not tolerate my feelings of sadness, maybe I start to feel anxious whenever something reminds me of my sadness. Over time, my unexpressed sadness might build up so that more and more things remind me of it, and thus more and more, I feel anxious. Then bang, a therapist might say I have an “Anxiety Disorder.” But really, what I have is difficulty tolerating my feeling-state of sadness.

The prior example is very simplified. I’m not saying things are always that straight forward. However, I am saying that without the ability to tolerate our affect, we are more likely to experience mental health symptoms. Therefore learning to tolerate our affect can be thought of as a primary goal in therapy work. The good news is that it is a very learnable skill.

Before ending the article, I’d like to give you some tips and tools to better develop your affect tolerance. I’d also like to point out some behaviors that can negatively impact affect tolerance and contribute to issues for you now or down the road.

Activities That Support Affect Tolerance:

1. Mindfulness Meditation- You probably guessed this one if you read this far. Mindfulness is all the rage in mental health, and there is a good reason for that. In Mindfulness practice, we begin to learn how to observe our thoughts and feelings without reacting to them. This effectively helps us develop the skill to tolerate our feeling-states.

2. Journaling- When we journal we express our thoughts and feelings and can see them in front of us. Over time this process can allow us to accept our feelings as they are without acting them out or shutting them out.

3. Drawing- You do not have to be an artist in order for drawing to be helpful. I know I’m not. However, drawing or coloring touches into the right side of our brains which is thought to be the side connected with our emotions. Even if we just choose a color to represent our affect state and start scribbling that color, we give ourselves an opportunity to develop a tolerance for and express that affect state.

4. Therapy- One goal of therapy is about learning the skill to tolerate our affect. Most therapists have developed this skill through their own therapy process, or through sitting with other folks for countless hours as they express their feeling-states. When looking for a therapist, try to find one that helps you feel at ease in sharing your feeling-states, no matter what they are.

Activities That Do NOT Support Affect Tolerance

1. Substance Use- Any substance use that alters our mood in a significant way can negatively impact our ability to tolerate affect— especially if it is habitual use. This really deserves a longer post, but in essence, even if I don’t use alcohol or marijuana or something else because I WANT my anger or sadness to go away, the process of getting high or taking the edge off does change my feeling-state from one state to another. If this is repeated over time, I may become LESS tolerant of my feeling-states because I’ve learned that I can change my mood almost instantly with little effort. The problem is not only can I start to depend on the substance to tolerate my affect even if I don’t intend to, but if you take away the substance I haven’t practiced other skills for affect tolerance, thus I will have start from square one every time…

2. Raging, Blaming, or Shaming Others- Sometimes people think that the opposite of suppression is to unapologetically let their anger and hostility out onto others. This may allow them to experience some temporary relief, as they have discharged their intense feeling-state. However, this is NOT what is meant by affect tolerance… rather it indicates an inability to tolerate affect. As we do this, we may become accustomed to managing our feeling-states by placing them onto others. However, the end result is that we will experience MORE conflict in our relationships, more pain, and less peace of mind. These are the opposite outcomes of true affect tolerance.

3. Disavowing, Suppressing, Denying Our Feelings- Disavowing means that we say that we don’t feel some way when we actually do. Suppression is when we “stuff,” our feelings away, hide them, or deny that they exist. These are all indicative of an underdeveloped ability to tolerate affect. While these may function as a short-term coping strategy, in the long term they could contribute to mental health symptoms, unsatisfying relationships, and/or poor self-esteem.

Conclusion: This article is an introduction to the idea of affect tolerance and its importance to all of our mental health. Developing affect tolerance is a consistent practice that is very attainable for most people. It isn’t always easy, however, and it takes work. But the reward is worth it as we start to notice ourselves feeling more at ease with our feelings, ourselves, and able to talk about our emotions more readily in our relationships.

Distinguishing Two Kinds of Attachment

Attachment is an important idea in both contemporary psychology, and in the genesis of Buddhist thought. However, for folks who share an interest in each of these disciplines, it’s possible to get tripped up on the word—that is if we are trying to connect the attachment in psychology to attachment in Buddhism we may begin to scratch our heads. Despite utilizing the same word (at least in translation), these two concepts are totally different.

Attachment in psychology is based on the research of John Bowlby and Mary Ainsworth. This research focused on the bond between infant and mother. In essence, the theory postulates that the child may develop different “styles,” of attachment bonds based on their relationship with their primary caretaker. The ideal attachment bond being a “secure” one. Developmentally speaking, this bond forms a kind of template that the child then brings into future relationships—even into adulthood.

Let’s zoom out a little to address the importance of security for a child. As humans we depend on our parents for a long time relative to many other species. Security in relationship to our parents quite literally could mean the difference in our survival nowadays and also in our evolution as a species.

Yet, when that security is absent from the side of the caregiver (and there are many ways this can happen… I won’t get it into all of them here) then the child has to develop other strategies to cope with this insecurity. This idea lends itself more to the more traditional psychoanalytic concept of defenses… however it is definitely relevant to attachment.

While I am taking a very broad brush stroke here, I am attempting to illuminate the connection of these ideas of attachment and security in relationship to our development as individual and relational human beings. In an ideal sense we need relational security as human beings in order to feel at ease. When we don’t get that, it’s possible we can have trouble regulating our own emotional realities, and relating to others.

However, the reality is that we live in a fundamentally insecure world. While developing security is essential to emotionally healthy relationships, there is also the idea that existentially speaking, nothing can ever be that secure. This is what Buddhist thought seeks to address.

There are many different strands of Buddhist thought, however they all seem to emerge from the idea that not only is our world fundamentally in flux, always changing, but our self is too. In fact, according to Buddhism, if we look closely what we call “the self,” is more of a conglomeration of constantly changing streams of consciousness than a static entity. If we look even more closely, we might discover that “the self,” is not able to be found.

Attachment here is when we try to concretize or fixate something that is by nature always changing. We try to hold on to that sensation of joy as long as we can only to find out that it’s replaced by a loss. Inversely, we might try to get rid of the feeling of loss by eating a whole bunch of ice cream. We might feel better momentarily, but then we might feel sick. This is sort of a game our minds play to try and somehow keep us from pain, but according to Buddhism the end result is always that we end up feeling quite sick. That is because we try to dictate to “reality,” the terms that are acceptable to us, but this is not really possible because everything is always in flux.

So attachment in Buddhism, the literal translation of which is “thirst,” is really considered to be the primary cause of dis-satisfaction in life—which is sometimes translated as suffering.

Why am I making this distinction? Well, terminology is difficult. In the US, Buddhist thought is often lumped into the psychology category and for better or worse these two traditions are associated here. The two kinds of attachment are about entirely different topics: relational development and existential malaise. Sure they may intersect, but their contexts are different.

I believe both are relevant to our understanding of psychology and mental health as a whole. We should just be careful about defining our terms clearly, understanding their appropriate contexts, and discussing how they are functionally relevant to us as human beings.

Is Cannabis Good For My Anxiety or Depression?

There are some folks out there who consider cannabis to be a panacea—a substance that is effective for all ailments. When it comes to mental health, I've read that some believe marijuana helps anxiety, depression, and PTSD (1), …but is this really true? Does weed actually help with these issues? When one does some research into this subject, it is very likely they will find mixed messages.

The reality is that there are many unknowns about marijuana use and mental health. However, just because there are unknowns doesn't mean we should throw caution to the wind. Rather, I would be inclined to interpret that such results suggest exercising extraordinary caution when it comes to using cannabis in any way related to mental health. Let's look at why…

Research has shown a correlation between marijuana use and depressive symptoms. A 15-year study of a group of nearly 2,000 adults in the US showed that marijuana use increased the risk of major depression at the follow up by nearly four times (2). According to the same study, marijuana use was specifically associated with an increased risk of suicidal thoughts and chronic low-energy (anhedonia), both symptoms of depression. Similarly, the CDC noted an increase in suicidal thoughts of heavy cannabis users compared to non-users. That being said, it is unclear if these results are causally related to marijuana use or simply due to already depressed people trying to medicate themselves with weed. I myself am reluctant to turn a blind eye to the correlation. 

In another study, researchers found that cannabis use was correlated with a significant self-reported reduction of depressive symptoms in the short-term. The same study noted that repeated marijuana use led to no long-term symptom reduction or remission and may increase depressive symptoms over time for some people (3). Another way of thinking about this research's findings is that marijuana is often used to alter mood. Still, over time such mood alteration does nothing to actually change the patterns of this mood or the individual's relationship to the mood. Lastly, I will state that long-term marijuana use has been associated with amotivational syndrome, a term to describe apathy, social withdrawal, and lower level of everyday functioning (4). We will return to some of the ideas in the following paragraphs. Still, for now, let's look at how cannabis may impact anxiety.

What should we expect in regards to marijuana and anxiety? Most are aware of the paranoia and anxiety that can accompany early exposure or overexposure to marijuana. Of more interest to me in this segment is the interplay between marijuana as it impacts the processes of anxiety over time and the impact of self-medicating anxiety with marijuana. 

One thing is relatively certain regarding chronic marijuana use and anxiety. Research indicates that long-term users are more likely to develop social-anxiety than non-users (5). Additionally, while using cannabis could help relieve anxiety with the correct dosage in the short term, one study reported that anxiety symptoms returned upon cessation of marijuana use (6). In considering the usage of cannabis as a treatment for anxiety disorders, it is important to note that regular use is likely to include tolerance. This pattern may increase the risk of anxiety upon cessation of use and, thus, psychological dependence on marijuana (7). According to Volkow et al. (2017), as of the time of that study, there have been no randomized controlled trials to show sustainable benefits of marijuana as a treatment for anxiety disorders (7).

What’s the issue with “dependence” If I think cannabis helps with my anxiety or depression? Most people know that marijuana does not include the same physical dependence that heroin or alcohol does. However, there is evidence that there can be withdrawal symptoms associated with long-term use which may include: aggression, anger, irritability, anxiety, insomnia, anorexia, depression, restlessness, headaches, vomiting, and abdominal pain (8). Perhaps not everyone would experience such symptoms, however it is important to note that these are genuine possibilities.

Some cannabis advocates may argue that it is more natural than pharmaceuticals, which may carry their own set of side-effects and potential withdrawal symptoms. While it is true that pharmaceuticals may entail negative side-effects and withdrawal symptoms, these are closely monitored by a psychiatrist, whereas marijuana is most often self-administered. While I can understand the reservation about pharmaceutical intervention for anxiety or depression, I also want to bring attention to an aspect of cannabis dependence that I don't see many marijuana advocates talking about: psychological dependence.

Psychological dependence is often over-looked by pro-pot advocates for reasons I can only chalk up to a lack of knowledge. Stea (2019) described this issue clearly: 

“cannabis can reward by enhancing positive feelings and can also be relieving insofar as it can almost immediately take away the experience of uncomfortable emotions. But evidence-based psychological treatments of many psychiatric conditions involve learning skills to confront and engage with difficult emotions, not avoid them. If cannabis is being used to avoid uncomfortable emotions, thoughts, and memories, it can lead to the development or worsening of symptoms. In other words, repeated temporary relief from psychiatric symptoms by using acutely-mind altering substances is not therapy, and in fact, often runs counter to therapy” (1).

Let me break this down a little more. When we use a substance like marijuana, we alter our mood. This mood-alteration is what people often call “getting high.” That is, using cannabis in any form changes our mood from one state to another. This is why people think marijuana can help with anxiety or depression because they may feel immediate relief. The problem with this is that if we are using cannabis—or any other substance or behavior—to try and change how we are feeling, we are avoiding some aspect of our experience. While this may bring short-term relief, we can grow to depend on marijuana more and more so that we turn to weed every time we feel down, anxious, upset, or angry. If we do this, we may never develop the skills to accept and manage our emotions. Most people have heard of the popular show Arrested Development. Arrested development literally means that we have stopped developing psychologically speaking. Chronic marijuana use or use of any substance may keep us from developing healthy coping strategies that will allow us to function fully in our lives and relationships. 

Our emotional health is directly correlated to our mental health. If we are not able to accept, talk about, and cope with our emotions, then we are much more likely to have issues with our mental health AND our relationships. Why is that? Our emotions are innately part of us. They guide our self-care and our relational needs. That is part of why I prefer to use the term emotional health as opposed to mental health. Paradoxically, even difficult emotions are essential to our emotional health. If we are constantly trying to get away, change, or manipulate difficult emotions, we are more likely to experience anxiety or depression. Why is that? Because difficult emotions are simply a part of life. Therefore, learning how to accept and tolerate these emotions is going to be the best for us in the long term. Emotional well-being includes the capacity to experience the full range of human emotions, while continuing to be in touch with a sense of purposefulness in life.

Because I have a background in studying Buddhist thought, I will also mention a Buddhist perspective on this topic. The Buddha’s principal teaching was to say that dissatisfaction in life is caused by craving. This isn’t just a craving for chocolate or even weed. Craving here means attachment or aversion to however life is showing up for us. That is, when we are attached or averse to anything, we suffer. Please don’t take my or Buddha’s word for it; observe your own experience. When we use weed to try and alter our mood, we are in effect averse to an experience that we are having…From the Buddhist perspective, there can only be one outcome here… and that outcome is dissatisfaction… needing more… and a lack of lasting contentment.

However, you don’t have to believe in Buddhist philosophy to change the patterns of marijuana—or any other—dependence. The first step is always to be aware of the consequences that this pattern of behavior is having on you. Sometimes folks are not even fully aware of these negative consequences until they have some time away from the substance. I know that was how it was for me. The good news is that you can change this pattern. The best motivation happens inside of you, with your own clarity as to how this behavior is an obstacle to you living the life you want to live. Here are some ideas if you want to cultivate a change in your relationship to marijuana or any other problem behavior.

Things to try:

• Make a list of consequences of your substance use. Be honest. Notice if there is a part of you present that wants to rationalize or minimize these consequences. Ask others (see below) if they have observed negative consequences from your use.

• Practice meditation. This helps you develop an awareness of your mental patterns, and with greater awareness comes greater choice. Also, meditation is a coping strategy that can provide us with sustainable changes in our state of mind.

• Attend a Marijuana Anonymous meeting. Yes, they exist. They are full of stoners like me, and maybe you. If you allow yourself to get over your own judgments, you may find a new family of loving, supportive people.

• Ask your friends and family about their perceptions of your use. Sometimes if all of our friends and family smoke weed, they may not see the negative impact it has on us. However, if you have friends or family that use less than you or don’t use… ask them about their experience with your weed usage.

• Journal before and after you use cannabis. Journaling is an excellent practice to help us develop an awareness of our patterns. Journaling before we smoke can help us learn about the feelings we may be trying to get away from by smoking. Journaling when we are coming down or after using may help us develop an awareness of the less desirable side-effects from our use.

• Consult a therapist. When someone comes to me with a chronic weed habit, my first order of business is to try to educate them on how this pattern may be negatively impacting their emotional well-being. Typically, I will tell someone that it is hard to make sustained progress in therapy while regularly using marijuana to self-medicate. That is because therapy is meant to help us learn new ways of coping… If someone is using weed to deal with challenging emotions, they are unlikely to be able to get an accurate readout of how these new coping strategies are helping. That being said, I have extensive experience working with substance use and can work with folks at whatever level of readiness they are to change. Look at my page on addiction here or contact me for a free phone consultation.

(1)Stea, J. N. (2019). "Is cannabis good or bad for mental heath?" https://blogs.scientificamerican.com/observations/is-cannabis-good-or-bad-for-or-bad-for-mental-health/

(2)Bovasso, G.B. (2001) Cannabis abuse as a risk factor for depressive symptoms. Am J Psychiatry. 2001 Dec; 158(12):2033-7.

(3)Cuttler C., Spradlin A., Mclaughlin R.J. (2018). A naturalistic examination of the perceived effects of cannabis on negative affect. J Affect Disord. 2018;235:198-205. doi:10.1016/j.jad.2018.04.054

(4)Lac A., Luk J.W. (2018). Testing the amotivational syndrome: Marijuana use longitudinally predicts lower self-efficacy even after controlling for demographics, personality, and alcohol and cigarette use. Prev Sci. 2018;19(2):117-126. doi:10.1007/s11121-017-0811-3.

(5)National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. Washington (DC): National Academies Press (US); 2017 Jan 12.

(6)Walsh Z., et al. (2017). Medical cannabis and mental health: A guided systematic review. Clinical Psychology Review 2017;51:15-29.  

(7)Volkow N.D., Hampson A.J., Baler R.D. (2017). Don't Worry, Be Happy: Endocannabinoids and Cannabis at the Intersection of Stress and Reward. Annual Review of Pharmacology and Toxicology 2017;57:285-308. 

(8) Grinspoon, P. (2020). Harvard Health Blog. https://www.health.harvard.edu/blog/if-cannabis-becomes-a-problem-how-to-manage-withdrawal-2020052619922

Letting Go of Anxiety: It May Be Easier Than You Think!

We have ALL experienced anxiety at one point or another in our lives. It is that gnawing sense that something is wrong, even if we are not sure exactly what. The American Psychological Association defined anxiety as: “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.” Simply put, anxiety is uncomfortable.

While many may experience periodic anxiety related to the events or circumstances in our lives, some of us develop more chronic anxiety that can have a negative impact on our emotional well-being or day-to-day functioning. Anxiety is a very common issue that leads people to seek out mental health treatment in order to get support in overcoming the challenges that it presents.

The Good News: Anxiety is HIGHLY Treatable

The APA noted that anxiety disorders are highly treatable and that most people respond positively to therapy. In fact, the APA reported that many experience the reduction or elimination of symptoms of anxiety after several—or fewer—months of treatment and that some feel relief even after a few sessions. This is great news! Unfortunately, the Anxiety and Depression Association of America reports that under 37% of folks dealing with anxiety disorders receive treatment. I can only speculate as to why that is. My guess would be that some combination of lack of access to mental health resources, stigma, and lack of access to mental health awareness all play roles in the prior statistic. That being said, help is available and regardless of your income status you deserve support to help you overcome your anxiety. Lets look at some ways we might understand anxiety more fully so that we can move towards healing it.

Getting Anxious About Your Anxiety Only Makes it Worse!

This is a point commonly cited in the evidenced-based therapy model called Acceptance and Commitment Therapy. When we get anxious about our anxiety, we effectively are developing an anxiety feedback loop. This is not only unhelpful in terms of relieving anxiety, it actually most often makes it worse. In the following paragraphs, I will discuss some ways to minimize the potential of getting anxious about anxiety itself. Please note, that these ideas are introductory and should not replace seeking help if you need it!

Anxiety as a Cycle

Let’s take a look at the anxiety feedback loop a little more fully. As I stated in the last paragraph, when we get anxious about our anxiety we develop an anxiety feedback loop. In this light, it may be more helpful to think of anxiety as a cycle rather than an isolated event. According to Cognitive-Behavioral theory, this cycle is held together by our thoughts, beliefs, feelings, and behaviors. The anxiety feedback loop predisposes us to interpret our experience through a lens of fear and worry, and when we do we are likely to alter our behavior to avoid whatever triggers anxiety in us. Therefore, from a CBT perspective it is best to become aware of the thoughts that contribute to our anxiety and to truly examine their validity. In this examination, its possible we may arrive at alternate conclusions than the ones we accustomed to; conclusions that are outside of the anxiety feedback loop. From a CBT perspective cognitive distortions often contribute to anxiety. So we want to be able to ask ourselves if we are stuck in unhelpful thinking patterns, and if we are to try to develop new ways of thinking about our experience. A therapist can help guide you through this process, and often it can bring significant relief from anxiety.

Anxiety as Physiological, or Somatic Sensations

In the anxiety cycle, thoughts are not the ONLY aspect of our experience that are present. Rather, accompanying thoughts are physiological, or somatic (simply a word for our felt-sense of our bodies) sensations. Often these sensations are uncomfortable as in the experience of bodily tension, irritation, the feeling of being ungrounded, or even an increased heart rate. In the anxiety feedback loop, what can happen is that we can say to ourselves these sensations shouldn’t be happening. Of course, this is natural to say. Instinctively we want to move away from discomfort. However, the problem is that when we tell ourselves that something shouldn’t be happening when it is already happening, we are most likely going to experience more anxiety. Why is that? Because in rejecting what is happening for us already, we may feel paradoxically less in control which can then feedback into our anxiety. Therefore, many approaches to the treatment of anxiety such as ACT, CBT with exposure therapy, and mindfulness based treatments actually suggest that we learn to tolerate or observe the uncomfortable experiences rather than trying to suppress, avoid, or judge them.

Mindfulness & Self-Observation

For many, the suggestion of learning to observe or tolerate these sensations associated with anxiety is sort of underwhelming. “But I want the sensations to go away!” Of course everyone wants relief, it is only natural. I have experienced chronic pain, so I really understand. However, because anxiety is a cycle we have to be aware of the parts that keep that cycle in place… And the evidence shows that trying to reject our experience typically feeds back into the anxiety. Thus, rather than replicate this cycle, the suggestion is to learn the capacity to observe without reacting. This is really what the practice of mindfulness is. It is a kind of self-observation where we learn to notice our mental patterns without stepping inside of them.

The mindfulness that is practiced in the mental health field originated in the context Buddhist thought and practice. In Buddhist thought, suffering or dis-satisfaction is caused by attachment or aversion. Now this can go as deep as you’d like it… However, the main point here is that this is exactly the same for anxiety. As natural as it may be, aversion to the physiological and somatic experience of anxiety actually increases our suffering. Therefore, to practice observing without reacting allows us to more readily accept our present-centered experience, which while it may include sensations that we calling “anxiety,” likely also includes other sensations, the space around those sensations, and the observation of those sensations. In other words, mindfulness or meditation allows us to widen our mental aperture which so often gets narrowed when we are in an anxiety feedback loop.

Final Thoughts and Suggestions

Anxiety is challenging to cope with, but it can get better. Sometimes people get better quickly, sometimes it takes longer. Regardless, there are practical steps you can take to reduce the impact of anxiety in your life. Therapy can be extremely helpful in helping folks get unstuck from the anxiety feedback loop. Learning to identify our thoughts that contribute to anxiety can help us choose alternative ways of understanding ourselves and our experience that don’t contribute to the cycle of anxiety. Self-observation or mindfulness practices help us learn to observe without reacting which ultimately helps us to reduce our anxiety over time. For folks new to mindfulness, there are many apps that teach this practice. Head space and Calm are apps with a variety of guided approaches to meditation. I personally recommend the work of Dr. Richard Miller and iRest which is an evidenced-based guided meditation practice shown to help with depression, anxiety, and trauma. iRest actively supports us in cultivating the skills to observe without reacting to our body sensations. It also helps us cultivate a relaxed state of body and mind. I also wrote this blog post on tips to develop a regular meditation practice. Read more about my approach to anxiety, or contact me for a free phone consultation about how therapy can help.

Boundaries 101

Boundaries are an often cited, yet commonly misconstrued psychological idea. Difficulty with boundaries is one of the most common issues I see with clients dealing with a variety of presenting problems—from anxiety, and depression to life transitions and relationship conflict. I had the good fortune of completing a two year training with the former Bay Area affiliate of the John Bradshaw Center where a premium was placed on learning boundaries.

Perhaps the easiest example of a boundary system is that of the cell wall. Simply put, cell walls keep out the bad stuff and let in the good stuff. While that may be an oversimplification, it is a helpful guiding principal. Similarly, our boundaries are a part of our emotional self-care system. They express a limit, whether that be physical, emotional, sexual, intellectual, or spiritual. When we have poor boundaries, we open ourselves to harmful experiences or dissatisfactory relationships. On the other hand, if we have too rigid of boundaries, we might not let in some of the emotional nourishment we need.

I teach people that boundaries are always connected to our feelings and needs. You might say that feelings are our best guides to our needs and limits. Often when people come to therapy, they have difficulty identifying their feelings. This is common, and not a reason to feel shame. However, when we have difficulty identifying our feelings, it is very hard to ask for what we need in relationship and to set limits.

The first step in having good boundaries is to develop awareness of our feeling states. How do I experience myself when I am angry? Sad? Ashamed? Scared? Hurt? Knowing the cues to these emotional experiences allow us to plug into our emotional self-care system, to clearly define our needs and limits. For example if I know I am sad, I might just need to ask for some reassurance or for someone else to listen while I express my feelings. If I’m frustrated or resentful with someone else, its very possible I have been neglecting my boundaries. If these feelings arise, there is always an opportunity to check in with myself and say… “Do I have a limit here that I haven’t expressed?” “Is there something I am needing that I haven’t asked for?”

Boundary work is a practice. It’s an ongoing learning process that takes time, self-observation, and self-love. We are all works in progress. I am confident that you can learn boundary skills and that knowing these skills will benefit you greatly. I will post more in the future about this very important topic, but for now… be well!

5 Tips For Cultivating a Meditation Practice During COVID

Despite the challenges that it presents, living in the time of COVID also offers us a unique opportunity to look at how we practice self-care. Of all the forms of self-care practice, perhaps the most commonly recommended is meditation, or mindfulness. In this post, I am going to discuss some tips for developing a regular meditation practice. I have practiced meditation in fits and starts since I was 20 years old, with extended periods of daily meditation. It changed my life, and it could very well change yours. So here it goes:

1. Consistency is the best way to practice. In almost all cases, is better to practice a little (5-10 mins) regularly than a lot rarely. Meditation is a form of workout for your mind. When we work out, we start small and build up. Other ways to help stay consistent is to develop a routine. Try choosing the same time every day, or meditate after you do something else that you do everyday (e.g. brushing your teeth). Try meditating in the same place. Find what works for you, and do your best to commit to that daily.

2. Don’t judge your practice. I can’t tell you how many times I have heard, “I’m not sure meditation works for me… I was so distracted while trying to meditate!” People often think they are supposed to be laser focused from the get go during meditation. While some advanced meditators may get to that stage (so I have heard) for most of us this is NOT realistic as we start out… In fact, distraction is a normal part of meditation! What is important is that you are paying attention. It is best to not place such high expectations on our meditation practice, and to see it as a process of learning about our minds.

3. Try some different meditations, but then stick to one practice that you connect to. I am all for people trying different meditations. There are apps that may guide you through several different kinds of meditations. However, at a certain point if we are trying so many different meditations we might end up getting confused. We might not be able to develop a rhythm or relationship with that practice. In meditation the idea is that we are not giving ourselves MORE to think about. Therefore, I suggest that once you find a practice you connect to that you give it some time to go deeper with. That is not to say you have to be locked in forever, just try being consistent with one practice for a month or two. If you feel inclined to try something else after that, then go for it. If you are comfortable in your practice at that time, then keep it up!

4. Be kind to yourself. If you miss a session, don’t beat yourself up. If you are so distracted during a session that you lose hope, don’t worry. You are human, and meditation is not about being perfect. There is no benefit to shaming or putting undue pressure on yourself. Rather, try to remember what motivates you to meditate. What is good about it. Meditation is a privilege, not an obligation. It is something to do for your health and well-being out of self-love, not self-hatred.

5. Enjoy it. This one might seem difficult if you are new to meditation, and just learning how much your thoughts run the show. Yet, I am very confident that if you stick with it, you will find pockets deep enjoyment that come with giving our minds the opportunity to rest. No need to chase the experience, but when it shows up its okay to appreciate it and gently remind yourself that this is one of the greatest gifts you can offer to you!

Building a Legacy

I am not a fan of the hyper-individualism that is marketed to us everyday. I have no intention for the name Legacy Psychotherapy to be used to sell you the idea that I can help you “be your uniquest self.”

Yet, I do believe that our actions have enormous significance. What we do speaks volumes about who we are. And I’m not saying this to try to pigeon-hole anyone either. When it comes to leaving a legacy, what we leave is in our actions.

Good therapy should reflect this. The proof is in the pudding. That is, good therapy should support us in learning to take actions that are of significance to us, or in alignment with our values. Additionally, it should support us in learning to not take action when that action would compromise our values.

Therapy is a self-awareness building exercise. Family therapy is a self-and-other awareness building exercise. When we develop awareness of our patterns, and motivations behind our behaviors we actually increase our ability to make choices about how we want to act. That is, with increased awareness, there is increased choice. It is my opinion that such choices offer us the opportunity to live a life full of meaning, self-empowerment and integrity.

In therapy, I first try to understand what motivates “problematic” behaviors in my clients, whether in adults, children or in families. We do this by bringing attention to and reflecting on our feelings, thoughts, and behaviors. Often there are feelings that have never been talked about, or we might struggle to verbalize. In learning how to talk about these feelings, we open the door to new possibilities for our actions.

However, there is no perfect. This process is one of continual trial-and-error. With children this takes patience and support from parents. With adults this takes learning how to accept the myriad of feelings that are part of our human experience. In each case, I am here to support you along the way. I am so confident that you or your child can make progress through this process, whether it is with me or another therapist. One of my mottos is that “showing up is half the battle.” If you have questions pertaining to the therapy process, please reach out to have a free consultation with me. I would be glad to offer my experience to you.