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

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.