See, Do, Teach

If you think that going to therapy means you can go to a shrink’s office, unload all your problems, and walk away a new man, you’ll be disappointed. You might feel better for a minute, but if you go home and do the same things you’ve always done, you’ll get what you’ve always got.

Therapy involves learning new skills. The couple who’s coming in for marriage counseling needs to learn to listen and respond differently. The anxious person must learn to relax; the depressed one, how to keep going; and the addicted one, why and how to stop using their substance. Every person must be able to observe themselves accurately and compassionately. The greater part of all this learning occurs outside the therapy hour, far from your shrink’s office.

A surgeon once told me they have a saying in medicine: see one, do one, teach one. Only when you complete all three can you say you know the procedure well enough to do it on your own. See one means you watch someone perform a surgical procedure. When you try your hand at it under supervision, you are doing one. Teach one requires you to explain it to someone else, so they can do it, too.

There’s a lot of wisdom in this method, which can be applied with variations to almost any kind of learning. It’s not enough for me to tell you how you can calm yourself down in sixteen seconds by square breathing, you must do it. Then, it’s not enough for you to do it, you must explain to someone else how to do it. I have often found that I think I know something when I start writing about it, only to be confronted by all the ins and outs of the topic before I’ve reached the end of the page. Teaching someone is how you work out the kinks in a skill and develop real mastery. Then, if you really want to learn something, learn it well enough to explain it to your grandmother.

Learning a new skill in therapy is harder than learning a surgical procedure because you really need to use the skills when you are under extreme duress. You need to learn to listen when your spouse is yelling at you, how to calm yourself when you think you’re going to die, how to go on when you wish you would die, and why and how to stop using a substance when it seems like nothing but the substance could solve your problem. You need to be able to observe yourself accurately and compassionately when you are the most ashamed. That’s hard. It’s as hard as a surgeon learning a new procedure, not on a patient, but on himself, blindfolded, without anesthesia. To be able to learn to do that is going to take more than watching one, doing one, and teaching one. You’re going to have to do ten thousand.

This is where drilling comes in, otherwise known as repeated conscious practice. No one likes to drill, but a musician who hasn’t done his scales will not know how to play. An actor who hasn’t rehearsed does not know her lines. A basketball player who hasn’t shot from the foul line countless times will not score a point when the game is at stake. The idea of drilling is to repeat something often enough so you can do it in your sleep. If you’re ever going to be able to listen when your spouse is yelling at you, listening must be automatic.

If change is ever going to occur as a result of therapy, then most of the work, and the drilling, must occur between sessions. The anxious person must take up meditation; the depressed one, action; and the addicted one must repeatedly choose not to use his substance. Everyone must practice observing themselves accurately and compassionately if they’re ever going to have a chance of doing it when it’s hard.

How to Get Out of Quicksand

Old Posts

I was walking along the beach one day, having a nice vacation, when I stepped into quicksand. It wasn’t a deep pit like you see in the movies, the kind that can swallow a horse and rider, but it was quicksand, just the same. I soon was in up to my knees, just like in the movies. The more I struggled to pull my feet out, the more stuck I became.

Perhaps you’ve noticed by now that you get more entrenched in your issues the more you try to solve them; just like quicksand. You have a library of self-help books, have seen a score of therapists, attend groups, seminars, and yoga classes, you take medicine, and practice mindfulness. All this and you are still anxious. In fact, you’ve gone from being anxious to being anxious about being anxious. If your method of escaping is similar to my method of getting out of quicksand, you will get more stuck. You’re doing it wrong. Continue reading

The Shrink’s Links: Bright Ideas for Treating the Winter Blues

Bringing you the best of mental health every week.

Christmas time is a busy time of the year for malls, elves, and postal workers, but, despite the myth, it is not a busy time for us shrinks. Actually, it’s April.

Nonetheless, there is something about this time of year that makes it hard, especially in the Rochester area, to kick it into gear. It’s the time when clients complain more and more about loneliness, family conflicts, and dashed expectations. Alcoholics have more temptations to drink, overeaters to eat, and drug addicts remember the time they once hocked the kids’ Christmas to score, get guilty, and hock Christmas again just to feel better. There is something about Christmas that makes people miserable.
Why is this so? Christmas is supposed to be a happy time of the year.

Have you looked outside lately? Go ahead and do it now. What do you see?
Chances are, you can see nothing because it is dark. It’s mostly dark this time of year. Can that have anything to do with it?
It does. A lot of of heartache could be prevented by turning on a few lights.
Read this article from the Wall Street Journal to learn more.

When Madness Takes Cover

So, you’ve stopped drinking, or drugging, or gambling, or sleeping around. Your depression seems to have lifted. You haven’t been violent. Your anxiety no longer makes all the decisions. You’re up in the morning and dressed when you need to be. The madness seems to have gone away.

Has it, really?

Madness takes cover sometimes when it feels threatened. It’ll hide in the bushes and come roaring out when you least suspect it. Make no mistake, madness is cunning, baffling, and very, very patient. While you’ve been collecting key rings at your NA meeting, the madness has been doing pushups in the dark.

Madness prefers the dark. It likes to perform its dirty deeds in secret. The night belongs to Michelob. However, madness is rarely ever a real secret. It’s kidding you when you believe it leaves no trace. You can tell when madness is still afoot if you are willing to read the signs.

These are the signs:

You haven’t done the things promised for your recovery

If the problem behavior is gone, but you still haven’t been to see a therapist, attended meetings, written that letter of apology, changed associates, or done any of the things you promised, then the madness is just hoping you won’t notice.

The behavioral changes have been minor

The more serious the madness has been, the more excited you’ll be when there’s been a slight improvement.

You were drinking every day, now you’re thrilled that you cut down to once a week. You used to gamble away all of your paycheck, now you only buy a few scratch-offs. You used to beat your wife, now you only puts holes in the wall. The underlying attitudes towards drinking, gambling, or violence have not changed; the only thing changed is the frequency and severity.

When gardeners trim bushes back a little, they call it pruning; it doesn’t destroy the bush, it makes it grow more. The same thing happens when only minor changes are accomplished. You wouldn’t be satisfied with your surgeon if you had a mastectomy and he left some cancer behind, so don’t fool yourself by minor behavioral changes.

Other problems have arisen

Sometimes the illness plays whack-a-mole by extinguishing one problem behavior, only to transfer it to another. We see this frequently with addicts who will use one drug until the heat is on, and then switch to a different drug. Instead of scoring heroin on the street and using dirty needles, they get their narcotics from a doctor. You’ll think that’s an improvement, until you start to abuse those pills, too. The underlying issue remains.

Thinking has not changed

If the rationalizations that have justified the madness are still in evidence, then the madness has not gone away. You used to say you needed to drink, so you drank. Now, you don’t drink, but you still say you need to. Guess what? You’ll drink again. If the madness was truly gone, you’d no longer believe you needed it.

No fence has been built

It is not enough just to change the problem behavior to eradicate an illness. You also have to know the route that it takes before it arrives. You need to put up a gate and shut out behavior that, in itself, is not problematic, but leads up to the problem.

Madness comes masquerading as something harmless so that you will not see it coming. Pedophiles start off by making friends with a child. There’s nothing wrong with making friends with a child, right? But, then they gradually groom the child to accept more and more sexual behavior. We protect children from pedophiles by not permitting them to live near schools. This is not because it is bad to live near a school, but it is bad for pedophiles to live near schools.

Authentic recovery means that you see through all the disguises.

History is minimized

If the story you tell about the illness differs significantly from your partner’s, then the madness is still lurking about. If you talk about your depression only in terms of your suffering and leave out how it affected others, then you’ve not incorporated other points of view into your own. Your limited perspective is still all you have. You have an incomplete appreciation of the costs of your choices. You should be able to tell your partner’s side of the story as well as your own.

You’re withdrawn

If your partner complains that you’re virtually unreachable, emotionally inaccessible, or sexually uninterested, then the madness may be in hiding. It doesn’t want people to ask too many questions, know too much, or get too close.

You’re always angry with your partner

You may be blaming other people for calling out the madness and challenging it. you may be using anger as a way to keep others away, off balance, and uninformed. You may still be taking sides with the madness, against your partner.

Your partner is working harder at recovery than you are

Your partner has been on you like white on rice. Ever since you had that affair, she’s been monitoring your phone, checking your whereabouts, scanning your emails, opening your letters. She met every single female acquaintance you have and gave them all the stink eye. She scrutinizes your expression when every waitress approaches. She tried every new position you wanted in an attempt to reawaken your sex life. She found a therapist for you, set up the appointment, went to every session, paid, and did the homework assignments. Your partner is working harder than you are.

If you have not taken responsibility for change, then you will not make the right choices the moment your partner’s back is turned.

You say everything is changed

You’re not the one to judge whether anything has changed. When your madness fools people, it fools you first.

You want to move on and not get stuck in the past

That’s the madness talking, trying to convince you to not learn from the past. Truly recovering people remind themselves of the past regularly, so that they’ll not repeat it.

You want credit for improvements

An adult straightens the house every day. He scrubs the toilets when they need it and mops the floor when it’s dirty. He doesn’t expect a medal for it. He just does it because it needs doing.

A toddler tickles the furniture with a feather duster once in a while and everyone will fall all over him, saying he was very helpful. That’s what they do for a child. Are you a child?

When madness takes over: the less you do, the more credit you think you deserve.

In a healthy world: you don’t earn special points for doing what you should have been doing all along.

It’s still all about you

Not only have you stopped the problematic behavior, but you’ve been going to therapy, attending AA, writing in your journal, and getting in touch with your feelings. These are all good things, but you’re still as self-involved as ever.

Real change means taking action towards becoming more loving, generous, caring, and empathetic towards others.

There are no signs

You looked over this list and you did not find a single thing that indicates madness may be lurking. There seem to be no signs. Well, that’s your sign. If you aren’t seeing signs, then you’re fooling yourself. There are always signs.

The road to recovery is the same road as the road to ruin; you’re just traveling in a different direction. You pass by the same markers as when you were heading to ruin. You should be seeing them now and recognizing them for what they are. You should also be seeing some signs that indicate you are heading in the right direction. You should be seeing meaningful change.

Listen to your Lookout

When the wheels start to come off, everyone has their own kind of madness. Some use substances, others get controlling, others depressed or anxious; some have a combination of several methods of madness; whatever. Your own type of madness was custom-made just for you. It sneaks up in your blind spots. It fits you like a glove. When your madness tricks, it tricks you first.

It takes hard work to eradicate madness and eternal vigilance to keep it away. Relapse can be expected. When we’re talking about addiction, it takes an average of seven real attempts before recovery feels solid and, even then, you won’t know if you’re going to need eight. Mental illness also tends to be episodic, and each new episode is worse than the last. People who have succumbed once to the temptations of violence, sexual recklessness, self harm, suicide attempts, or self pity are more likely to do it again. Moreover, madness will often go into hiding when it feels threatened, so that what appears to be recovery is really a more pernicious hidden phase of the same madness that troubled you before.

If you’re in a close relationship, you have a resource that others don’t have. You have a lookout. Your madness was not custom made just for her (or him). It doesn’t sneak up in her blind spots. She spots it coming before you do. She can see through the deceptions more easily. She has a vested interest in keeping you safe from madness. She could warn you that it’s approaching if only you will listen.

Paid professionals can help, they have the knowledge, they have the objectivity, but they don’t have the access your partner has. They don’t see you on the weekends and at night when madness often strikes. They do not have as much at stake.

Far too many people fail to use their lookout. The lookout sees the madness coming and they argue with her, deny it’s happening, get defensive. This is a mistake. It’s as if a lookout on a ship, up in the crow’s nest, saw an iceberg up ahead, and the captain yelled, “You’re crazy, I’m not going to hit an iceberg. You never trust me. I’m going to do what I want. Get off my back.” It would not be good if a captain did that.

To be sure, many lookouts don’t understand their role too well. When they see madness coming, they often make accusations, rather than observations. It’s as if the lookout, up in the crow’s nest, called out, “You’re hitting an iceberg again! Don’t you care about me?” They should just warn you that there’s an iceberg. You might be tempted to dismiss their warnings as crazed paranoia. It would not be good if you, or any captain, did that.

However, you’ve got to realize that you’ve hit a few icebergs in your day, already, and your lookout should be excused if she gets excited when she sees another one.

There’s a few things you can expect from a good lookout. Don’t be surprised when you see them.

· A good lookout doesn’t resign. If your partner comes down from the crow’s nest and tells you that you’ve got to look out for your own madness, you can figure that next she’ll be going off in a lifeboat. True partners do not resign as lookouts, unless they’re about to leave the relationship, or they’re a damn fool. She has to be a lookout, if only to guard her own interests.

· A good lookout stays awake. She doesn’t watch like a hawk in the beginning and then forget about it later on. If it’s months or years since madness last struck, don’t be surprised if she still on the lookout. She has to be. That’s her job.

· A good lookout scans the horizon. She doesn’t keep looking in the same place. The main thing to look out for is the way the madness arrived in the past. It is likely to come that way again. If, for instance, you get depressed at Christmas time, then she should be especially on the lookout at Christmas time. But understand, madness can come wherever there is busy-ness, family contact, alcohol use, overeating, darkness, or an imperative to be merry.

· A good lookout is not deceived. Madness arrives in disguise. No one starts off drinking three six packs a day just to feel normal. No, they start off with a glass of wine at dinner, a beer during the game, or doing a shot with a friend. These things are all good things, there is nothing wrong with any of them in themselves. They are only evil because of where they lead. A good lookout sees through the disguises. She knows the masks that your madness wears.

· A good lookout is jumpy. She’s got to be vigilant. If you keep driving by that place where you used to score drugs, she should be seeing red flags. This may very well be the way the madness creeps up innocently.

· A good lookout raises the alarm. If she sees madness come up on you, she should say something, not keep that information to herself. You need to know it. She may not want to do it, no one wants to be the bearer of bad news, but this is what lookouts are for. If the madness has given the two of you a lot of trouble in the past, she might not want to believe it’s back. If the madness has already taken you over, she might get an argument.

· A good lookout keeps her eye on the hazard. If your lookout spots some madness, she should keep her eye on it, even if you say it’s nothing. In the case of chemical use, don’t be surprised if she looks for confirmation in the form of a home drug or alcohol testing kit to eliminate suspicions. For this, or other kinds of illnesses, she may want to get a second opinion from a professional; sort of like calling in another lookout and asking what he sees.

· A good lookout keeps herself safe. She shouldn’t be so busy being a lookout, watching out for your madness that she gets overcome by her own. Yes, even your partner has her own kind of madness.

· A good lookout has someone looking out for her. Be your partner’s lookout, just as she is yours. Watch each others’ backs. You can see her madness more clearly than she can her own. If your partner has been dealing with your madness for a long time, she’s probably worked very hard to keep herself strong. Someone in the house had to function. The laundry, the cooking, the kids, the relatives, the shopping, and going to work don’t get done by themselves. She may not be accustomed to relying on you for anything; you just haven’t been reliable. That’s going to have to change. She needs a lookout, too.

If you’ve ever complained that your partner doesn’t trust you, let her be your lookout. This is how she learns to trust you again.