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by Michael Ventura
You sort of know who he is, even if you don't know who he is. You may not watch afternoon TV, you may be in bed by the time The Tonight Show airs, you may not like talk shows in general, but our media-infested world buzzes certain names into our ears until they're inescapable--names like Leno, Oprah, Dr. Phil. So you know, by a kind of osmosis, that Leno is a comic, Oprah is a force of nature, and Dr. Phil is some sort of therapist. And you know he's "huge," as we say of "hot" celebrities. You see his name at the top of bestseller lists, you see his face in bookstore displays--a genial, ruddy, not unintelligent face. There's something accessible about his presence and he's . . . some sort of therapist.
For those aware of him only out of the corner of the mind's eye, so to speak, it may be something of a shock to learn that, for millions, Dr. Phil is the therapist, paying daily house calls via TV to countless living rooms. His TV show is watched by an average of 6.6 million people every day, and five of his books have been number one on the New York Times bestseller list. He not only offers celebrity endorsements for weight-loss products and regularly goes on sold-out speaking tours around the country, but even has a muppet on Sesame Street named after him--"Dr. Feel." So you might ask yourself, as I asked myself, "What's going on in this world when the dominant male star on daytime TV is a clinical psychologist?"
A few months ago, The Economist shed some light on why a therapist might command so much attention: "About one in five Americans now suffer from a diagnosable mental disorder. The National Institute of Mental Health estimates that more than 13% of Americans--over 19 million people between the ages of 18 and 54--suffer from anxiety disorders, 9.5% from depressive disorders and millions of others from conditions ranging from post-traumatic stress disorder to schizophrenia and bipolar disorder." In addition, "in 2001, 5.5 million more Americans were taking prescription drugs for mental health problems, or problems of substance abuse, than was the case only five years earlier."
Of course, statistics on psychiatric diagnoses are questionable at best. How many people who are simply going through a hard time are classified as "depressive"? How many recovering from traffic accidents have "post-traumatic stress"? Still, there's no denying that in post-9-11 America--with its color-coded terror alerts, two continuing wars, rising gas prices, and an uneasy economy--the general level of anxiety is higher than it was during the boom years of the '90s. So, while it may be an exaggeration to state that one out of five Americans suffers from mental disorders, it's a safe bet that the general level of fear and uncertainty is higher than it's been in the memories of most people born after the Depression. The social climate has never been riper for a TV therapist. It's no wonder that many are calling out (as they do every day on his show), "Help me, Dr. Phil!"
Who then is Dr. Phil? What sort of help does he offer? How did he show up on the scene, and what is his scene?
Enter Dr. Phil
In the '70s and '80s, for the first time in the history of recent civilization, it became acceptable to speak openly of the terrors in the family closet. The women's movement, the men's movement, Adult Children of Alcoholics, and various survivor movements outed the all-too-common agonies that had previously been terrorized into silence. Every conceivable variety of incest, abuse, addiction, and destructive relationship became part of our daily dialogue.
This phenomenon represented a tremendous breakthrough for psychotherapy. After nearly a century, its insights and practices had finally filtered into the general culture to the extent that lay people, many of whom hadn't had direct contact with therapy and therapists, incorporated the language of the consulting room into their lives. Psychotherapy served as a powerful ally to this self-disclosure movement, giving it legitimacy and authority. Secret shame was publicly confronted, taboos were swept aside, and what had been unspeakable was not only spoken, but shouted from the rooftops, and from our radios and televisions.
There can be no denying this movement's fundamental benefits. Millions have been helped and healed, abusers have been held to account, and the onus of shame has been at least partially lifted from sufferers and victims. But it's just as undeniable that things went too far. For many, traumas were enshrined and victimhood became a central source of identity. What began as curative became a new kind of malady.
For many people, including therapists, it became obvious that identifying trauma is valuable, while identifying with trauma is destructive. Victimhood devolves into whining, and whining is tiresome, solves nothing, and leaves people stuck in their traumas. It also became obvious that new strategies were necessary--strategies that focused on coping in the present, while not denying the past.
Many therapists worked hard developing and refining new ways of helping clients deal with a traumatic past. But many outside the circles of therapy--either through ignorance, financial necessity, or simple distaste for the process--were still in need of something or someone to point the way out of victimhood.
Enter Dr. Phil. Tune him in and you see an affable, vigorous, eloquently plainspoken man, radiating certitude. His presence on screen has a 3-D effect. He looks directly into your eyes, talks directly to you, effortlessly including you in every conversation with his guests. He seems not to be "on television," but rather to emanate from the television. Jay Leno and Oprah Winfrey are in studios somewhere, and you watch; Dr. Phil is in your room, and you react. No man since Walter Cronkite has commanded the television medium with such seemingly effortless intimacy. Authoritative and comforting, Dr. Phil confronts victimhood with what has become his signature phrase, a challenging injunction spoken with earnest concern: "Get real."
A Star Is Born
Dr. Phillip Calvin McGraw, a clinical psychologist, began his practice in his native Texas in 1979, just as the revelation of taboo secrets was picking up steam. He practiced therapy for 10 years during the heyday of tell-it-all trauma. He quit clinical practice because, as he's famously said, he "didn't have the patience for it"; he saw no virtue in whining, or on dwelling upon pain. And the intricacies of therapeutic delving didn't suit his solution-oriented mind. But he did see that psychological insights might be commodified and sold.
He cofounded Courtroom Sciences, Inc., a company that employed psychological research to assist trial lawyers in areas like jury selection. His company's client list is impressive: Exxon (in court over the Exxon Valdez oil spill), The New York Times, many Fortune 500 companies, and, as fate would have it, Oprah Winfrey herself. Oprah had offended the cattle industry and was fighting a suit in an Amarillo court. She hired Courtroom Sciences, Inc., won her case, and hit it off with Courtroom Sciences' Dr. Phillip McGraw.
Invited on her television show, he became a Tuesday regular, and her Tuesday TV ratings quickly became her highest. On Oprah, he morphed into Dr. Phil, a doctor who had no patience for victims. His attitude might be summed up as: "You can talk about that stuff, and that's good, but now get real. What are you going to do about it?!"
Dr. Phil struck a nerve--and had a point. To people identifying solely with their pain, he offered other, more traditionally American, self-reliant avenues of identity. Dr. Phil was a corrective to a victim-oriented psychology that had bloated into a fad.
His approach might have been popular coming from any charismatic guy named Phil, but he's Dr. Phil. His background as a clinical psychologist was his entry pass, his source of authority. Clearly, he wasn't practicing psychotherapy on Oprah. Just as clearly, though, Dr. Phil spoke for himself, but as a psychotherapist. As his website says, he draws on "30 years of experience in psychology and human functioning." In the context in which he's presented, there's no mistaking that, when he speaks, we're listening to a therapist.
With his popularity proven by her Tuesday ratings, Oprah and her producers conceived a wider format for him-- The Dr. Phil Show. It was an instant megahit, second only to Oprah herself in the daytime ratings. Dr. Phil went from being a celebrity to being a phenomenon: tune in the show, buy the bestselling books, visit the website, and get real.
But the question remains, what's the reality behind "get real"?
An Internet Phenom
Dr. Phil's "get real" is based on an appealing assumption: that well-informed common sense can be successfully applied to any dilemma. Here's the dilemma; here are your options; choose and enact the wisest option, and the dilemma will be fruitfully resolved.
It sounds like it should work. Certainly, for everyday situations, there's no arguing with it. There's not much to argue about for complex situations either, at first glance anyway. For instance, here, on his website, is Dr. Phil answering a mother who can't believe her daughter is gay--the "get real" approach:
"Homosexuality is not a learned behavior. A sexual orientation is inherited; you are wired that way. Certainly some people will experiment with a gay lifestyle, and a gay person might experiment with a heterosexual one. If she is really gay, she will find a place in that life and in that community. The important thing is that you just love her through that. What difference does it make if she is gay? Accept her, support her and do not be judgmental. It is difficult enough for her to live openly and honestly in this society; don't put your judgment on top of that."
Is this sound advice? In most cases yes, though if you're a fundamentalist convinced your gay daughter is doomed to Hell, "What difference does it make?" brings up major issues that can't be solved by love alone. Is Dr. Phil's statement a brave thing for a public figure to say? In today's cultural climate, his stance probably angers a hefty chunk of his audience. He's clearly not pandering. He's taking a stand that the vast majority of therapists would support and that gay activists must welcome.
But it's no small thing to drop judgments about your child. Most therapists know that the "real" work begins after the paragraph is read. Therapy might come next, because, for most people, taking such a step alone is beyond their emotional resources. In fact, such a situation is exactly what therapy is for. But in that web offering, there's no suggestion that if you find these issues too difficult, you might want to seek counseling.
Dr. Phil's advice falls loosely into the category of self-help. Now self-help is, by definition, something you do yourself, without the need of additional relationships. If you're in good enough shape to do that, then books and sites are enough, and you aren't in need of therapy or any other kind of help. The danger is when you're not in good enough shape or haven't the coping skills to get real and make the self-help sites and books useful. Then you may pile up self-help advice as an act of denial that keeps you in the problem. In that case, self-help becomes like self-medication: you may be alleviating symptoms without treating the disease.
Any person of common intelligence can see that what's on the website is bare-bones stuff. More help may well be needed, and it's offered: the appropriate Dr. Phil book is displayed alongside the site's spare advice, with a convenient link for purchase. He definitely wants his website to be part of your life, because it's a colorful hook for his books and a running ad for his show. The show hawks the books and the website, the website hawks the books and the show, the books cite the show, and the show cites the books--a perfectly contained conceptual universe in which there's never the slightest hint of doubt. The instructions are so clear and unnuanced as to be absolute. Over and over, in his writings and on his show, there's a clear message: everything will be all right, if you do what Dr. Phil says.
Dr. Phil sells certainty. In an ever more uncertain world, a world craving clear direction, certainty certainly sells. But is Dr. Phil really so certain? And is he even offering self-help? Not according to a link on his site's first page, "Legal Disclaimer."
"All material provided on the DrPhil.com web site is provided for entertainment, educational or informational use only, is not necessarily created or approved by a certified mental health professional, and is not intended to be used in lieu of medical or emotional therapy for those in need of psychiatric or emotional care. We suggest you consult an appropriate health care provider or servicer in your community . . . ."
In politics this is called "plausible deniability."
The honorable alternative of self-help is demoted to the adjective "informational," as though to deny any serious intent. The message is: if you follow Dr. Phil's advice, you don't need a doctor--unless of course you do, in which case, Dr. Phil isn't your doctor. It says so in the small print.
The disclaimer makes an admission many of his fans might find disquieting: Dr. Phil does "not necessarily" have much to do with the content of the site that he says should be part of your life; nor does he "necessarily" stand behind its content, nor does any "certified" psychological authority. "Get real," indeed! To get real therapy, or substantial help of any kind, you must look elsewhere.
Before tuning in to Dr. Phil, let me say that during the course of my life, I've seen four "traditional" therapists, amounting to some seven years in the consulting room. The first was Freudian, the second Gestalt, the third Jungian, the fourth--she didn't name it, but it was practical. All four were useful to me, and all four had much in common. The setting, for one: a consulting room is usually smallish and modestly furnished; the decor is tasteful, quiet, comfy; the lighting is gentle, intimate. The physical space between patient and therapist is well defined but living-room close. Two human beings have made an appointment for some serious talk. There are long silences. There are outbursts--I'm free to disagree, free to walk out. I'm paying for a service, which means I have a right to expect something. My therapist and I are protected by laws, both civil and professional, which regulate our boundaries and guard our privacy. Within those boundaries, a personal relationship develops: we have a stake in each other, my therapist and I.
There's nothing more alive than two people sequestered in a room who must deal with each other as human beings, and it's the aliveness of that contact that ultimately heals. Therapy is primarily a private, secluded relationship that develops over time, and therapist and patient must have the patience to get to know each other and to work on complex dilemmas that can only be addressed and solved gradually.
The words patient and patience are connected--both derive from Latin pati, to suffer. This is one reason I regret that the old usage patient has been replaced in psychotherapy by client . Speaking for myself, I didn't feel remotely like a client in therapy. I was a wounded, suffering, panicky person in need of help and healing, and I felt not at all demeaned if the fact of my situation was acknowledged by the word patient. Medical doctors can have "patients," why can't therapists? My being a "patient" also (so I fancied) gave my therapist a little more responsibility and class than, say, a lawyer or a publicist, for whom I'm certainly a "client." I was definitely not a "guest" or a "contestant," as Dr. Phil refers to his TV consultees. In any case, it's through my experience as a patient that I viewed Dr. Phil's TV show.
Contrast the consulting room with a television soundstage. A soundstage is bright--much brighter than it appears on TV. Watch any talk show or sitcom and you'll see that no one casts a significant shadow, barely any shadow at all (a living metaphor that Jungians can have fun with). For people to cast no shadows, no matter how they move, lots of light is required; banks of lights overhead, pointed every which way. Performers (talk-show hosts, actors, newscasters) are used to all this light, but watching TV can't possibly prepare the uninitiated for the bright reality of a soundstage. Dr. Phil's patients/guests--mostly working-middle-class folks from all walks of life--are like deer in the headlights. (Imagine walking into a consulting room and squinting into a thousand-watt spotlight.)
To that unnatural brightness, add a live studio audience. The vast majority of workaday people have never addressed a large room full of strangers. Nothing can prepare most patients/guests of Dr. Phil's for walking onto that soundstage, where their intimate problems will be the subject of "entertainment" and "information," to crib from DrPhil.com's disclaimer.
On that stage, the patients/guests interact with a consummate performer, who's also what we call "a star." They've already invested him with tremendous authority or they wouldn't be there. They've relinquished their privacy in return for his help. Now, under the bright lights, in front of rows of peering strangers and with Dr. Phil himself, they must make their stand. By definition, they're troubled. Now they're also surrounded and outnumbered. Can healing possibly take place in such an arena? What could be further from the environment and process of therapy? Yet these people think they're going to a doctor.
Any TV program, by virtue of its repetition, partakes of ritual. Quiz show and sitcom, newscast and episodic drama, talk show and sports show, each establishes a format and rhythm, enhanced by repetitive theme music, which creates a particular signature. A prime pleasure of television viewing is to sync in with the ritualistic repetitions of each favored program, surrendering to the (usually narrow) spectrum of responses that the program dependably, predictably elicits. A successful program achieves its own defined space, which it repeats and repeats and repeats. Each program is, in an archetypal sense, a kind of Mass, with its own particular and peculiar Communion. You know what's going to happen before you get there, though you don't exactly know--and this knowing-but-not-quite-knowing sustains both the comfort level and the interest.
Dr. Phil's TV show works this form masterfully.
To appear on the show, you send Dr. Phil a home video in which you reveal your troubles. If he and/or his staff chooses your video, they interview you on film, and sometimes place cameras in your home to watch your troubles firsthand and collect clips to be aired on the program. If they decide you're telegenic enough, you're invited on the show, where your average screen time with Dr. Phil is eight minutes (though subjects that are especially telegenic get more).
In those eight minutes, your situation is presented and analyzed, a solution is proposed, and you agree to it--cue up the applause! Dr. Phil has famously said, "I've never been under the impression that we're doing eight-minute cures on television." One wonders if the same can be said of his audience or his patients/guests, since he works so hard to give them precisely the impression that he can cure them.
In any case, viewers know when they tune in that they'll see footage of people much like themselves, beset with various dilemmas, and the footage will conclude with the cry, "Help me, Dr. Phil!" The subjects will be trotted out, talked to and talked about; various products will be hawked. And as the show ends, Dr. Phil will stride up the center aisle, to be greeted by his wife, and the two will walk off hand in hand while the audience applauds. There are variations in the middle, but the beginning and end are invariable.
Such is the essence and core of Dr. Phil's house call.
The opening footage of the first Dr. Phil Show I watched was calibrated to excite fear and disgust in whoever watched it: "nanny-camera" shots of babysitters beating and abusing infants and small children. The viewer couldn't help but think in terms of "monster" and "victim." Monsters and victims are common enough in our world, but in the consulting room, both are subjects to be understood. On the tabloid screen of Dr. Phil, both are excuses for titillation. After overwhelming viewers with this footage, Dr. Phil inserts, with all possible seriousness, "We're not saying that everyone's at risk." What he Âdoesn't say is that there are millions of babysitters, nannies, and day-care workers, and only a tiny percentage of them are abusers. He also doesn't say we live in an economy in which many mothers have to work and have no choice but to employ the services of care providers. Instead, he makes working mothers feel guilty and frightened for a choice they can't avoid.
Immediately after his not-everyone's-at-risk qualifier, he shows staged "docudrama" footage of a true case: a 2-year-old who drowns because of a babysitter's neglect and bad judgment. The footage is far more powerful than the disclaimer. What can it do but excite--and excite is the proper word--guilt and fear in any insecure parent employing a babysitter? Meanwhile, on his soundstage, women who've lost their children to negligent providers, or whose children have been injured by same, sit unhappily in uncomfortable chairs.
What does Dr. Phil say to these grieving, piteous women? With the earnestness of a preacher and the authority of a cop, he tells them, "You've got to turn this thing around. Time heals nothing. It's what you do in that time that begins to heal the loss."
All the poor women can do is nod and, haltingly, agree.
Then Dr. Phil mixes good sense with vague sentimentality, both spoken in that preacher-cop delivery that makes you hang on his every word, never quite knowing whether you're about to be redeemed, arrested, or both. Good sense: "How much you loved that little boy isn't measured by how much you suffer." Vague sentimentality: "You can honor his life by doing a couple of things . . . by finding meaning to your suffering . . . something good has to come of it . . . I don't know what it is for you, but if you use the experience in some way . . . ." What could be more vague, in this context, than words and phrases like "meaning" and "something good" and "in some way"? Even Dr. Phil admits, "I don't know what it is for you." Then he says: "Do you think you're ready to try that?"--as though his "that" is something concrete. They nod. "I'll get you some good professional grief counselors, will you do that?" At last, something concrete. They agree, numbly, their faces set in baffled depression.
But Dr. Phil has just made an interesting admission. They need therapy, which isn't what he does. What he does is spectacle. For isn't it lascivious fun to watch other peoples' embarrassing miseries?
And it works. All our buttons have been pushed; we've been treated to a televised tabloid spectacle designed to arouse one basic feeling: fear. Fear of our surroundings, our neighbors, our world. And fear, as Dr. Phil knows, is a profitable commodity. So he introduces a woman who heads a company that installs nanny-cameras. She describes the price range of her installations and services. Money will change hands. Which hands, we don't know. But the object of the program has been to get fearful parents to spend money--and to spend money on something his guests and viewers probably don't need. What those women really need, even according to Dr. Phil, is grief counseling, i.e., therapy--personal, professional contact, committed to the slow, grueling process of learning to live with tragedy. But that fact gets lost in the program's emotional bath.
A guest's need for therapy is never the message Dr. Phil's viewers are left with. The image the show imprints is that of a tall Texan brimming with certainty--not unlike the present occupant of the White House--who has all the answers and is never wrong.
The Healing Power of Celebrity
For some years now, well before Dr. Phil came on the scene, television has thrived on shows featuring the public exposure of privacy: courtroom and discussion programs in which people from all walks of life--usually, though not always, people of the lower middle class--expose their most intimate difficulties, often in raucous settings. Couples quarreling, mothers and daughters fighting over the same lover, abusers and abused, all indulging in a kind of public celebration of humiliation. What would be anyone's motivation for exposing themselves in this way? Clearly, to be on TV confers a sense of reality and importance upon their lives--for in their subcultures, what's important is on the TV. To be on TV is to be real to oneself; it's to have one's existence confirmed by this culture's arbiter of existence. This is the syndrome on which Dr. Phil thrives.
In fact, he's unthinkable without it. The people who send him videos ("Help me, Dr. Phil!"), as well as those who watch, are counting on the healing power of celebrity itself--the authority of celebrity in our culture. To be closer to celebrity is to be closer to power, and is, symbiotically, to be more powerful. In that sense, Dr. Phil is a magic act, a witch doctor if there ever was one (shaman is the polite word). He confers a whiff of his celebrity upon the people he displays, and, in this form of teleshamanism, that's supposed to effect some measure of cure. His patients/guests hope to feel more real, more worthwhile, by being more of a celebrity and rubbing up against celebrities. They're on TV so they must be important--their shift from anonymity to celebrity will somehow magically help solve their problems.
Dr. Phil is an Â¨uberelectronic daddy-figure, and his audience his children. He creates a relationship that's mere mystification. You can have no relationship with a human being named Phillip McGraw. You're "interactive" (as the fashionable phrase goes) with an image called "Dr. Phil"--psychology's Barbie Doll--on which you can project all the help you crave.
A show devoted to two boys obsessed with sports--basketball for one, football for the other--demonstrated perfectly Dr. Phil's ability to use his guests to display his particular brand of teleshamanism. Both boys had good grades in elementary school, but now, in the early stages of high school, they do nothing except play sports, and their mothers are desperate. Before introducing the first boy and his mother, Dr. Phil endorses and heavily plugs the movie Coach Carter, to be released later that week. He even shows clips. The movie depicts the true story of an inner-city high-school coach who, by all accounts, had a tremendously positive effect on his young players.
Then Dr. Phil introduces, to the adulation of the audience, the actor Samuel L. Jackson, who plays the coach. Then the real Coach Carter comes on. It's no exaggeration to say that the studio audience beams in all this reflected "star"-light--a TV star, a movie star, and a real-life guy who's so great they made a Hollywood movie about him. The screen fairly shimmers with celebrity-power.
Into this highly charged environment comes a terrified boy (the basketball kid) and his almost equally intimidated mother. The boy is convinced that he's going straight from high school into the NBA, though he admits he's not an exceptional player, not the best on his high school's team. In short: he's delusional. "When I can't play basketball," he says, "it's like I'm a drug addict." The kid himself makes the connection between basketball and drugs, but nobody picks up on it. That would be too much like therapy. Never is it suggested that the onset of adolescence and the slow realization of the kind of world he'll soon be asked to confront on his own has terrified this boy so deeply that the only place he feels safe is on a basketball court, and the only safe and meaningful future he can imagine is as an NBA player, shielded by money and celebrity from the rigors of the world.
This child is now harangued by Samuel L. Jackson, Dr. Phil, and Coach Carter, who lets slip the only cogent sentence of the hour: "You can't solve a problem on the same level as the problem."
Tell that to Dr. Phil.
The quips of the movie star and the star therapist get immediate audience applause, while the kid stares into the TV monitors on the soundstage with a fixed look. Of course he agrees to anything they say to him. What choice has he? How many frightened high school kids could stand up against all that star-power?
And Dr. Phil's solution to the boy's problem? A video is shown of a player on the same team as the boy's hero, telling him how important school is. Then he's told that if he gets his marks up, he can go to an NBA play-off game and meet his hero. Nobody displays the least interest in what the kid actually feels, or recognizes that he's feeling anything at all. Everybody tells him what to do, and he just nods agreement.
In the next segment, the football-obsessed kid, who thinks he'll be drafted into the NFL directly upon graduation, gets the same treatment. Then both boys are given jerseys identical to those of their heroes and assured that, if their marks go up, they'll get to meet their heroes. The problem is being addressed on the same level as the problem (and isn't that the essence of "self-help"?). But in reality, the problems of those boys aren't being addressed at all. They may be coerced into getting better grades, but how will intense exposure to the object of their delusions do anything but deepen their delusional desires? How does this "treatment" address their fears?
They sit there, beside their mothers, with the jerseys on their laps and their problems "solved" by superexposure to celebrity of every conceivable variety. How this might help families watching who have the same problem isn't addressed, and with good reason. And what's actually happened? Two terrified children have been exploited for the promotion of a movie.
One might well ask why the studio audience doesn't rise up in arms about such exploitation. But like the "guests," the studio audience has a great deal invested in Dr. Phil. They're invested in seeing the show they expected to see--the ritual they're accustomed to, enacted for their benefit, in their presence. If they didn't believe in the efficacy of Dr. Phil, they wouldn't be there. It would take an exceptionally self-possessed person to get disgusted and walk out, and the camera--the all-seeing eye of the program--wouldn't record their exit.
And yet, and yet . . . I wonder about Dr. Phil. His sincerity seems unfeigned. While it's hard to believe that he's oblivious to the crassness of his enterprise, it's equally hard to believe that he Âdoesn't intend good. Nevertheless, meaning well doesn't excuse his means. A therapist friend said to me, "The show isn't cynical." Sorry, no. The show is cynical. Deeply and fundamentally cynical. It's cynical in direct proportion to how much it pretends not to be cynical.
Whether Dr. Phil himself is cynical--that's another issue. He may not have had the patience to practice psychotherapy, as he's famously said, because he may sincerely believe that digging into the depths is a waste of time. That's surely a defensible position. But the show is a different matter. Not only does the show ignore the depths, the show ignores the danger signs. Further, the show goes out of its way to ignore danger signs. That's cynical.
The Depths of Shallowness
Addressing a problem on the same level as the problem, and thereby deepening the problem, is one of Dr. Phil's formulas. Case in point:
Â In January, Dr. Phil displayed six overweight women desperate to slim down to fit into their wedding dresses. In fact, some of them had scheduled their weddings at least once before, but canceled because they felt too overweight to walk down the aisle. Dr. Phil treated this strictly as a weight problem. The idea that they might not be losing the weight because they were frightened of getting married never came up.
These women were presented as "contestants," who, if they met Dr. Phil's weight-loss goals, would win upgrades of their wedding rings and many other gifts. "I'm going to throw every resource I have to help you lose the weight." "This isn't about willpower, it's about programming." "The wedding day is often the biggest day of a woman's life. All eyes are on her. Now there's a big problem if she's--too big." The implication being: her family and friends, and his family and friends, can't love or approve of her unless she's of an acceptable size.
Dr. Phil doesn't know or care or question why being fat is such a shaming thing in America, or why it's unhealthy. He's content to exploit the culture's loathing of fatness (even while we're a culture of fatties).
What does Dr. Phil tell these fleshy women? "The only way you can fail is to stop talkin' to me. 'Cause if you keep talkin,' I'm gonna keep pushin'." Dr. Phil says outright that he's The Answer. He's The Guarantee. His claim is to be Therapy personified. "The only way you can fail is to stop talkin' to me."
And the audience is delighted at the announcement that a copy of Dr. Phil's bestselling weight-loss book is under each and every one of their seats. Almost as an afterthought, he informs us all that the book is "out in paperback now, by the way." By the way, indeed. Of course these women should lose the weight; obesity, some studies show, is as unhealthy as smoking. But health is barely mentioned, much less stressed.
It's about fear. And it's about money. This program not only played upon the fears of these women--and of the millions like them viewing at home--but Dr. Phil used his considerable charisma to reinforce their fears and their shame, so that millions more would buy his book.
Dr. Phil may be sincere. He may himself be stuck in the illusions that he's selling. But the show isn't about therapy. It's about selling. And its immense popularity is, in large part, about buying. Dr. Phil exploits a consumer society's delusion that you can buy something--a book, a pill, a "programming" regimen--that'll fix your broken, sad life.
What may the Dr. Phil phenomenon mean for psychotherapists?
In one sense, nothing. Patients walk into your consulting rooms every day beset by illusions (as I certainly have), and Dr. Phil, if he comes up at all, is just one more illusion you need to help them through.
In another sense, a lot. Dr. Phil is the opposite of you. With, according to his website, 22 million books in 37 languages, countless hours of internet log-ons, plus (when you include reruns) an infinite number of television hours worldwide, he takes his viewers and readers to the limits of simplification. If they need to go beyond the banal and simple, they need you. Which is to say, they need the patience to be patients--they need the gradual fix, the personal touch. The working therapist is everything Dr. Phil isn't.
So the most famous psychotherapist in the world is the most famous therapist in the world precisely because he doesn't do therapy. And therein lies the secret of his phenomenal success. Therapy is personal, and messy, and takes time. What Dr. Phil sells is standardized, and efficient, and takes eight minutes. Therapy is expensive, and insurance covers less and less of it. Dr. Phil's website and TV show are free, and you can purchase the books at a discount at Border's. You can buy Dr. Phil, or click him on your remote. Your assumptions and defenses can remain intact, because, unless you're one of his unlucky guests, you're always at a safe distance from him. Therapy is serious work. Dr. Phil, by his own disclaimer, is entertainment--given that you're entertained by the heartbreak of strangers.
"Get real," counsels Dr. Phil.
But, alas, those two words take us back to where Dr. Freud began: What is the nature of human reality? What does it really mean to "get real"? And then the complications start. And where complications start, Dr. Phil stops.
Dr. Phil--the Anti-Therapist.
Michael Ventura's biweekly column appears in the Austin Chronicle . Letters to the Editor about this article may be e-mailed to firstname.lastname@example.org.
by Richard Simon and Mary Sykes Wylie
In 1966, Jon Kabat-Zinn, a graduate student in molecular biology at the Massachusetts Institute of Technology, was walking down one of MIT's endless, pallid-green corridors when he spotted a flyer advertising a talk about Zen by somebody named Philip Kapleau. A former reporter at the Nuremburg War Crimes Tribunal, Kapleau had spent years practicing Zen in Japan, and was about to publish a book, The Three Pillars of Zen, that would become a classic text for American students of Buddhism. Kabat-Zinn was a very bright, hard-driving, 22-year-old kid from New York City, the son of a distinguished research immunologist, who was just starting out on his own promising scientific career. He had no idea what Zen was or who Kapleau was, but, in a sea of notices posted on one of the huge bulletin boards lining the corridor, this flyer somehow called out to him.
There were only five or six others at the talk, Kabat-Zinn writes in his new book, Coming to Our Senses. He doesn't remember much about what Kapleau said, except that conditions in a traditional Zen monastery sounded basic to a fault--primitive, no central heat, and freezing cold in winter. But Kapleau explained that within six months of moving into the monastery, his chronic ulcers went away, never to return. Kabat-Zinn was startled to hear that ulcers--a physical ailment--could clear up without medical treatment. This fact seems to have sparked in him some barely-conscious surmise about the mind's power to affect the body that would later form the nucleus of his own vocation.
More important to Kabat-Zinn at the time, however, was something he remembers about the way Kapleau himself demonstrated the power of paying attention as if it really matters . This orientation to being in the moment, embodied by Kapleau and at the heart of the ancient Buddhist practice of mindfulness meditation, sounds pretty mild today--taught as part of meditation and yoga classes in every "Y" in America--but it was radical stuff in 1966. It apparently evoked in Kabat-Zinn a deep curiosity about the possibility that simply being fully aware of each moment as it happens could subtly but profoundly transform the entire quality of life. As he began his own daily practice, Kabat-Zinn started to discover for himself how meditation can take you deeply into the living, pulsing heart of reality, the bodily, down-home feel of your minute-by-minute, second-by-second existence.
Today, nearly 40 years after that portentous afternoon talk, Kabat-Zinn is acknowledged as one of the pioneers in mind-body medicine--a field that integrates ancient spiritual traditions like yoga and meditation with mainstream medical practice. In 1979, Kabat-Zinn established the Stress Reduction Clinic at the University of Massachusetts Medical Center, the first center in the country to use meditation and yoga with patients suffering from intractable pain and chronic illness. Since then, the clinic--now housed in the Center for Mindfulness in Medicine, Health Care and Society (CFM) in the Department of Medicine--has treated about 16,000 patients and trained about 5,000 medical professionals, 30 to 40 percent of them M.D.s. More than 250 similar programs have been set up at other major medical institutions around the country. At least 1,000 research studies on mindfulness-based stress reduction (MBSR) are in print in peer-reviewed journals, showing it can reduce chronic pain, high blood pressure, serum cholesterol levels, and blood cortisol, and alleviates depression, anxiety, post-traumatic stress disorder, and eating disorders. MBSR can also change the way emotions are regulated in the prefrontal cortex and alter the immune response to an influenza vaccine. In short, Kabat-Zinn has been instrumental in bringing a body of practices and beliefs, once the considered a fetish of spiritualized hippies, right into the mainstream of contemporary medical practice.
Finding A Calling
At the time of his first exposure to Zen, Kabat-Zinn was very much on the intellectual fast track and engrossed in the pursuit of scientific knowledge. Nevertheless, he was beginning to question the entire edifice of academic science and the hyperintellectual, highly abstract, amoral worldview it spawned. Like thousands of other students of the era, he was deeply embroiled in the movement opposing the Vietnam War then beginning to inflame campuses all over America. And, like them, he was becoming disenchanted with what the best scientists of his era were actually doing with their sharp intellects--creating the next generation of highly sophisticated and lethal weapons systems.
He was dismayed that the world's most brilliant scientists, many of whom were on his own campus, could be so sophisticated about science, yet so unsophisticated about the nature of the mind that produced the science. "We use all these fancy instruments, which are extensions of the senses--electron microscopes, radio telescopes, spectrophotometers--to study the world, but we haven't paid much attention to who's doing all this studying. Who's doing all this knowing? What's the mind of the scientist? We were, and are, smart in a lot of ways, but idiotic in a lot of other ways," he says.
By the time Kabat-Zinn finished his dissertation, he'd been studying Buddhism and yoga for about four years and knew that the standard life of an academic scientist wasn't for him. His academic advisors got a hint that his career trajectory might be a tad unorthodox when they saw that the first page after the title page of his Ph.D. thesis on molecular biology contained only the aphorism, "He who dies before he dies does not die when he dies." He spent about half the time allotted to the defense of his dissertation answering the committee's questions about what he meant by those 12 words, delivering an earnest and high-minded exposition on Buddhist thought in the process.
It was all very well to get hooked on Buddhism and mindfulness, but a young Ph.D. still has to go out and make a living. If, after years of studying with the world's biggest brainiacs, he didn't now want to take his appointed place among them, what, exactly, did he want to do? Kabat-Zinn would spend the next eight or so years trying to figure that out.
He taught science as a substitute junior-high-school teacher--occasionally teaching classes from a yoga headstand to keep his students' attention--then taught biology to nonscience majors at Brandeis, did research on anesthetics at Harvard Medical School, and, finally, secured a post-doc in cell biology and gross anatomy at the University of Massachusetts. Part of the reason he took the position was to apply what he learned dissecting cadavers to increase his yoga students' understanding of how yoga postures affected the inner structures of the body.
All these years, he focused on the question of what he was meant to do, what job--"with a capital 'J'"--he was supposed to have on this planet. He never felt that his training as a scientist had been a waste of time; on the contrary, he believed that, somehow, science would figure into whatever he ended up doing--but what might that be? He'd heard architect-visionary Buckminster Fuller say that the seeker after a vocation should ask him- or herself, "What can I do that isn't going to get done unless I do it, just because of who I am?" This question obsessed him, becoming the subtext of all his meditations, the koan he lived with for 10 years.
The answer finally began to come to him while he was working in the U Mass anatomy department, where he had the opportunity to talk to doctors and go on rounds with orthopedic surgeons. What did the surgeons do to help their patients deal with intractable pain that drugs didn't help, he wanted to know. Send them for physical therapy, was the answer, though it didn't usually work very well. Patients tended to passively accept physical therapy, the way patients generally accepted drugs or any other medical treatment, as something being done to them to make the pain go away. In difficult and longstanding cases, when these interventions didn't work, patients felt themselves progressively ground down by their chronic pain. And Kabat-Zinn soon found that most of the doctors, of whatever specialty, had patients they could no longer help, didn't know what to do with, and secretly hoped would just go away.
At about the same time that he was discovering this little-advertised fact about the limitations of high-tech medicine, Kabat-Zinn embarked on a two-week Vipasana meditation retreat getting up to practice in the cold at 3:00 a.m., suffering the all-consuming discomfort of sitting cross-legged and motionless for hours and days. One morning, an idea serendipitously struck him with all the force of a keisaku --the wooden stick used by Zen teachers to administer a bracing, but physically harmless, whack on the back to wake up sleepy or daydreaming sitters. As he recalls, "It was on the 10th day, or something like that, and after all of those years meditating on what my job on the planet was, I suddenly thought, 'Oh my God, I could bring all this stuff--meditation, mindfulness, yoga--into the hospital!'" In a sudden epiphany, Kabat-Zinn could see the entire plan unfolding in his head--how these techniques could be taught to chronic-pain patients in a hospital setting and to healthcare workers from other hospitals and clinics, who could teach them to their own patients. Mindfulness training wouldn't necessarily relieve pain, but it could transform the experience of pain, help people change their relationship to it and thus soothe their suffering, even when no drug or medical treatment made any real difference.
But would these peculiar ideas fly back at U Mass Medical? There was already a relatively small, but nicely growing, body of literature suggesting that meditation and yoga could influence physiology. Studies in the early '70s by Harvard medical professor Herbert Benson, for example, had shown that practicing Transcendental Meditation promoted physiological relaxation and lowered blood pressure. So, when Kabat-Zinn broached the idea of teaching meditation to pain patients, the head of the pain clinic, the assistant director of the orthopedics department, and the director of the primary-care clinic, all agreed to send in patients right away. Soon after Kabat-Zinn began his one-man, two-day-a-week program in an office borrowed from a physical therapist, the chief of medicine (royalty in the hierarchical world of the medical establishment) came down and asked him if he wanted to run the program through his department--a vote of confidence, if there ever was one! Kabat-Zinn soon began gathering together a pool of "interns"--anybody in the hospital who wanted to learn about this new thing--developing in the process a small core team to run the rapidly expanding program.
How was it that Kabat-Zinn was allowed to try a decidedly fringy approach on patients in the absence of any professional credentials in this line of work? Or as he puts it, "How the hell did somebody with no training in clinical medicine or psychology, no credentials, and no license, get to work with medical patients?" He was given carte blanche partly because he was passionate and articulate, and also because his Ph.D. in molecular biology from MIT with a Nobel Laureate dissertation advisor provided an entrÂ´ee in professional circles, even if it didn't have much bearing on his new job.
While the program was a "clinic," in name only when it began, today, it stands proudly housed in its own spacious quarters, with the full staff of directors, instructors, administrators, receptionists, and bureaucratic billing procedures of any self-respecting hospital department. Still, the basic content of the program has hardly deviated from what it was at the beginning. While patients are greeted with open-hearted kindness and authentic presence, they're also asked to commit themselves to full participation in the eight-week program--go to weekly classes, meditate for at least 45 minutes six days a week (using tapes provided), and attend a day-long, silent retreat in the sixth week.
The results patients experienced in the new clinic were almost immediate. One doctor told Kabat-Zinn, "You did more for my patient in eight weeks than I've been able to do in eight years." People with all kinds of medical and emotional conditions reported that they slept better, were more relaxed, and were less anxious. Persistent headaches went away, blood pressure dropped, and pain often decreased. What Kabat-Zinn had done for them was "astounding," they told him, "a miracle." To which, Kabat-Zinn, ever the stern empiricist, constitutionally allergic to both mysticism and hero worship, would reply, "Don't use that language. I didn't do anything for you. You did it yourself. All I did was arrange the conditions and give you enough support and encouragement and tools to do it."
The skills the clinic taught patients were hardly the stuff of science. Nonetheless, from the get go, science counted for Kabat-Zinn, who realized that if he wanted to have any impact on the world of medicine, his clinical cases would have to be backed up by solid research. So he quickly began learning how to do outcome studies in behavioral medicine. By 1983, he and his colleagues were publishing research papers and monographs on treatment outcomes related to chronic pain, anxiety, cancer, immune function, heart disease, and trauma. In a 1988 landmark study, he and Jeffrey Bernhard, chief of dermatology at the U Mass Medical Center, demonstrated that patients undergoing ultraviolet-light treatment for psoriasis--a chronic and unsightly skin disease--healed four times faster if they'd been meditating in the lightbox. The study powerfully suggested that, at least in some circumstances, the activity of the mind could speed healing of the body and save money in the bargain; in some cases, the meditating psoriasis patients needed many fewer treatments than did their nonmeditating cohorts. Meditation also reduced the incidence of skin cancer caused by the UV treatment.
A Well-Kept Secret
During the next decade, the clinic quietly went about its operations, attracting little fanfare in the wider world. As Kabat-Zinn recalls, "The work was a really well-kept secret. Nobody knew what we were doing, and no one cared. It was just fabulous--a kind of golden era, without all the challenges brought by notoriety or fame or whatever you want to call it." Then, in 1990, Kabat-Zinn published Full Catastrophe Living, a book describing the program at the Stress Reduction Clinic and his experience with the power of mindfulness training to help people cope with stress, pain (physical and emotional), and illness. With a preface by Buddhist monk Thich Nhat Hanh and plenty of testimonials from physicians and medical professors on the cover, the book blended ancient tradition, modern science, and Kabat-Zinn's own reassuringly commonsensical approach that appealed both to experienced students of meditation and people who'd never heard of it. It almost immediately began to attract a devoted readership, and has gone on to sell about a half-million copies.
HASH(0xc8dee0c) Full Catastrophe Living also caught the attention of celebrated television journalist Bill Moyers, who included Kabat-Zinn's Stress Reduction Clinic in his five-part PBS television series Healing and the Mind. The film crew shot about 54 hours of film for a 45-minute segment featuring the clinic, an improbably riveting piece of filmmaking, particularly considering that a great deal of the "action" consists of one chronic-pain patient silently meditating. "The film was its own guided meditation on television," says Kabat-Zinn, "and captured the feeling and tone in the room in a way that, I think, entrained the 40 million people who saw it to intuitively resonate with what they were seeing and feeling."
If the book made waves, the PBS special started a deluge. The hospital had to set up a special phone bank to deal with the onslaught of inquires about the clinic, which numbered well over a thousand calls in the month after the show. As many as 40 percent of the callers were doctors, many of whom said they didn't know what they'd seen, but whatever it was, they wanted it. Within six months, Kabat-Zinn and his staff set up a larger, more accessible training program for doctors and patients.
In 1994, Kabat-Zinn published Wherever You Go, There You Are, a kind of meditation on meditation, which has sold, to date, 800,000 copies. This January, his new book, Coming to Our Senses, about the power of mindfulness as a means to social change, will be published.
Although retired from his position as professor of medicine and executive director of the Center for Mindfulness in Medicine, Health Care and Society, Kabat-Zinn continues to be involved with his colleagues in pursuing a range of studies on the impact of mindfulness-based stress reduction on such conditions as prostate cancer, hypertension, asthma, fybromyalgia, chronic fatigue, and irritable bowel syndrome. They have also just completed, but not yet published, a paper on the impact of mindfulness training in Spanish and English on inner-city residents, and are writing a paper on a project looking at the practice of mindfulness in prisons.
In all of this blizzard of work and work in progress, one fact stands out: Kabat-Zinn is as much a scientist who also meditates, as he is a meditator who does science. In a world that prefers its distinctions to be clear-cut and mutually exclusive, he's someone who's successfully built bridges between different worlds and worldviews.
And a bridge-builder between wildly different ways of looking at the world inevitably embodies certain paradoxes. A student and practitioner of an ancient spiritual tradition, he's suspicious of the word spiritual, because he thinks it obscures and mystifies more than it reveals. In his view, while meditation may ground people in the fundamental reality of their being, in another sense, it's nothing special. In fact, practicing mindfulness may be the most democratic of skills. "Anybody can meditate," Kabat-Zinn says. "You don't have to be a college professor." And you don't have to be a Buddhist. Although many people assume that he's a Buddhist, he prefers to describe himself as a student of Buddhist meditation.
His entire career has been devoted to bringing this practice home, into the life of anybody who wants to find some peace of body and mind, some sense of clarity and calm, even in the midst of enormous challenges. "My interest has been to find a way to make mindfulness available to regular people, people who are suffering in one way or another, and who may benefit from mobilizing inner resources they may not even know they have."
In the following interview with Networker editor Rich Simon, Kabat-Zinn, who'll be a keynote speaker at the Networker Symposium in March, discusses the "science" of meditation, the nature of inner freedom, and the distinction between mindfulness and psychotherapy.
--Mary Sykes Wylie
Psychotherapy Networker: In Coming to Our Senses, you try to show the connection between the Eastern knowledge tradition of meditation and Western science. Could you start off by explaining what one has to do with the other?
Jon Kabat-Zinn: Western science, for the most part, has devoted itself to studying nature and what's observable in the outer world. Basically, meditation is about bringing the same kind of systematic discipline to understanding inner phenomena, and that, too, is a legitimate field of investigation for science. You could call it the science of subjectivity, of first-person experience, of interiority.
For example, my colleague and friend Richie Davidson is involved in inviting Tibetan monks who've devoted their entire lives to meditation practice into his laboratory of affective neuroscience at the University of Wisconsin to be studied by various means while they're meditating. What he's found is that these monks have an extraordinary ability to describe the inner terrain of subjective experience with reliability and objectivity. They can tell you exactly what's going on inside them when, for example, you're picking up changes in the fMRI scanner. When one of these monks says, "My mind is stable," you can actually see stability on the brain scan in that moment. And when the scan reads a shift activity associated with a particular meditation practice, they're able to reproduce the shift voluntarily in almost no time.
This isn't a question of having them meditate for an hour and then measuring the change in the brain pattern. They can shift into very different states and corresponding brain patterns every 90 seconds. By contrast, if you ask college students hooked up to the same equipment what they're experiencing in the mind, as a rule, they just don't know. They're not such reliable reporters on inner experience, and show much less coherence in their brain patterns or the ability to change them at will.
PN: In Coming to Our Senses, you also shoot down a number of what you consider to be popular misconceptions about meditation. What are these misconceptions?
K-Z: First of all, I wouldn't say "shoot down"--that's a little violent for my taste. But people do have a lot of misunderstandings about meditation. As it's become more popular in the West, it's also become loaded down with a lot of images, associations, and connotations that aren't necessarily useful. One common misunderstanding is that meditation is some kind of interior maneuver into a special state of relaxation, as if you're throwing a switch in the back of your mind and then you're in the "meditative state." But mindfulness is really about bringing awareness to virtually any situation or any circumstance or any mental state. It's not about staying in any one particular state. You practice it just to be awake.
Now we all have the capacity to be awake, but that wakefulness is usually so fleeting because we're so used to distracting ourselves or propelling ourselves or repelling ourselves that we normally don't do very much to feed that tiny little flame of recognition that awareness is.
PN: I remember years ago seeing Bill Moyers nonplussed on his PBS special when, after he asked you whether the purpose of meditation was to slow down the mind, you answered, "There is no purpose to meditation. As soon as you assign a purpose to meditation, you've just made it just another activity to get someplace or reach some goal." What did you mean?
K-Z: What I was emphasizing there was the nondoing element of meditation, getting away from the goal-oriented thinking that takes up so much of our lives. But, of course, in a larger sense, the purpose of meditation is really just to know yourself. In our everyday lives, we're not really aware of knowing as the fundamental organizing principle of who we are. So we're always trying to get stuff to complete ourselves, without recognizing that we may already be complete. And even if we need to work everyday to get food or problem-solve or handle the other stresses of being a human being, we can do that best by bringing the entirety of our being to bear on whatever we may be doing.
Most of us are usually out of touch with the present moment to some extent. We all create a certain kind of story about ourselves, and then proceed with our lives without realizing that, in doing that, we've removed ourselves from the actuality of living itself. We're so caught up in the story of "I," "me," and "mine" that we lose what's best and deepest in ourselves. That creates a huge amount of suffering and alienation. And, basically, meditation says that's unnecessary. The Buddha, who you could say was a great scientist of the mind, taught, based on studies in the laboratory of his own experience, that it's possible to liberate ourselves from many of the habits of mind that contribute to that suffering and alienation. Meditation offers us a chance to taste or feel or smell the actuality of our experience without all the stories we usually associate with it.
PN: But how do you live without a story? Are you saying that meditation is opposed to what modern neuroscience is telling us about the brain's apparent predisposition to organize our experience through story?
K-Z: What I'd say is that meditation enables us to reconstruct the stories we live by to make them more accurate and larger than they'd be otherwise. Of course, meditation doesn't give you different parents. Your mishigas (this is a technical Buddhist term) is going to be your mishigas the rest of your life. But meditation helps us to recognize that we're bigger than we think are. And it helps us to come to our senses, to wake up, to realize what's actually going on in the realm of experience.
Let's say we take the sense of our own breathing--because so many meditative traditions start with the breath for a variety of reasons. It's part of the body. It's close to home. You can't leave home without it. So you start to pay attention to the breath. You don't need to be "mystical" or "spiritual" to do that.
So, if you start to pay attention to something as simple as the breath, you all of a sudden notice some really dramatic and shocking things. You can do this as an empirical scientist. The first thing--never mind for the moment who's the "I" that's watching--but the first thing that happens is that "someone" notices that it doesn't take long for the mind to go off someplace else and lose the breath completely. Breath is still going in and out, but there's no awareness of the way it feels. That then gets noted because some corner of the awareness sooner or later remembers or detects, "Oh, wait a minute. I was supposed to be on my breath for these five minutes as if my life depended on it, and here I am emphasizing something or other or obsessing about this or that. What just happened?"
So then you notice what's on your mind, whatever it is. But instead of beating yourself up and saying, " I'm a bad meditator," the exercise would be more like, "That's interesting. I said I was just going to stay with the feeling tone of the breath, not thinking about breath, but just the sheer sensation of the belly rising and falling, or the feeling of the air passing by the nostrils, and five seconds don't go by and I'm off someplace else." Noted. Back to the breath. There you go again. Another five seconds go by. You're off someplace else. You rapidly come to realize this is a habit. "This is part of the way my mind is wired. Holy smoke. I can't even focus." Well, that, in itself, is very interesting data.
PN: Thus the "inner scientist."
K-Z: Yes. Life itself becomes your laboratory. This little experiment of observing your own breathing for five minutes can be quite revealing, and humbling. It's like, "Oh, I may think I'm free, but actually my mind is at the mercy of whatever crosses my field of vision, my hearing, or smelling, or whatever." There's nothing wrong with that. I'm not judging it. I'm just saying it's interesting to notice. It's not about good or bad.
So what we're saying is, for a moment, let's just see if we can be with our direct experience and not label it all. Just note it. Just see. The mind wanders. You bring it back. The mind wanders. You bring it back. The mind wanders. You bring it back. The mind wanders. You don't want to bring it back anymore. You're bored with it already! A minute has gone by. I get the idea. I'm not interested in meditation. Or, I'd rather be thinking whatever. I'm busy. And then something strikes you. "Holy smoke. This is kind of like the native space of my mind. When I want to bring it to something really important, say an emotional issue, relationships, work, or anything else, I'm bringing that same mind. It's like it has no capacity to get out of its own way or be more spacious, be more stable, more calm and open, or be less reactive and judgmental."
As I say, that's interesting. You know how long it takes for you to realize that? Less than five minutes, because in five minutes, the mind will wander an infinite number of times, or close to an infinite number of times, especially if you're living a busy life.
PN: At the same time that meditation has become so popular, I know so many therapists who insist that it does nothing for them. For whatever reason, they don't get what you're trying to describe here. How do you convey to people like that what meditation has to offer?
K-Z: Certainly, I hear from people all the time who say things like, "I just sat there and it was just nothing. Why would I waste my time doing that?" One of the best lines was from one of my patients at the clinic who said, "I might as well be ironing the couch."
Now I don't like to "sell" meditation or give people a sense of "Just meditate and these are the things that you'll feel." From my point of view, that's much too goal oriented. But I'd say that, at the most fundamental level, meditation can show you how to cultivate intimacy with your own body and be in what the Buddhists might call "right relationship" with it.
Many of us are just really encapsulated in our head and in thought, while our bodies are kind of on their own. Then when we experience pain or disease, we may realize that we're actually in an adversarial relationship with our own body. We may be obsessed or preoccupied with its appearance. Or when our body does something we don't like--like come down with disease--we want to drive it to the hospital and have it fixed, as if it were an automobile.
In our clinic, many people learn through meditation that the body is the fundamental ground of our relationship to the world, even if, most of the time, we're not paying attention to it. Through meditation, they learn to call on deep inner resources for healing that are biologically available to all of us.
I, Me, Mine
PN: What about how meditation shifts our experience of personal identity?
K-Z: Moment to moment, we're usually flitting around, living inside our heads. You might think about it this way: if you wanted to look at the moon, for instance, and you put your telescope on a waterbed, you wouldn't really have very much success focusing on, or even finding, the moon; your instrument of observation would first need to be stabilized. In the same way, if you want to understand something about the nature of your own life, then you have to learn to stabilize your mind.
But when you begin to meditate, you soon realize that your major instrument for understanding both your relationship with the outer world and your relationship with the inner world is so much more unstable and chaotic than you usually notice in everyday life. Pretty soon, you come up against this basic mystery that some people can spend a lifetime ignoring: who is this "I" who's doing all this experiencing? After all, if you ask biologists looking at how the 100 trillion cells in the body interface with each other, they'll probably tell you that it's an impersonal process--there's no "person" in there. Yet, somehow, out of this three pounds of meat we carry around inside our heads, we get the idea that there's an "I" involved in all this. Yet you can't find that "I" anywhere by looking at all those cellular interactions. It's an emergent phenomenon, so to speak, that comes out of the complexity of it all.
Maybe because it's all so complex, lots of people develop some reified notion of themselves and live their life based on some kind of diminished story of who they are. You can live a great deal of your life in delusion of one kind or another and miss altogether the larger mystery of being human. What meditation does is help us find a way to embrace our interconnections with the outer and inner worlds. It's what Whitman was talking about when he wrote, "I am large, I contain multitudes." Yet most of us feel small, and, if we contain multitudes, they're often at war with each other.
We're all out of a painting by Marc Chagall--figures floating in the air, twisting in this huge spaciousness that surrounds our lives. There's no solid, reified, absolute "me" that we can build a fort around. Meditation teaches us how to become at home in this groundless domain, like a fish in the water. We discover that we don't need to have the usual artificial props of our "identity" to ground us, when we realize that the ground actually is itself also floating.
PN: As you say this, I keep thinking of where we started this conversation and the connection between meditation and the scientist's drive to find order in the world.
K-Z: What I'd say about that is that meditation helps us find the relationship between the chaos and order that are both part of our lives. As we were saying earlier, the mind is chaotic: our focus keeps shifting, seemingly uncontrollably, from moment to moment. But inside of that chaos, at any and every level, you also find order. And then if you look inside that order, you find some other level of chaos. The interesting thing isn't to be too ordered--that's actually a state of stasis or death. But if the body gets too chaotic, you'll be in atrial fibrillation or a complete state of mania. Living systems are continually at the edge of chaos. That's why meditation can teach us the deepest lessons of what it means to be alive. It shows us how to surf the wave between the chaos and the order. Even when it's very, very turbulent, meditation helps us find the sweet stillness inside the wave. That's what I call being awake.
Ultimately, meditation teaches us that if you bring mindfulness to the present moment, you have more ways of seeing that are fresher, and you're less likely to be caught in conditioning. Then, of course, the next moment you'll get caught again. So that moment's already gone, and there's another one for you to experience. The question is always, "How am I going to be in right relationship, or wise relationship, to this moment at the level of the body, at the level of the mind, at the level of feelings, at the level of perception?" And it's all one piece: it's not fragmented. And that's why I say meditation isn't a technique that you deploy to get to some kind of special state. It's a way of being in your life that's embodied and awake, and without agenda. It's not about trying to get somewhere. I guess the way to put it is that you are where you are.
Therapy and Mindfullness
PN: As the man said, wherever you go, there you are.
K-Z: Exactly. Then your luggage is another story.
PN: What's the difference between the kind of mindfulness that you're describing and what therapists are trying to accomplish in their work?
K-Z: I know many therapists who are incredibly empathic with their patients and extremely good at listening and not being judgmental. They know how to make things spacious and cultivate calmness in the relationship, but they sometimes don't admit that they themselves haven't come close to dealing effectively with their own suffering. And their own therapy doesn't help all that much. Perhaps this is why many therapists are drawn to the interface between mindfulness and therapy as much for themselves as for their patients. In therapy, there's a huge amount of the compassion perspective, but the wisdom perspective--the ability to get beyond the psychological story of "me"--can be a long-term challenge, or even an obstacle.
PN: Can therapy provide anything that mindfulness doesn't?
K-Z: I think there is something that only good therapy provides: the opportunity for a relationship with someone who's honest and loving, yet recognizes the sovereignty of the individual other. That's a huge difference. In our clinic, we see 25, 30, 40 people at a time in our classes. We don't have the resources to spend hours a week talking with people about their personal issues, although we do to a degree, as required.
People who've been badly harmed may need that kind of attention at a much more in-depth level than we can provide; others may not. But the primary relationship in Mindfulness Based Stress Reduction is actually their relationship with themselves, not with us. That's why we start with the body and the breath. The challenge is, "Can I befriend myself?" In that sense, the therapeutic aspect of meditation doesn't start with the therapist: it starts with your relationship to your own experience. And if you hold that in a way that's benign and compassionate, some people might say you can serve as your own therapist, although putting it that way seems to pathologize something that's only a natural part of being human.
PN: From the viewpoint of mindfulness, what happens in the "relationship" that you're referring to? What is it exactly that the therapist offers the client?
K-Z: The therapist is trying to help the patient cultivate a kind of autonomy that's already here, that's at his or her core, even though the patient might not be able to experience it yet. Holding that kind of space for the other person is probably the most compassionate thing one human being can do for another. That's what I'd call love. But what's most important for therapists, in my view, is to approach what you do with real caring, and not just as a job to get done. That means truly recognizing that every single person is different, even though you've seen a million cases that may seem the same. That means experiencing each moment with them as unique--and that may mean reminding yourself, "This is a human being, who's always more than any small story she may be telling herself at any moment."
PN: What you're describing is what some therapists might call bringing a "spiritual awareness" into their work. But in your books, you seem to go to great lengths to avoid using the term spiritual.
K-Z: You're right. I almost never use it. In fact, in Wherever You Go, There You Are, the last chapter is called, "Is Mindfulness Spiritual?" There tends to be a lot of confused thinking about spirituality that comes perhaps out of a natural hunger we may have for some kind of transcendent experience. When I hear another person describe someone as "very spiritual," I often just find myself laughing inside. Who isn't "spiritual" when it comes right down to it?
Usually, it's just a projection. I prefer to use the term "fully human," rather than talk about "spirituality." For me, it's a way of speaking about waking up to what's deepest and best in all of us, and already here, if only sometimes in seed form, undeveloped.
PN: You don't need to go to some magical, rarefied place. We're already there.
K-Z: Not "there." There's no "there." We're talking about "here." What's happening right here is what it's all about. It's about realizing, with a hyphen-- real-izing --making real, what's actually already so. We're largely ignorant of those dimensions of our being that tend to be bigger than our thinking. As I ask in Wherever You Go, There You Are, is having a baby a spiritual experience? Is being a father a spiritual experience? Is chopping vegetables a spiritual experience? Is taking a crap a spiritual experience? If they're not, then what's a spiritual experience? Anything can be a spiritual experience. It depends on the quality of the being that's in the experiencing.
So if you're thinking, "Oh, now I'm having a spiritual experience. I can't wait to tell people about it," it's really just another way to show how accomplished you are--another advertisement for yourself, to yourself, more clinging without awareness to those knotty personal pronouns I, me, and mine. Acquiring new "spiritual experience" can be just another addition to one's CV, as opposed to actually becoming more aware of one's being and the obstacles to wisdom, compassion, and the ability to be balanced and helpful in the world. To me, it's utterly simple: the most spiritual people I've ever met don't look "spiritual." They're not trying to be spiritual. They're just who they are, whatever the costume.
by Barry McCarthy
At 52, Alex was worried about the state of his penis. He missed the easy, automatic erections he once had and sometimes was mortified by his inability to be hard enough to engage in intercourse. With every such "failure," he felt his sexual confidence waning. Alex was sold by the Viagra ads on TV and went to his internist, who was more than willing to give him a free sample of pills.
The first three times Alex took Viagra, it worked as promised. "Whew," Alex thought, glad he hadn't raised this touchy issue with Lorraine, his wife of 28 years. He felt he shouldn't have to talk about sex; he'd always been a take-charge kind of guy, who certainly had never had any problems on this issue, thank you very much.
But the fourth time Alex took Viagra, he got an erection and was able to insert, but he promptly began to lose his erection and felt very panicky. Lorraine tried to restimulate him, but Alex pushed her away. This wasn't supposed to happen. How could the "miracle drug" not work for him? It had to be Lorraine's fault.
The Truth About Erections
Adolescent and young-adult men learn that erections are easy, automatic, and most important,Â autonomous. They can experience desire, arousal, and orgasm without help, or even active cooperation, from their partners. Alex subscribed to the common belief about male sexual performance on demand: "A real man is able to have sex with any woman, any time, any place."
The Viagra media blitz both feeds and amplifies this male performance standard. The blue pill, the ads suggest, will restore to you the automatic, autonomous, rock-hard erections of your twenties. But even for successful Viagra users, 20 to 35 percent of the time, the drug doesn't work. More striking still, the estimated dropout rate for Viagra within a year is between 40 to 80 percent of users. This is caused by unrealistic expectations of returning the man to 100-percent guaranteed erections. Medication cannot be a stand-alone intervention. As with so many one-shot, simplistic solutions to human emotional problems, the promise of cure far exceeds the reality.
The real news
behind the Viagra sensation is what it says about men's misunderstanding of their own sexuality as they age. Young men can and often do get erections quite suddenly and unexpectedly, simply when a good-looking body swims into view or a sexual fantasy wafts through their brains. They don't need the stimulus of physical touch to become aroused. Middle-aged men expect the libido of young studs long past the time when their bodies can keep up the pretense.
Contrary to media myths, movies, and male braggadocio, sex is seldom 100-percent successful, especially as men age. The most important fact for our sex-saturated society to accept is that 5 to 15 percent of all sexual experiences among well-functioning couples are dissatisfying or dysfunctional. In other words, contrary to the cultural myth of ecstasy all the time as the norm, almost all happy, sexually fulfilled couples experience lousy sex occasionally.
Unfortunately, men who haven't gotten beyond the equation of sex = erection = intercourse become more vulnerable to sexual dysfunction as they age. Often, like Alex, they're only one or two flagging erections away from feelings of sexual inadequacy. Indeed, for men, the largest factor causing inhibited sexual desire is fear of erectile failure. By a certain age, men need to learn what most women already know: good, satisfying, pleasurable sex, particularly in midlife and beyond, is more a matter of intimate teamwork than of physical hydraulics.
Once "the machine" fails to function a few times as it always has, confidence in the normal cycle of positive anticipation, satisfying sex, and a regular rhythm of sexual contact is lost. Instead, a new, more pernicious, cycle takes its place: anticipatory anxiety, tense and failed intercourse performance, embarrassment, and sexual avoidance. The man becomes an anxious, self-conscious, sexual spectator, the worried and passive observer of his penis--a state of mind that's the very antithesis of eroticism.
It was at this juncture--post-Viagra failure--that Alex and Lorraine, at Lorraine's insistence, came to see me, a couples therapist with a subspecialty in sex therapy.Â As often occurs, Lorraine was more enthusiastic about addressing the sexual problem than Alex. He felt embarrassed, ashamed, and demoralized. In the first session, I normalized both the erectile dysfunction (ED) and his experience with Viagra.
Alex was used to being the expert, not the one seeking help, especially from Lorraine. Yet Lorraine was more than willing to help resolve this problem, as long as Alex didn't blame her for the ED. She enjoyed sex and wanted it to be a part of their lives. She missed not just intercourse, but the whole range of sensual, playful, and erotic experiences that went with it. At the end of this session, I gave them a chapter from Rekindling Desire , which I wrote with my wife, Emily, to reinforce the need for them to work together in the face of a common enemy: inhibited sexual desire and performance anxiety.
After the initial couples session, I see each person for one individual sexual-history session to tell his/her story of their psychological and sexual life. Then we have a couple-feedback session.
From those sessions, I developed a therapeutic plan aimed at revitalizing desire and helping Alex regain confidence in his erections. Alex needed to stop seeing sex as a competitive performance--in which Lorraine's existence and sexual feelings were almost incidental--and begin approaching his wife as his dearest, most intimate, friend, with whom he could share pleasure, eroticism, and arousal.
Alex had always felt that he shouldn't have to have his penis stimulated by Lorraine--his erection should be sufficient unto itself. I told him he'd need to be open to her penile stimulation. Even more potentially alarming for a man who so valued his own sexual self-sufficiency, Alex needed to learn to piggyback his arousal on Lorraine's arousal. Alex began to learn that it was both normal and manly to use the "give-to-get" pleasuring guideline, so that the more responsive and aroused she was, the more aroused he became. This was good news for Lorraine, who'd been afraid to let herself get too aroused for fear Alex would feel even more pressured to perform. I pointed out that a woman's arousal can be a major aphrodisiac for the man. The key to achieving change was Alex's willingness to try new ways of thinking about and experiencing sexuality, and Lorraine's enthusiasm for renewed intimacy and eroticism.
I asked Alex to tell Lorraine the emotional, physical, sexual, and interpersonal factors he found most attractive about her. Then he was to make one to three requests--not demands--that would make her more attractive to him. The next day, they were to switch roles, and Lorraine would do the same with Alex.
Alex told Lorraine that he appreciated her spunkiness, her interest in working with him to revitalize their sexual life, her work skills, her help in caring for his mother when she was dying, and her staying in good physical shape and carrying herself in an attractive manner. Making requests was harder for Alex. His three requests were to give penile stimulation before he had to ask for it, to be sexually receptive and responsive, and to not talk about sexual problems when in bed. Lorraine enthusiastically agreed to them.
Lorraine wrote out the characteristics she found attractive about Alex. Alex had developed such a negative sexual self-esteem, it was difficult to accept Lorraine's genuine compliments. From this exercise, Alex realized how contingent on performance his sexual self-esteem was.
Alex was surprised by Lorraine's first request--to remember her birthday and plan something special--but was quite willing to do this. The two sexual requests that followed--that Alex shower before a sexual encounter so that oral sex would be more inviting and that he not apologize if they didn't have intercourse, but to just hold her--were more difficult for him. Alex realized with surprise that he had no idea that these three issues bothered Lorraine. But as he thought about it, they really were pretty easy requests to fulfill. At this stage, both Alex and Lorraine felt more positive and hopeful, realizing this wasn't an adversarial process; they could be on the same intimate team.
Lorraine had previously only achieved orgasm occasionally during intercourse. I suggested they refrain temporarily from having intercourse, and encouraged them to explore erotic stimulation to orgasm. She reported that she enjoyed the pleasuring exercises she and Alex were trying and found it considerably easier to reach orgasm, and they were more intense and satisfying than those she'd experienced during intercourse. Alex was ambivalent about these developments. He was glad that he could please Lorraine sexually, but afraid that she might not enjoy intercourse as much as he. I assured Alex (and Lorraine reinforced this) that intercourse would continue to be an integral part of their sexual relationship. The problem wasn't intercourse, but Alex's pass-fail approach to it. The goal of therapy was, in part, to help him realize that there was more to making love than successful intercourse.
Alex was enjoying the pleasuring exercises, especially the comfort exercise, in which they engaged in playful (mixing nongenital and genital) touch in the living room with music on but no talking. The hardest thing for Alex to accept was that instead of being the Lone Ranger, he enjoyed and even needed Lorraine's stimulation.
The most helpful exercise was the "wax and wane erection" experience. When Lorraine stopped manually or orally stimulating him, Alex's penis would become somewhat flaccid. While this sent him into a panic at first, after coaching in therapy, he let himself simply relax and allow Lorraine to begin stimulating him again until his erection came back. The realization that relaxation was a more powerful erection enhancer than force of will was itself reassuring.
We reintroduced intercourse into Alex's and Lorraine's sex life at the sixth therapy session. I emphasized that intercourse wasn't the preeminent goal of sex, but a natural (though not inevitable) extension of the pleasuring/erotic play/arousal process. The experience now was far different from their previous pattern of foreplay before intercourse, in which Alex paid less attention either to Lorraine or to his own erotic sensation than he did to the problematic state of his penis. Once Alex accepted that Lorraine's arousal could be an aphrodisiac, he let go and was involved with the erotic flow, piggybacking his arousal on how sexually excited, aroused, and orgasmic she was. Lorraine's being highly aroused with Alex's stimulation was a powerful erotic stimulant.
Bridges to Desire
An important component in sex therapy is helping couples do what I call "building bridges to sexual desire--his, hers, and theirs." Bridges to desire means discovering individual cues, places, and scenarios that are sexually inviting for one or both partners. Alex was so used to the idea that the signal that he wanted sex was his erection that the concept of planning sexual dates or consciously inviting sexual encounters was foreign to him. Lorraine took the lead in setting the mood to be sexual. She compared making a sexual date to preparing to attend a play you really want to see: you plan for it, you set aside time to do it, you look forward to it, and, chances are, you enjoy actually doing it.
One of Lorraine's favorite "bridges to desire" was to shower with Alex and have a lit, scented candle in their bedroom. Alex's favorite bridge to desire was cuddling on the couch and becoming more and more turned on before moving into the bedroom. The bridge to desire they both enjoyed the most was a weekend away, especially to a romantic B&B with access to hiking trails. The different environment was a major desire cue for Alex. He liked variety and new challenges in other aspects of his life, and came to understand that was true sexually as well.
Now Alex was beginning to gain a more realistic sense of middle-aged sexual expectations. In one of our last sessions, Alex announced proudly that, a few nights previously, they'd not been able to finish intercourse but, for the first time in his life, he felt okay about it. He comfortably laughed it off and went to sleep cradling Lorraine in his arms. He and Lorraine were enjoying a broader sexual repertoire, and he valued a richer, deeper sexuality, even if it didn't always lead to intercourse.
Couples who are comfortable with their sexuality can genuinely value erotic play that leads to high arousal and orgasm for one or both partners, as well as sensual scenarios--mutual massage or close cuddling--that allow warm, loving, physical encounters without involving arousal or orgasm. Sharing intimacy, pleasure, and eroticism makes sexuality more human and genuine. The man who accepts and values a variable, flexible approach to sexuality in his fifties will inoculate himself and his marriage from sexual problems in his sixties, seventies, and beyond.
This isn't to say that medical interventions to facilitate erections and intercourse shouldn't be used. There are times when men are so anxious that they can't relax, even with coaching. Until the process of allowing their erections to wax and wane comes more naturally, Viagra can be used and integrated with pleasuring exercises as a backup resource. But these medications will only work--in the sense of contributing to a richer, more satisfying sex life--if a man values sharing intimacy and eroticism in both intercourse and nonintercourse sexuality.
The man who has a more spacious, healthy understanding of sex knows that it involves two people, not two sets of sex organs (with his clearly the most important). Sexuality is as varied as human interaction in general, encompassing many daily, intimate moments of tenderness, sensuality, pleasure, and mutual teamwork with a beloved mate and friend, not just the culminating drama of intercourse. Real-life, adult sex isn't a kid's game--it can be really well played only by men who've gained some wisdom and experience about the world and themselves, even if their penises are no longer the envy of the locker room.
By David Treadway
While it may not be true that men's brains reside in their penises, their fascination with their own performance in the bedroom often gets in the way of the shared experience of sexuality with their partners. One woman in my practice said it very succinctly to her husband: "I feel like you're more involved with your thing than you are with me."
Barry McCarthy's discussion of his excellent work with Alex and Lorraine gets to the heart of the matter. Middle-aged men who are naturally losing some of their performance abilities may be drawn to some quick pharmacological fix, but, ultimately, they need to learn that sexuality isn't about performance. In fact, boys of all ages need to learn this message. As women become freer to express their own sexuality, performance anxiety in men is skyrocketing, and even college men are having more instances of erectile dysfunction.
Both men and women need to understand that men's preoccupation with their sexual performance isn't simply about testosterone and narcissism. Boys still are being socialized in latency to master and deny their neediness, vulnerability, and insecurities. When they go through puberty, all those socially unacceptable and repressed feelings suddenly assert themselves relentlessly below the belt. The tender feelings that little boys have are transformed into the insatiable demands of the ever-present erection. Thus the often voracious sexuality that drives boys and men, frequently experienced by women as impersonal and hurtful, is really an expression of the same yearnings that women bring to relationships: the desire to be seen for who one truly is; the wish to love and be loved without shame.
In teaching Lorraine and Alex how to truly make love with each other, McCarthy is really helping them risk being vulnerable, needy, and insecure together. Alex's fear of Lorraine's disapproval or disappointment and his reluctance to discuss these things with his wife are the real issues. Unfortunately, many men still presume that they're supposed to be skillful sexual partners without ever consulting their partners. Why does it take over a million sperm to fertilize just one egg? None of them will stop and ask for directions.
I confess that Alex and Lorraine's willingness to take direction in the couples therapy and do their therapy homework did give me a case of client envy. My clients frequently have difficulty doing their therapeutic homework, particularly in situations involving sexual intimacy. It would have been useful in this case if McCarthy had added a little more discussion about how Alex, who'd been very private and unilateral in his approach to sexuality, became such a willing participant in the exercises, both with Lorraine and in discussions in front of the therapist. Clearly, McCarthy joined with Alex very skillfully, and I wanted to see a little more how he did that. Unlike the doctors in white coats measuring blood flow with electrodes and prescribing medications, McCarthy is practicing sex therapy based on a strong therapeutic connection that's based on healing the couple's relationship. The case is a helpful demonstration of the limits of pharmacological solutions. Ultimately, it's not Viagra: it's the vitality of relationship that makes a difference in the bedroom.
Despite all the obvious distinctions between men and women, our hearts share the same fears and yearnings. Learning how to hold each other's hearts tenderly is the art of lovemaking.
Barry McCarthy, Ph.D., is a professor of psychology at American University and practices at the Washington Psychological Center. He's the coauthor of Rekindling Desire: A Step-By-Step Program To Help Revitalize Sex . Address: AU Psychology, 321 Asbury Building South, Suite 321, 4400 Massachusetts Avenue, N.W., Washington, DC 20016. E-mails to the author may be sent to email@example.com.
David Treadway, Ph.D., is director of the Treadway Training Institute in Weston, Massachusetts. He's the author of Before It's Too Late: Working with Substance Abuse in the Family and Dead Reckoning: A Therapist Confronts His Own Grief . Address: 228 Boston Post Road, Weston, MA 02493. E-mails to the author may be sent to firstname.lastname@example.org.
Letters to the Editor about this department may be sent to email@example.com.
by Margaret Wehrenberg
"I don't think I want to live if I have to go on feeling like this." I hear this remark all too often from anxiety sufferers. They say it matter-of-factly or dramatically, but they all feel the same way: if anxiety symptoms are going to rule their lives, then their lives don't seem worth living.
What is it about anxiety that's so horrific that otherwise high-functioning people are frantic to escape it?Â The sensations of doom or dread or panic felt by sufferers are truly overwhelming--the very same sensations, in fact, that a person would feel if the worst really were happening. Too often, these, literally, dread-full, sickening sensations drive clients to the instant relief of medication, which is readily available and considered by many insurance companies to be the first line of treatment. And what good doctor would suggest skipping the meds when a suffering patient can get symptomatic relief quickly?
But what clients don't know when they start taking meds is the unacknowledged cost of relying solely on pills: they'll never learn some basic methods that can control or eliminate their symptoms without meds. They never develop the tools for managing the anxiety that, in all likelihood, will turn up again whenever they feel undue stress or go through significant life changes. What they should be told is that the right psychotherapy, which teaches them to control their own anxiety, will offer relief from anxiety in a matter of weeks--about the same amount of time it takes for an SSRI to become effective.
Of course, therapists know that eliminating symptomatology isn't the same as eliminating etiology. Underlying psychological causes or triggers for anxiety, such as those stemming from trauma, aren't the target of management techniques; they require longer-term psychotherapy. However, anxiety-management techniques can offer relief, and offer it very speedily.
The unpleasant symptoms most likely to be helped by medication are the very ones that the 10 best-ever anxiety-management techniques are intended to correct. They fall into three typical clusters:
- the physical arousal that constitutes the terror of panic;
- the "wired" feelings of tension that correlate with being "stressed out" and can include pit-of-the-stomach doom;
- the mental anguish of rumination--a brain that won't stop thinking distressing thoughts.
A therapist armed with methods for addressing these clusters can offer her anxious client the promise of relief for a lifetime, if she knows which of these "10 best" techniques work for which symptoms, and how to use them.
Cluster One: Distressing Physical Arousal
Panic is the physical arousal that sends many clients running for Xanax. Sympathetic arousal causes the heart-thumping, pulse-racing, dizzy, tingly, shortness-of-breath physical symptoms that can come from out of the blue, and are intolerable when not understood. Even high levels of acute anxiety that aren't as intense as outright panic attacks can constitute very painful states of arousal. Physical symptoms of anxiety include constant heightened physical tension in the jaw, neck, and back, as well as an emotional-somatic feeling of doom or dread in the pit of the stomach. The feeling of doom will always set off a mental search for what might be causing it.
Bad as these symptoms are, there are methods that, when followed regularly as lifelong habits, offer tremendous relief.
Method 1: Manage the Body. Telling anxiety-prone clients to take care of their bodies by eating right, avoiding alcohol, nicotine, sugar, and caffeine, and exercising is a strikingly ordinary "prescription," but not doing these things can undermine the effectiveness of other antianxiety techniques. During the summer before Ellie went off to college, for example, she'd almost eliminated her anxiety by practicing deep, calm breathing and learning to stop her catastrophic thinking. She'd even been able to stop taking the antianxiety medication she'd used for years. But two months after starting college, her panic attacks came roaring back with a vengeance.Â She came back to see me, but quickly let me know that she was going to call her psychiatrist for another Xanax prescription. I suggested that, before she made the call, she spend a couple of weeks keeping a "panic profile"--a journal recording when and under what circumstances she suffered from panic attacks.
A couple of weeks later, she came to my office smiling broadly. "I figured it out," she said, grinning as she showed me her panic profile. She'd traced her panic attacks to days after she drank heavily and smoked cigarettes--neither of which had she done over the summer while living in her parents' house. Also, her caffeine use had risen dramatically while at school--to help her wake up for classes after partying at night--and her diet had devolved to pizza and doughnuts. She really didn't want to give up these habits, but keeping the journal had reminded her that her anxiety symptoms are physical, and that calming her body had defused her panic triggers once before. Taking care again to eliminate CATS (caffeine, alcohol, tobacco, sugar + Nutrasweet), Ellie got back on track without returning to meds. The simple rule--manage the body--must remain a first priority throughout treatment for anxiety. Ellie had a major relapse when she let go of routine self-care.
Therapists who remember that humans have bodies as well as minds are much likelier to inquire routinely about ongoing self-care, including sleep and exercise. They're also more willing to help clients overcome their reluctance to follow a self-care routine. A tip to remember for female clients who experience a resurgence of symptoms in spite of the fact that they're managing their body is to consider hormonal changes. Pregnancy, postpartum changes, hysterectomy, and interruptions in cycles may contribute to anxiety. The slow process of menopause, which may begin over a wide range of ages, is another factor to consider. Shifts in thyroid function also contribute to shifts in anxiety. They can occur at any age, and predominate in female clients. Therapists need to be particularly alert to what might be going on in the body when a client who was previously doing well starts having trouble.
Method 2: Breathe. Ellie and I next reviewed her use of diaphragmatic breathing to ward off the panic. As it turned out, she'd forgotten how helpful breathing had been when we first started working together, and had quit doing it. Now, not only did she suffer again from panic, but she thought it was too powerful to be relieved merely by breathing deeply. She'd begun to panic just thinking about feeling panic. I've often found that when clients say that breathing "doesn't work," it's because they haven't learned to do it correctly. Or once having learned it, they've given it up when they felt better, believing that they no longer needed to do it. By the time they feel anxiety returning, they're convinced that something so simple can't possibly be really effective. Therefore, it's important for therapists to emphasize and reemphasize that breathing will slow down or stop the stress response, if the client will just do it.
The biggest block to making breathing truly helpful is the time it takes to practice it until it becomes an ingrained habit. Most relaxation books teach clients to practice breathing once a day for 10 minutes, but I've never found a client who actually learned how to do it from this one, daily, concentrated dose. I don't teach clients to breathe for lengthy periods until they've practiced it for very short periods many times a day. I ask them to do the conscious, deep breathing for about one minute at a time, 10 to 15 times per day, every time they find themselves waiting for something--the water to boil, the phone to ring, their doctor's appointment, the line to move at the bank. This will eventually help them associate breathing with all of their surroundings and activities. This way, they're more likely to actually remember to breathe when anxiety spikes. Ellie needed a review session in breathing to help her get back on track.
Method 3: Mindful Awareness. Since the return of her panic attacks, Ellie had also begun to fear that she'd always be afraid. "After all," she said, "I thought I was cured when I went back to school, and now look at me! I'm constantly worried I'll have another panic attack." She'd started to give catastrophic interpretations to every small, physical sensation--essentially creating panic out of ephemeral and unimportant changes in her physical state. A slight chill or a momentary flutter in her stomach was all she needed to start hyperventilating in fear that panic was on its way, which, of course, brought it on. She needed to stop the catastrophic thinking and divert her attention away from her body.
Like most anxious people when they worry, Ellie was thinking about the future and wasn't in the moment. She felt controlled by her body, which required her to be on the lookout for signs of panic. She'd never considered that she could manage her body--and prevent panic--by controlling what she did or didn't pay attention to. But, in fact, by changing her focus, she could diminish the likelihood of another panic attack. A wonderful technique, this simple "mindful awareness" exercise has two simple steps, repeated several times.
1. Clients close their eyes and breathe, noticing the body, how the intake of air feels, how the heart beats, what sensations they have in the gut, etc.
2. With their eyes still closed, clients purposefully shift their awareness away from their bodies to everything they can hear or smell or feel through their skin.
By shifting awareness back and forth several times between what's going on in their bodies and what's going on around them, clients learn in a physical way that they can control what aspects of their world--internal or external--they'll notice. This gives them an internal locus of control, showing them, as Ellie learned, that when they can ignore physical sensations, they can stop making the catastrophic interpretations that actually bring on panic or worry. It's a simple technique, which allows them to feel more in control as they stay mindful of the present.
Cluster Two: Tension, Stress, and Dread
Many clients with generalized anxiety disorder (GAD) experience high levels of tension that are physically uncomfortable and compel them to search frantically for the reasons behind their anxiety. They hope they can "solve" whatever problem seems to be causing anxiety and thus relieve its symptoms. But since much of their heightened tension isn't about a real problem, they simply waste time running around their inner maze of self-perpetuating worry. And even if their tension does stem from psychological or neurobiological causes, there are ways to eliminate the symptoms of chronic worry before addressing those dimensions. The following methods are most helpful for diminishing chronic tension.
Method 4: Don't Listen When Worry Calls Your Name. Colleen feared I'dÂ think she was crazy when she said, "It's as if my anxiety has a voice. It calls to me, 'Worry now,' even when there's nothing on my mind. Then I have to go looking for what's wrong." And she was very good at finding something wrong to worry about. An executive who had a lot of irons in the fire, she had no shortage of projects that needed her supervision. On any day, she could worry about whether a report had been correct, or projected figures were accurate, or a contract would generate income for her firm. In describing the voice of worry, she was describing that physical, pit-of-the-stomach sense of doom that comes on for no reason, and then compels an explanation for why it's there. This feeling of dread and tension, experienced by most GAD clients, actually comprises a state of low-grade fear, which can also cause other physical symptoms, like headache, temporo-mandibular joint (TMJ) pain, and ulcers.
Few realize that the feeling of dread is just the emotional manifestation of physical tension. This "Don't Listen" method decreases this tension by combining a decision to ignore the voice of worry with a cue for the relaxation state. Early in treatment, GAD clients learn progressive muscle relaxation to get relief. I always teach them how to cue up relaxation several times throughout the day by drawing a breath and remembering how they feel at the end of the relaxation exercise. We usually pair that deeply relaxed state with a color, image, and word to strengthen associations with muscle relaxation and make it easier to cue the sensation at will.
We then use that ability to relax to counteract the voice of worry. Clients must first learn that worry is a habit with a neurobiological underpinning. Even when a person isn't particularly worried about anything, an anxiety-prone brain can create a sense of doom, which then causes hypervigilance as the person tries to figure out what's wrong. Colleen smiled with recognition when I said that, when she was in this state, it was as though her brain had gone into radar mode, scanning her horizons for problems to defend against. I asked her to pay attention to the order of events, and she quickly recognized that the dread occurred before she consciously had a worry. "But," she announced, "I always find something that could be causing the doom, so I guess I had a good reason to worry without realizing it."
She believed the doom/dread must have a legitimate cause, and was relieved to learn that her need to find the cause (when there really wasn't one) stemmed from a brain function. This cause-seeking part of her brain, triggered by changes in her physiology that made her feel dread, in effect, called out, "Worry now!"
To stop listening to that command to worry, I suggested that she say to herself, "It's just my anxious brain firing wrong." This would be the cue for her to begin relaxation breathing, which would stop the physical sensations of dread that trigger the radar.
Method 5: Knowing, Not Showing, Anger. Anger can be so anxiety-provoking that a client may not allow himself to know he's angry. I often find that clients with GAD have an undetected fear of being angry. Bob was a case in point. He had such a tight grin that his smile was nearly a grimace, and his headaches, tight face muscles, and chronic TMJ problems all suggested he was biting back words that could get him into trouble. There were many arenas of his life in which he felt burdened, such as losing out on a promotion and his wife's chronic inability to spend within their budget, but he genuinely believed he was "putting a good face" on his problems. As with other anxious clients, the acute anxiety was compelling enough to command the therapy time, and it would have been possible to ignore the anger connection. However, as long as anger stays untreated, the anxious client's symptoms will stay in place.
When a client fears anger because of past experience--when she remembers the terrifying rage of a parent, or was severely condemned for showing any anger herself--the very feeling of anger, even though it remains unconscious, can produce anxiety. The key to relieving this kind of anxiety is to decrease the client's sense of tension and stress, while raising the consciousness of anger so that it can be dealt with in therapy. I've found that simply being able to feel and admit to anger in sessions, and to begin working on how to safely express it, diminishes anxiety. I tell clients, "To know you're angry doesn't require you to show you're angry."
The technique is simple. I instruct clients that the next time they're stricken with anxiety, they should immediately sit down and write as many answers as possible to this specific question, "If I were angry, what might I be angry about?"Â I tell them to restrict their answers to single words or brief phrases. The hypothetical nature of the question is a key feature, because it doesn't make them feel committed to the idea that they're angry. They may destroy the list or bring it in for discussion, but I ask them to at least tell me their reactions to writing this list. Without fail, this exercise has helped some of my anxious clients begin to get insight into the connection between their anger and their anxiety, which opens the door to deeper levels of psychotherapy that can resolve long-standing anger issues.
Method 6: Have a Little Fun. Â Laughing is a great way to increase good feelings and discharge tension. The problem for anxious clients is that they take life so seriously that they stop creating fun in their lives, and theyÂ stop experiencing life's humorous moments. Everything becomes a potential problem, rather than a way to feel joy or delight.
Margaret was a witty woman, whose humor was self-deprecating. A high-level executive who typically worked 12- to 14-hour days, she'd stopped laughing or planning fun weekends about two promotions back. Her husband rarely saw her on weeknights, and on Saturday and Sunday, she typically told him she was just "going to run over to the office for a little while"--anywhere from 3 to 7 hours. When I asked her to make a list of what she did for fun, she was stymied. Other than having a drink with friends after work, her list of enjoyable activities was almost nonexistent.
Getting in touch with fun and play isn't easy for the serious, tense worrier. I've often found, however, that playing with a child will get a person laughing, so I asked her to spend some time with her young nieces. She agreed, and noticed that she felt more relaxed after being with them for an afternoon. Then I asked her to watch for any impulse to do something "just because," without any particular agenda in mind. When I saw her next, she seemed transformed. She said, "I had an impulse to stop for an ice-cream cone, so I just went out and got it. I don't know when the last time was that I felt like doing something and just did it--no worries about whether everyone else had a cone or whether I should wait till later. It was fun!" Over time, listening to her inner wishes helped Margaret feel that there was a reservoir of pleasure in life that she'd been denying herself, and she began to experiment with giving herself the time to find it.
But Margaret needed to rediscover what she liked after years of ignoring pleasure. For a time, our therapy goal was simply to relearn what she had fun doing. Fun-starved clients sometimes need a "prescription," like "Take two hours of comedy club and mix with a special friend, once a week" or "Plan one weekend out of town with your husband every two months." Not surprisingly, tightly wired workaholics initially need to make fun a serious goal of treatment, something to be pursued with some of the same doggedness they put into work.Â But once they actually find themselves laughing and enjoying themselves, they become less tightly wired, less dogged, and more carefree. Laughter itself is one of the best "medications" of all for tension and anxiety.
Cluster Three: The Mental Anguish of Rumination
The final methods are those that deal with the difficult problem of a brain that won't stop thinking about distressing thoughts. Worries predominate in social phobia, GAD, and other kinds of anxiety, and continual rumination can create nausea and tension, destroying every good thing in life. A metaphor drawn from nature for this kind of worry would be kudzu, the nearly unkillable plant that proliferates wildly, suffocating every other form of life, just as continual worry suffocates clients' mental and emotional lives.
I don't believe rumination is caused by deep-seated conflict in the way anger-anxiety might be; I think it's almost entirely a neurobiologically driven feature of anxiety. What clients usually worry about--often ordinary, day-to-day concerns--is less important than the omnipresence of the worry. Their brains keep the worry humming along in the background, generating tension or sick feelings, destroying concentration, and diminishing the capacity to pay attention to the good things in life. Seeking reassurance or trying to solve the problem they're worrying about becomes their sole mental activity, obscuring the landscape of their lives. Nor can ruminators ever get enough reassurance to stop worrying altogether. If one worry is resolved, another pops right up--there's always a fresh "worry du jour."
Therapy with these clients shouldn't focus on any specific worry, but rather on the act of worrying itself. If a ruminating brain is like an engine stuck in gear and overheating, then slowing or stopping it gives it a chance to cool off. The more rumination is interrupted, the less likely it'll be to continue. The following methods are the most effective in eliminating rumination.
Method 7: Turning It Off. Peter's rumination was the bane of his existence. A mile-a-minute supersalesman with remarkable drive, he had a capacity to fret that could wear out a less energetic person. His mind traveled from one possible problem to another like a pinball that never comes to rest. Ruminating worry preoccupied him so much that he couldn't enjoy being with his children or relax before going to sleep--his last conscious awareness at night was of worry.
In therapy, he had a hard time focusing on just one issue at a time; one worry just reminded him of another and another after that. Before addressing the psychological underpinnings of worry in his life, we needed to find a way for Peter to cool down his brain and halt the steady flow of rumination for a while.
From Eugene Gendlin's Focusing method, I've borrowed the concept of "clearing space" to turn off and quiet the ruminative mind. I ask the client to sit quietly with eyes closed and focus on an image of an open container ready to receive every issue on his or her mind. She's then instructed to see and name each issue or worry, and imagine putting it into the container. When no more issues come to mind, I suggest that the client mentally "put a lid" on the container and place it on a shelf or in some other out of the way place until she needs to go back to get something from it. Once the jar is on the shelf, the client invites into the space left in her mind whatever is the most important current thought or feeling. Perhaps she's at the office and needs to think about a work-related issue, or she needs to shop and should plan what she'll buy, or she's with friends and wants to focus on what they're saying. At night, right before sleep, the client is asked to invite a peaceful thought to focus on while drifting off.
Peter is a man who prefers tangible tools to metaphorical ones, so when he was at home, I suggested that instead of using imagery, he make a written list of the issues he couldn't turn off and put the list in a desk drawer to wait for him overnight, or even place it in his freezer to help him "chill out." Any tangible technique is fine, such as Al Anon's idea of a "God Box" to hold slips of paper, each with a worry written down that the client is turning over to God. The goal of "turning it off" is to give the ruminative mind a chance to rest and calm down.
Method 8: Persistent Interruption of Rumination. Ruminative worry has a life of its own, consistently interfering with every other thought in your client's mind. Thought-stopping/ thought-replacing is the most effective cognitive-therapy technique for interrupting chronic rumination, but I find the key to making it work is persistence . Clients very quickly pick up on the technique itself, but they're always shocked by how rumination can subvert all their good efforts, and by how persistently they have to keep at it to succeed. I've had clients come back and say the technique didn't work, because they'd tried it 20 to 30 times in a day and they still were ruminating. I tell them that they must do it every time they catch themselves ruminating, even if it is 1,000 times a day or more! That's what I mean by persistence.
Darla is a good example. She was a self-described worrywart before she got cancer, but after her diagnosis, her anxiety zoomed out of control. Although treatment was successful and she'd been in remission for some time, she still had constant, negative, racing thoughts about whether her cancer would recur. A really hard worker in therapy, she did every method I suggested, and was ready to use thought-stopping to interrupt her ruminations about cancer. "Remember," I told her, "winning this game is about persistence. Do the thought-stopping exercise every single time you find yourself worrying, no matter how many times you have to do it."
At the next session, she reported her success--she really had radically cut back the amount of worrying she was doing. But it worked only because I'd warned her about how persistent she'd have to be. "When you told me I'd have to thought-stop every time, even if it was 1,000 times a day," she said, "I thought you were kidding. If you hadn't warned me, I'd have given up in despair after about 100 times, thinking it would never work for me. Since you said 1,000, I figured I'd better stay the course. After a couple of days, it got markedly better." Rumination is persistent, and the only way to beat it at its own game, so to speak, is to be even more persistent.
Method 9: Worry Well, But Only Once. Some worries just have to be faced head-on, and worrying about them the right way can help eliminate secondary, unnecessary worrying. Connie knew that her next medical results were going to tell the story of whether she needed surgery. Although there's always a level of legitimate worry about any medical problem, some medical conditions, like high thyroid, create anxiety symptomatology. Connie's medical problems weren't causing the anxiety symptoms, but her anxiety about her condition was getting in the way of her medical recovery. She called the doctor's office repeatedly, until the doctor said she'd fire Connie if she got one more phone call before the test results came in.
Connie was out of control with worry, so we tried out a method that actually had her worry, but worry well--and only once. Here's how that works. The client must: (1) worry through all the issues; (2) do anything that must be done at the present time; (3) set a time when it'll be necessary to think about the worry again; (4) write that time on a calendar; and (5) whenever the thought pops up again, say, "Stop! I already worried!" and divert her thoughts as quickly as possible to another activity.
Connie and I set a 10-minute time limit on our worry session, and then together thought through all the possible ramifications of a positive test result. She covered things such as "Who'll watch the cat while I'm in the hospital?" "Will I have to miss too many days of work?" "Will I need a ride home?" We covered everything from the mundane to the serious, if unlikely, "What if I die while in surgery?"
It's critical to this method to cover all the bases, but 10 minutes, surprisingly, is an adequate amount of time in which to do that. At the end of the worry period, Connie agreed that she had no other worries related to the surgery, so we set a time at which she thought she'd need to think about the problem again. We agreed that the next time she should let the possibility of surgery cross her mind was when the doctor's office called. Until that moment, any thought would be counterproductive. She wrote in her PDA that she could worry again at 4 p.m. on Tuesday afternoon, by which time the results would be in and the doctor had promised to call. If she hadn't heard at that point, then she could start worrying and call the doctor's office.
Having worried well, we moved to the "Only Once" part of the method. She then practiced, "Stop It! I already worried!" and we made a list she could carry around with her that enumerated some distractions to use. While this may sound trite, her brain believed her when she said she'd already worried, because it was true.
Method 10: Learn to Plan Instead of Worry . A big difference between planning and worrying is that a good plan doesn't need constant review. An anxious brain, however, will reconsider a plan over and over to be sure it's the right plan. This is all just ruminating worry disguising itself as making a plan.
Clients who ruminate about a worry always try to get rid of it by seeking the reassurance that it's unfounded. They believe that if they get the right kind of solution to their problem--the right piece of information or the best reassurance--they'll then be rid of the worry once and for all. They want to be absolutely sure, for example, that a minor mistake they made at work won't result in their being fired. In reality, however, a ruminating brain will simply find some flaw in the most fail-safe reassurance and set the client off on the track of seeking an even better one.
One good way to get out of the reassurance trap is to use the fundamentals of planning. This simple but often overlooked skill can make a big difference in calming a ruminative mind. I teach people how to replace worrying with planning. For most, this includes: (1) concretely identifying a problem; (2) listing the problem-solving options; (3) picking one of the options; and (4) writing out a plan of action. To be successful with this approach, clients must also have learned to apply the thought-stopping/thought-replacing tools, or they'll turn planning into endless cycles of replanning.
After they make a plan, ruminating clients will feel better for a few minutes and then start "reviewing the plan"--a standard mental trick of their anxiety disorder. The rumination makes them feel overwhelmed, which triggers their desire for reassurance. But when they've actually made the plan, they can use the fact that they have the plan as a concrete reassurance to prevent the round-robin of ruminative replanning. The plan becomes part of the thought-stopping statement, "Stop! I have a plan!" It also helps stop endless reassurance-seeking, because it provides written solutions even to problems the ruminator considered hopelessly complex.
For example, if Connie, who'd worried well about surgery, found out she did have to have the surgery, she could write out the plan to get ready. The new plan would cover all the issues she'd identified in her worry session, from finding a catsitter to writing a living will. She'd put completion dates in for each step and cross off the items as she did them until the day of the surgery. Then, each time she needed reassurance, the concrete evidence that she had a good plan would enable her to go on to some other thought or activity.
While these techniques aren't complicated or technically difficult to teach, they do require patience and determination from both therapist and client. For best results, they also demand clinical knowledge of how and why they work, and with what sorts of issues; they can't simply be used as all-purpose applications, good for anybody in any circumstance.
But the rewards of teaching people how to use these deceptively simple, undramatic, and ungimmicky methods are great. While clients in this culture have been indoctrinated to want and expect instantaneous relief from their discomfort at the pop of a pill, we can show them we have something better to offer. We can give people a lasting sense of their own power and competence by helping them learn to work actively with their own symptoms, to conquer anxiety through their own efforts--and do this in a nonmanipulative, respectful, engaging way. People like learning that they have some control over their feelings; it gives them more self-confidence to know they're not the slaves of physiological arousal or runaway mental patterns. And what we teach them is like playing the piano or riding a bicycle: they own it for life; it becomes a part of their human repertoire. What medication can make that claim?
Margaret Wehrenberg, Psy.D., has been in private practice as a psychologist and addictions counselor for more than 20 years. She also specializes in trauma and anxiety, working with adolescents and adults. She's the cofounder of the Reflex Delay Institute, and the author of Stress Solutions: Effective Strategies to Eliminate Your Stress. Contact: firstname.lastname@example.org. Letters to the Editor about this article may be e-mailed to email@example.com.
by Katy Butler
Three years ago, a therapy-conference brochure arrived in the mail containing an arresting image of the tenuous act of human transformation. Under the title Shaping the Future, a man with butterfly wings--holding an artist's palette under one arm--climbed up the rainbow he was painting into the air just steps ahead of his dancing feet.
This is how we often feel. Suspended in midair, we don't know how to move from the life we live to the self we wish to be. Ask us to name what we value most, and we may talk about our families, our creativity, our relationships, or our health. Then look at how we really live: overworking, overeating, talking on the phone to someone we say we love while clicking through e-mail, or watching television while our children pester us over take-out cartons of KFC.
Once in a while--perhaps inspired by therapy or a retreat or a friend's heart attack--we may make concerted attempts to be kinder to our spouses, less impatient with coworkers, more loving with our children, or more attentive to our own self-care. But our chaotic 21st-century lives often lack the structure, discipline, and even the raw physical energy required to make the changes stick. After a few weeks of trying something as simple as swimming at lunchtime--never mind reforming our characters--we sag beneath the weight of too much distraction and too little sleep. We know everything except how to live.
In earlier centuries, before the train whistle and the factory siren drowned out the village church bells, step-by-step systems of human transformation were embedded within local religious life. Whatever their limitations, the mosque, temple, and church offered communal, time-tested practices designed to foster altruism and slowly transform character--soft technologies of change, which the religious sociologist Robert Bellah called "habits of the heart" in his 1985 book of the same name.
These customs and ceremonies punctuated the narrow rhythms of village and shtetl life with regular periods of community-wide reflection, celebration, and remembrance. Each week took its shape in the quiet of Saturday's Shabbat or Sunday morning's mass and confession. Autumn brought Days of Atonement to Jewish people as regularly as late winter brought Lent to Catholics and spring the ancient pagan celebrations of the maypole and the morris dance. Inside the thick stone walls of monasteries from Ireland to China, every hour of the day, from meditation at dawn to the last chant by candlelight, was ordered, ritualized, and sacralized. Even the word ordained has its roots in the notion of communal order.
As religion faded in the early 20th century, the freer, secular discipline of the talking cure took its place, widening our sense of choice about who we might become, but rarely providing much practical guidance as to how we might get there.
Now, at the opening of the 21st century, in a culture freed from communal and familial rhythms by 24-hour Wal-Marts, Burger Kings, Nokia cell phones, and DSL lines, the practices that Bellah called habits of the heart are nearly forgotten. They lie in the backs of our mental closets, like robes dusty from disuse, barely serviceable when we put them on for a funeral or a retreat somewhere far from home. Therapy, the modern substitute, has often proven less effective in changing lives than once was hoped.
In this postmodern world of infinite choice and incoherent structure, what practical steps should we take now--a personal trainer? more therapy? feng shui? life coaching? Food Addicts in Recovery Anonymous? martial arts? Zen meditation?--to become the self we see shining in our best moments? How can we learn to live in consonance with what we value most? And how can we construct a ladder to the stars while we stand on its lowest rung?
What Really Matters?
Such questions have long preoccupied the writer Tony Schwartz, who paid a price in the mid-1980s for failing to live in accord with what he valued most. He was a tennis player and a 35-year-old former New York Times reporter--quick, angular, pessimistic, thoroughly psychoanalyzed, and driven--when real estate developer Donald Trump offered him a quarter of a million dollars plus royalties to ghostwrite a book that became a bestseller, The Art of the Deal.
"I did it with great guilt, enormous guilt," says Schwartz, who was raised in a relentlessly secular Manhattan family that valued political activism far more than either money-making or traditional religion. "My wife was pregnant with our second child. I was making $45,000 a year supporting a family in New York, and this was a chance to make a lot more money. I had two sides at war with each other, and what won was the darker, more primitive side--my desire for money, for fame."
The day the book was published in 1987, bookstore staff buyers around the country told The Wall Street Journal that nobody outside Manhattan would read it. They were wrong: it was the Gordon Gecko era of deals and Wall Street greed, and the book hit a nerve and the bestseller list.
Not long afterward, Schwartz woke up in the bedroom of the house he'd bought in Riverdale, just north of Manhattan. The Art of the Deal was number one on the New York Times bestseller list, and well on its way to selling a million copies in hardcover. He'd achieved much of the fame he'd hoped for, and earned enough to think he'd never worry about money again. "And I felt bad, I felt lousy," Schwartz says. "That was what prompted me to write What Really Matters. It was my penance."
For the next eight years, Schwartz abandoned the art of the deal for the heart of the matter. What's a truly meaningful life? he asked. And who could show him how to live it? He flew to California and talked to Michael Murphy about human possibility at Esalen and to Ram Dass about transcendence. He tried meditation at Insight Meditation Society in Barre, Massachusetts, and biofeedback at the Menninger Clinic. He worked with the mind-body back doctor John Sarno, drew on the right side of his brain, and explored his difficulties with intimacy through the Enneagram, the Diamond Heart method, and dreamwork.
When What Really Matters was published, in 1995, M. Scott Peck (author of The Road Less Traveled ) said its last chapter contained "as good a description of wisdom as any I know in literature." But Schwartz had spent all the money he'd earned from The Art of the Deal. He still sometimes woke up in the bedroom of his house in Riverdale feeling pessimistic and driven. And he found his thoughts returning to one of the most prosaic of the people he'd interviewed--a former tennis coach named Jim Loehr.
Loehr was 47 and working at a Florida tennis camp when Schwartz first interviewed him about mind-body approaches to personal change. Raised in a devout Roman Catholic family in rural Colorado but intensely pragmatic, Loehr had attended Jesuit schools before becoming a clinical psychologist and the director of a community mental health agency. There, he'd lost faith in therapy (as he had earlier in religion) as a sufficient force to catalyze change. "I just didn't see it working," he told Schwartz. "I'd watch people get lost in their own conflicts and come out no better than when they started--and often worse."
Loehr--a careful researcher and gifted amateur athlete with no patience for New Age spirituality or wishful thinking--left his agency in the early 1980s to become a sports psychologist in Denver, experimenting with a broader technology of human change. His first private clients were two demoralized professional athletes who went to see him, literally, under the cover of darkness, because they were choking during important games. Cobbling together cognitive approaches and guided imagery, he tried to apply conventional psychotherapy principles to high-stakes athletic performance. "I felt my brain was being squeezed," he says. "I was completely ill-prepared."
Loehr now says he was working in "too narrow a bandwidth. . . . I didn't have any sense of how to connect them to the spiritual dimension--to a notion of their life mission or vision. Nothing in my therapeutic training had led me to that. And I had no sense that even professional athletes could just come apart because they lacked fitness or didn't eat right or hadn't been sleeping. That was completely off the page."
In 1984, after nearly starving to death in private practice, Loehr went to work at the Nick Bollettieri Tennis Academy near Sarasota, Florida--a struggling place full of talented but underperforming teenage athletes with overly ambitious parents. In this unpromising environment, he tried to get the kids to reframe their challenges as opportunities and to practice guided imagery and emotional discipline.
Conventional sports psychology alone didn't work. He saw kids in the late afternoons, after six hours of nonstop tennis competition on top of a lunch of cheap fried food. "Their blood sugar was low, and they'd be tired, angry, upset, and spacey," he says. "No matter how much training I did with them mentally and emotionally, the whole thing was an impossible nightmare."
He first addressed the management of their bodily energy--the raw fuel for every sort of change. He got the school to throw out its doughnuts and deep-fat fryers and to provide healthier lunches and fruit between meals. In the mid-afternoons, he took the kids off the court and into a darkened classroom, where they lay down, closed their eyes, and rested while he played relaxing music.
True to his Catholic upbringing, he also addressed what a less practical person might comfortably call the spirit. He listened to the kids and tried to discover how becoming good tennis players could serve deeper values, like sportsmanship and courage, rather than simply their parents' ambitions--or their own--for trophies, one-upmanship, and fame.
Loehr now says the tennis school was a "living laboratory--a fabulous arena for distilling how the mind, body, and spirit work, where nobody died and there was no real consequence if people didn't get it." He spent six years there. Bringing the scientific experimentalism of research psychology to bear on every factor affecting athletic performance, he worked by trial and error, jettisoning anything--self-hypnosis, for example--that didn't bring measurable results on the court. Oddly enough, his greatest successes came when he got the athletes to adopt a life dominated by secular rituals--a life as repetitive and habitual as that of a 17th-century monk or a modern Marine.
Loehr got his first clue to the significance of what he calls "positive rituals" in 1987, while studying hundreds of hours of videotapes of professional tennis matches to find out what set champions apart from also-rans. It wasn't their raw talent or their strokes, he discovered, but what they did during the seemingly unimportant 15- or 20-second pauses between points.
During these breaks, the less successful players--both among the kids at the training camp and on the professional circuits--dragged their rackets, muttered under their breaths, dropped their heads and shoulders, looked around at the crowd distractedly, or even threw fits. Giving vent to energy-draining emotions like anger and fear, they looked either demoralized or tense.
Champions like Chris Evert, on the other hand, kept their heads high even when they'd lost a point, maintaining a confident posture that telegraphed no big deal. Loehr nicknamed this "the matador walk" after a Spanish matador told him, "The most important lesson in courage is physical, not mental. From the age of 12, I was taught to walk in a way that produces courage."
The tennis champions like Evert would next concentrate their gazes on their rackets or touch the strings with their fingers and stroll toward the back court--focusing, avoiding distraction, relaxing, and effectively letting the past go. After this mini-meditation, they'd turn back toward the net, bounce on their toes, and visualize playing the next point.
These athletes didn't use their limited reservoir of "free will" to tell themselves to relax. Instead of cluttering their brains with that kind of management decision, they followed a behavioral sequence repeated so often that it had grooved itself into the cluster of brain cells close to the brainstem sometimes called the "reptilian brain." Their rituals were automatic, even under pressure. They were done mindlessly, just as an experienced driver steps on the clutch and smoothly shifts gears without thinking about it.
Between-point rituals turned out to have startling training effects. Loehr fitted the athletes with wireless monitors and discovered that the heart rates of the champions dropped as much as 15 to 20 beats between points. They didn't win every game. But because they took real breaks--what Loehr called "oscillation"--they played at the top of their games for years, while talented but volatile players, like John McEnroe, burned out young.
Loehr showed his videos to the tennis kids--and his growing list of private clients--and had them mimic the champions' confident walks. Their games improved. He organized 90-minute cycles of oscillation (intense exertion followed by rest and recovery) into their days, and they improved again. He tailor-made new rituals to address individual weaknesses, and the athletes improved still more.
Outcome research shows that social support--or "team spirit"--makes any change easier to maintain. But most of Loehr's private clients played individual rather than team sports, and the rituals he crafted for them were individual as well. Among his clients was the gifted speed-skater Don Jansen, who'd participated in three Olympics without winning a medal. He came to Loehr convinced he'd never win the 1,000-meter race and that he hated it. Loehr had Jansen repeat "I love the 1,000" hundreds of times, like a prayer, and got him to put the message on a Post-It on his bathroom mirror. At the next Olympic Games, Jansen won the gold medal for the 1,000-meter, breaking the world record.
Loehr became well known for pulling pro athletes out of slumps and helping them break through self-imposed limitations. Golfer Ernie Els, middleweight boxer Ray "Boom Boom" Mancini, and tennis player Martina Navratilova all came to work with him. More than 20 of his Bollettieri students became world-ranked tennis players, among them Andre Agassi, Monica Seles, and Jim Courier. Another client--tennis player Sergi Bruguera--went from a number 79 in world ranking to win two French Opens.
By the early 1990s, Loehr had lost interest. He'd come to the conclusion that he'd helped many athletes develop a shallow "performer self" at the expense of a "real self" that he couldn't fully define. He was tired of working with people narrowly focused on fame, million-dollar endorsements, and the pure pleasure of physical training. Many of his athletes had learned to use some version of the "matador walk" to handle any life problem. If they didn't like an emotional state, they switched to a more pleasant one without further reflection. Living in a social vacuum populated mainly by their entourages, they were accountable to no larger community. "A lot of them," Loehr says, "ended up with no idea of who they really were."
A Larger Self
But could Loehr'sÂ training principlesÂ help people develop a "self" fueled by something larger than self-interest? Could people develop character, altruism, and closer relationships--things that really mattered to them--using the techniques that improved their hand-eye coordination? In the mid-1990s, Loehr began experimenting with nonathletes, especially middle-management employees on the verge of burnout, sent by their Fortune 500 companies to his training center in Orlando, Florida. Another early guinea pig was writer Tony Schwartz.
During his research on mind-body transformation for What Really Matters, Schwartz--an energetic but self-critical tennis player--had spent four days on a Florida tennis court with Loehr, learning to oscillate and to pump his arm in the air and cheer between points, no matter how badly he'd played. By the fourth day, his critical thoughts had quieted; he felt notably more cheerful, and he handily beat one of the young Bollettieri camp's hotshots in a single game.
But tennis, after all, is just tennis.
Now Schwartz wanted to change negative character traits that affected the lives of his wife, his daughters, and other people he loved. Over the next couple of years, extrapolating from what he'd learned from Loehr, he designed three rituals. Every Saturday morning at 8, he'd talk privately with his wife for an hour. Every morning, he'd get up and write down his pessimistic thoughts, and then find the opportunity and challenge within each perceived threat. Before he went to bed at night, he'd make a list of what he was grateful for.
Over the course of a year, the pessimism Schwartz had assumed was indelibly stamped into his character began to melt. He and his wife grew closer; they've since voluntarily extended their "intimacy hour" to two 90-minute sessions a week. "I could've spent 15 years in therapy talking about my reluctance to be intimate," Schwartz said. "Guess what? I just did it and I got better. Once you say--'This is just a muscle that's weak in me--if I developed it, I'd be more productive, I'd feel better, and I'd make other people feel better'--once that's clear, it's common sense. Push the weight."
In the late 1990s, Schwartz did some freelance writing for Loehr and then became his partner. The collaboration was a two-way street: Schwartz's contribution, drawn from his years of seeking, was articulating the connection between ritualized sports training and questions of deeper human purpose. Originally called the Corporate Athlete Training System, their work melded Loehr's technologies of change with Schwartz's ability to talk to businesspeople about a spiritual mission without sounding soft or squishy. Together they came up with a pragmatic definition of spirituality: actions taken in the service of deeply held values and a broader sense of purpose.
The book they cowrote chronicling this work-- The Power of Full Engagement --was featured on Oprah Winfrey's show last spring, and reached number four on the New York Times's "Advice" bestseller list. Perhaps, in a culture with so little common-sense understanding of the importance of daily ritual and rhythm, it touched a nerve. If The Art of the Deal promised something to a culture obsessed with the free market, The Power of Full Engagement spoke to the quotidian chaos of our present lives and their lack of self-care.
The case studies of businessmen and women in the book opened a disturbing window into well-compensated, 21st-century daily life. Many of the participants had high blood pressure and had gained 20 or 30 pounds since college. They rose at 6:30 a.m. and returned home from work at 7:30 p.m., too exhausted to exercise. After a preoccupied supper, they might spend an hour or so answering 50 to 75 business e-mails. Few practiced "habits of the heart" that counterbalanced the demands of their jobs. The concept of oscillation was foreign to them: there were no breaks in their days.
They skipped breakfast and lived on blueberry muffins, candy bars, sandwiches eaten at their desks, and pizza on the run. They drank too much, ate too much, and worked too much. Running on empty, many had lost touch with what they'd once passionately valued or wanted. More exhausted than they knew, they lived and worked in a culture hostile to rest.
Schwartz and Loehr first helped these men and women design rituals to recreate daily rhythms and rebuild raw, physical energy: a walk in the park at lunch, a mid-morning yoga break, a day a week working from home, a workout or snack in midafternoon.
Mindful of the power of environment and context in shaping behavior, Schwartz and Loehr also got them to clear out junk foods from the house, pack trail mix and protein bars in their briefcases, and put water bottles within arms' reach everywhere. Night owls were trained (over the course of a couple of weeks) to become early birds by using bright lights and alarm clocks placed on the far side of the bedroom.
Next, participants moved on to emotional and ethical reforms. Through pen-and-paper exercises, each was encouraged to create his or her own list of important values--a set of do-it-yourself commandments. On questionnaires designed by Schwartz (sample questions: What would you like to have written on your tombstone? Name someone you deeply respect and describe the three qualities you most admire in him or her.) many had named "family," or "respect for others," or "integrity, " or "meeting my commitments" at the top of the list.
In an earlier age, such a reflection on values might have taken place at church or temple, or implicitly, in gossip around the village well. Schwartz and Loehr turned to the Internet. There, family members and coworkers had posted responses to questionnaires. Asked about how the participants behaved in daily life, they often described these stressed men and women as short-tempered bosses and preoccupied spouses. They missed deadlines and made promises they didn't keep. They bought gym memberships and never went. They bought T-shirts for their kids in airports and when they finally got home, yelled at those same kids and reduced them to tears.
When faced with such a moment of truth, many a 20th-century therapist would have focused on family or trauma history, Jungian archetypes, cognitive style, or training in assertiveness or communication skills. Schwartz and Loehr--building deliberately on humanistic psychologist Abraham Maslow's hierarchy of needs--first wanted to know if their clients were eating regular meals and getting enough exercise, rest, and sleep.
Then came training rituals to build what Schwartz and Loehr called emotional, mental, and spiritual "muscles." One man, who left for work before dawn, began writing notes for his children's lunch boxes before he went to bed. A woman executive took storybooks on business trips and read to her kids over the phone while they followed along in a copy of their own. Another participant, troubled by his superficial relationships, made a daily cell-phone call to a friend on his drive home.
A sales manager became a volunteer coach on Saturday mornings for a local Boys and Girls Club. A father scheduled a regular Wednesday night dinner out with his teenaged daughter. A once-scatterbrained woman who frequently missed deadlines began rising at 6:30 to spend half an hour in quiet reflection and planning. An impatient boss learned to recognize the physical signs of her mounting frustration, and made a practice of breathing deeply and repeating "kindness matters" like a mantra under her breath.
These tactics weren't one-session wonders, but trainings--religious practices without the religion--to be repeated without fail until automatic, and then continued for life. Through the unexpected doorway of sports training, Schwartz and Loehr were creating a secular wisdom tradition that didn't require putting on a medieval robe and chanting in Japanese in a barn on the California coast.
When participants returned to Schwartz and Loehr's training center for six-month and one-year follow-ups, some had lost 10 to 15 pounds. Others had cut back on working hours and focused more on managing their energy than pouring in time. One exhausted, irascible, workaholic sales manager--who was on the verge of being fired when he entered the program--lost 19 pounds. Every afternoon, he took a break to call his two daughters and did 10 minutes of deep abdominal breathing; he also worked one day a week from home. "My life has acquired a certain rhythm," said the man, whose job performance reviews had improved markedly.
A religious leader might call Schwartz and Loehr's approach too individualistic--isolated fingers thrust in decaying cultural dikes. To a therapist familiar with cognitive and emotional approaches to change, it may appear ploddingly jocklike, mechanistic, or superficial. There's little specific outcome research to support it, beyond Loehr's proven success with athletes. Schwartz himself acknowledges that so far their work is "more wide than deep."
But this work echoes the common-sense wisdom within Alcoholics Anonymous mottoes like "HALT: Don't let yourself get too Hungry, Angry, Lonely or Tired" and "Fake it till you make it," and "If you want to change the inside, change the outside." It also echoes something Aristotle understood nearly 2,500 years before James Loehr ever hooked up a perspiring tennis player to a heart-rate monitor on a Florida tennis court: "We are what we repeatedly do. Excellence isn't an act, but a habit."
Mechanical as these ways may seem, they confirm what ancient folkways, religious custom, and the old joke about Carnegie Hall make clear: change requires not just inspiration, but practice. We don't simply paint a rainbow into the sky and climb it. We paint the rainbow over and over again until it's strong enough to bear our weight.
Therapy, as practiced in the 20th century, placed many of its bets on inspiration, even on a single session. But even the most dramatic emotional expression and healing is a consolation prize if clients don't or can't then shape a life that satisfies them. People don't just want to understand themselves better, have a paid friend, or quiet their demons. They want to shape their lives. They want to know how to live. And if therapists wish to be seen as experts in the technology of human transformation in the 21st century, they must help them.
This will require building on therapy's emotional and cognitive strengths to embrace a broader, more multidimensional sense of the therapeutic mission. Therapeutic effectiveness will probably increase when powerful, seemingly "unpsychological," factors--such as a client's physical health, work hours, need for rest, connection to a sense of deeper purpose, and practices of daily life--are no longer regarded as background music. A convergence of respected therapeutic approaches (notably cognitive and behavioral therapies, addictions work, and integrative hybrids like ATRIUM work and Dialectical Behavior Therapy) is already integrating elements of this territory. The therapists of the 21st century will continue to create this wider mosaic.
The work of expansion, systematization, and integration can be done without dismissing therapy's existing strengths. Make no mistake: every day, most therapists go where Schwartz and Loehr wouldn't dare to tread. When people are half blind with grief and rage, they're usually in no mood to hear someone talk about establishing a morning ritual. Therapists are natural experts at the delicate dance that in one moment emphasizes therapeutic rapport and emotional repair, and in the next moment turns to behaviors and habits.
This integrative work is necessary work. Forty years of outcome research confirms that no matter what the approach, the efficacy of all therapies remains positive, measurable, and less effective than anyone had originally hoped. The enormous semiprofessional armies on the borders of the profession--the addiction counselors, self-help groups, professional organizers, diet gurus, Narcotics Anonymous sponsors, inspirational speakers, personal trainers, and life coaches--are a testament to therapy's frequent failure to help people shape their actions to fit their ideals. It's into this gap that Schwartz and Loehr have stepped.
They call their work "training," not "therapy." But if therapy means helping people shape their lives, their work represents an implicit challenge to the effectiveness of the therapeutic enterprise. Their preoccupation with the minutiae of human behavior--and their ambition to tinker with it--place them within a larger tradition dating back at least to Sigmund Freud.
The Power of the Unconscious
Like Freud, they're fascinated by the unconscious--and equally at war with it--although they define the unconscious far more broadly than Freud ever did. Freud wanted to replace hysterical misery with ordinary unhappiness. Trained as a neurologist, he gave the name "the unconscious" to the inner forces that shaped human behavior outside verbal awareness. He conceived of these forces as a mass of brain cells located entirely within the skull, a place where hidden motivations and dream logic wrestled in the dark with drives, instincts, memories, and representations of traumatic events. It was a place, like China in the 1960s, knowable only by indirection.
Simply by naming the territory, Freud implicitly refused to accept the prevailing cultural fantasy (inspired by the Renaissance and reinforced by the market capitalism of Adam Smith) that human life is primarily governed by free will and conscious choice. He was attacked for it, but he hoped that his "talking cure" would bring at least some of the unconscious's puzzling and destructive behaviors under human control. "Where Id is," he once declared magisterially, "Ego then shall be."
Easier said than done! The intervening century has made it clear that in defining the unconscious, Freud didn't go nearly far enough. If by "the unconscious" we mean all shapers of behavior outside verbal awareness, we now know that its territory extends far beyond the individual body and brain.
In the 1950s, behaviorists shone a light into one of the hidden valleys of this terrain: the blind, animal responses of stimulus and reward that shape many patterns of human action. In the 1960s, the first wave of effective antidepressants cast a glimmering half-light into another valley: biological influences on mood and behavior.
More terrain came to light in the 1970s, when family therapists and systems thinkers named external behavioral shapers outside the sliver of an individual's conscious mind, such as habitual family patterns of interaction and other powerful forms of social context. In the 1980s, feminist and narrative therapists mapped out the unconscious further still, identifying "the problem that has no name" and addressing the shaping forces of gender, ideology, and power.
In the 1990s, the rapid growth of 12-step programs (whose systems of mutual support often succeeded where individual therapy and white-knuckle willpower had failed) named yet more shaping forces--physical and behavioral addictions, and the individual, familial, and social denial and isolation that often accompanied them. The 1990s--widely known as the "decade of the brain"--illuminated how trauma and perceived stress could reshape someone's neurophysiology, and physiological states could alter cognitive and emotional responses to external events.
Now, at the dawn of the 21st century, Schwartz and Loehr--and an array of life coaches, sports psychologists, meditators, and addiction researchers--have illuminated even more shaping factors, notably basic physical health, deeply held values, and the habitual automaticity of the reptilian brain.
Much of this territory has been ignored by therapists as either beneath their attention or outside their range. But if it can shape behavior so powerfully, perhaps it's time to expand the domain of the therapeutic enterprise beyond the cognitive and the emotional to the spirit, the body, the heart, and the larger human community that contains them all.
A therapist might explore, in an expanded initial clinical assessment., questions about values and physical health. ("Whom do you admire most, and why? Do you exercise? How much sugar and soda do you drink? When do you go to bed? Do you vote?")
The answers may reveal levers of change as decisive to change as knowledge of a clients' moods, family history, and sense of self-mastery. We're animals and social beings and psychological beings and spiritual beings and habitual beings. And therapeutic success is most likely to occur when all these systems are mobilized in a systematic and hierarchical strategy.
This requires expanding beyond a psychological construction of the self--a notion that's turning out to represent only a corner of our being, anyway. Free will--or, as we might call it now, the executive function of the neocortex--has turned out to be a limited commodity, more limited perhaps than even Freud understood. A vast body of research shows that human willpower is quickly exhausted, be it the capacity to resist a repeatedly proffered piece of cake or a toddler's ability to sit still on a sofa for more than two minutes.
Willpower may be limited, but that doesn't make it meaningless. Inside the consulting room, this precious and limited resource of conscious awareness can help clients clarify what they value and how they want to live. If there's a disconnect between ideals and actions--and there usually is--a conversation can begin about the factors that make it so.
That, of course, is only the beginning. Having clarified the motivation for change, it's time to address the mechanics of change more effectively than therapy ever has before. A good therapist can help clients build rituals outside sessions (see sidebar on page 36)--rituals that, over time, may transform the shape of clients' lives. An early bedtime, a daily run, a diet low in sugar, a morning meditation, a ritual walk in the park, an inspirational photograph--even an uncluttered desk or a Daytimer--all can help determine whether our clients' hopes become visions or remain dreams.
Nothing that we've learned about the unconscious suggests that the process will be easy. As anyone who's tried to quit biting her nails or overeating knows, it's far easier to decide to change a habit than to take action for 60 to 90 days in a row to make the changes stick. Destructive, ingrained life patterns like sleeping until noon or yelling at one's children can be as intractable as substance addictions--whether we call them behavioral addictions, compulsions, or just plain bad habits. Relapses are so frequent that addiction counselors consider them part of the process of recovery. Instead of internally blaming our clients as "unmotivated," we can turn our attention to the environmental context and every other factor that contributes to their success or failure.
To stop or change any habit creates anxiety, and human contact, be it in the form of a therapist or a support group, is a proven antidote for it. We're only generations away from the "habits of the heart" of the village well and temple; we remain communal creatures, and the individual-consumer model of change propagated by 20th-century therapy ignores the essence of our humanity. The influence we have on a broader community, and the way we're influenced by it, is another powerful part of the territory of the unconscious, and one that remains only partly explored.
Group support, classes, or psychoeducation may be necessary. Anyone who's ever had a running buddy or attended Alcoholics Anonymous or weighed in at Weight Watchers or chanted in unison at a meditation retreat knows the "entraining effect" of synchronizing one's body, voice, intentions, or actions with those of others. A two-year study of 200 people who made New Year's resolutions (by psychologist John Norcross of the University of Scranton) found the resolutions most likely to persist beyond six months were those with social support.
Change may also require learning the interpersonal effectiveness and communication skills required to say no to weekend work without getting fired, or to reinstate boundaries between work and home and between activity and rest. But once new routines are developed, they can help our clients structure a life worth living, without the cultural arrhythmia endemic to 21st-century life, even among people who've earned enough never to worry about money again.
The Illusion of Perfectability
Tony Schwartz was 35 when he lay in his bed in Riverdale, newly rich but as unhappy as ever, and decided to find out how to live. He was 43 when, in the same house, he finished the last chapter of What Really Matters, tapping out hard-won sentences like "No amount of insight counts for much if it doesn't lead to changes in behavior," and "I often feel I'm swimming upstream, not just against my own resistance but against the culture's, too."
Now, after five years of adapting the rituals of the tennis court to his daily life, much has changed, within him and the larger culture. Ram Dass, whom he interviewed for What Really Matters, is recovering from a stroke brought on by untreated high blood pressure. Michael Murphy, the founder of Esalen, now teaches (with author and Aikido teacher George Leonard) something called Integral Transformative Practice (ITP). The very opposite of a spontaneous Esalen gestalt weekend, it's an integrated series of physical, psychological, intellectual, and spiritual disciplines designed--much like Schwartz and Loehr's work--to be practiced for life.
Schwartz still lives in Riverdale. He's still thin and angular, and he still runs and plays tennis. He isn't as rich as he once was. He's closer to his wife, less pessimistic, and less driven. These days, he's trying to become kinder. Each night, he writes in an "accountability log," about the opportunities he took that day--or passed up--to give to others without thought of return and to value people unconditionally rather than for their potential usefulness. Practice, it turns out, hasn't made him perfect. He remains a work in progress.
This may be the greatest paradox of the expanded definition of the unconscious. The more we know about factors outside our conscious control, the greater the chance we have to influence and channel them. At the same time, the more the Renaissance vision of the perfectability of man recedes into the distance, the more our genuine ability to shape our lives grows, and the more our grandiose sense of complete control wanes. So does Freud's magisterial conception of an Ego that would, after indefinite years of psychoanalysis, supplant the writhing Id.
This paradox invites us to look over our lives, take a deep breath, and hold the reins with a looser hand. We can't control ourselves. We can't even control the factors that control us. We can simply help shape what helps shape us. We influence our lives, but we don't control them. If we want to be effective and happy, we need to include on our lists of values not only "excellence," "effort," and "integrity," but "self-acceptance," "persistence," and "forgiveness." This may be the deeper meaning of the notion of "practice" that the seeker and the tennis coach have stumbled on, and a way to approach the vast unconscious with a deeper emotional wisdom. n
Networker Â features editor Katy Butler, a former reporter for The San Francisco Chronicle , has contributed to Tricycle, The Los Angeles Times , The New Yorker , The New York Times Book Review and The Washington Post . Address: P.O. Box 832, Mill Valley, CA 94942. E-mails to the author may be sent to firstname.lastname@example.org. Letters to the Editor about this article may be sent to Letters@psychnetworker.org.
by William Doherty
Once every decade or so, we therapists awaken from our cultural slumber to see a problem that previously had no name in our clinical lexicon. In previous decades, we came to see sexism and racism as problems deeply rooted in the larger culture and spreading tentacles into family and personal life in ways we could no longer ignore in our work. I have a nomination for the problem of this decade: for many kids, childhood is becoming a rat race of hyperscheduling, overbusyness, and loss of family time. The problem is all around us, but we haven't noticed how many of our children, especially middle-class kids, need daily planners to manage their schedules of soccer, hockey, piano, Boy Scouts and Girl Scouts, baseball, football, karate, gymnastics, dance, violin, band, craft clubs, foreign-language classes, academic-enrichment courses, and religious activities. Parents have become recreation directors on the family cruise ship.
Stephanie, age 16, was living in the belly of this beast. The presenting problems in therapy were marital conflict and family tensions related to starting a new stepfamily. Stephanie was having trouble tolerating the supervision of her new stepmother, and was becoming alternately withdrawn and angry. I asked her about something I'd never have inquired about in the past: her schedule. When she recounted her typical day, the hair on my neck stood up. Out of bed at 5 a.m. to get across town to high school, home at 3:30, off to swimming practice from 4 to 7 p.m., then grab a quick dinner from whatever was in the refrigerator, and homework till midnight. Nineteen-hour days during the week. Saturdays were taken up with swimming meets. And yes, religious-education classes on Sundays, plus church youth-group events throughout the year. Stephanie admitted to being tired all the time, and acknowledged that she'd found it easier to accept her stepmother last summer when she wasn't so tired.
It isn't just teenagers like Stephanie who now live in the fast lane. A pediatrician told me that some of his young patients wanted him to convince their parents to let them quit a sport so that they could be home more often. Teachers describe a generation of young students weary from schedules that many adults couldn't handle. A second-grade teacher from a community near Albany, New York, used strong language: "This is an abused generation," she said at a public meeting. She went on to explain that, after 30 years of teaching the same age group, she's never seen children so tired and burdened from being up too early in the morning, going to bed too late at night, and being crunched in between by extremely competitive activities.
This fast-tracking of childhood is fairly new on the cultural landscape, having come upon us in the last two decades or so. A national time-diary survey conducted by the University of Michigan's Survey Research Center in 1981 and 1997 has documented this change in children's schedules and family activities. During those 16 years, children lost 12 hours per week in free time, including a 25 percent drop in playtime and a 50 percent drop in unstructured outdoor activities. During the same period, time in structured sports doubled and "passive, spectator leisure" (watching siblings and others play and perform) increased sixfold--from half an hour per week to more than three hours. Time spent on homework increased by 50 percent.
Partly as a consequence of children's new schedules, families spend less time interacting. According to the same survey, household conversations between parents and children--time for just talking and not doing anything else--nearly dropped off the radar screen of family life. Another national survey plotted a one-third decrease in the number of families even claiming to have family dinners regularly.
Kids themselves are recognizing the problem. A recent national poll of 746 children ages 9 to 14 conducted by the Center for the New American Dream found that fewer than a third of children say they have a lot of time with their parents. When asked about the barriers, they pointed to parents' work schedules and their own activity schedules. A national YMCA poll of teenagers taken in 2000 found that more than 20 percent of American teens rated "not having enough time with parents" as their top concern. For a new book, therapist Ron Taffel, one of our best observers of youth culture, interviewed 150 children attending preschool through sixth grade, and found that the one wish expressed by nearly every child was that their parents spend more time with them. Some of this "time famine" stems from a problem familiar to therapists--parents' having to work more hours and more jobs. But another, unnamed and insidious, factor is also at work: the overscheduling of kids.
In other words, we now know that children have a lot less free time, connect with their families less often, and live busier and more structured lives. This change in American family life is deep and broad, most strongly affecting the middle class, but cutting a wide swath across income and ethnic groups. (The very poor don't have the resources to overschedule their kids, but they face their own challenges in finding time to connect as a family.) And it has come upon us with amazing speed.
Is this change unwelcome? Academic researchers are just beginning to study the effects of overbusy family life on child development. Studies have shown the importance of regular family dinners, one of the chief casualties of hyperscheduling. The national Adolescent Health Study of American teenagers found a strong link between regular family meals and a wide range of positive outcomes: academic success, psychological adjustment, and lower rates of alcohol use, drug use, early sexual behavior, and suicide. On the flip side, not having regular family meals was associated with higher risks in all those areas. The University of Michigan study of children's time found that more meal time at home was the single strongest predictor of better achievement scores and fewer behavioral problems. Mealtime was far more powerful than time spent in school, studying, going to church, playing sports, or doing art activities. Results held across all types of families and all income levels.
When I first began to notice the impact of kids' schedules in my clinical practice, it came through mundane problems with scheduling appointments. When a couple I was seeing wanted to bring in their children for family therapy, I was able to offer them a precious 5 p.m. slot, having persuaded another client to give up that hour. I was perplexed when they replied that their son had one of his three hockey practices per week at that time. It would be unthinkable for him to miss practice every other week for family therapy. But they'd be willing to take him out of school without hesitation if we could schedule something earlier in the afternoon. I was flummoxed, and switched the family to an earlier slot. I then began to notice in my supervisees' clinical practices how hard it was becoming to schedule whole-family sessions, including the siblings, not because of parents' work schedules, but because of kids' activity schedules. It seemed intolerable to parents and kids alike that a sibling should miss an event or practice to attend a family therapy session. The therapists capitulated to the new cultural norm. More than managed care or the medical model, kids' soccer may be the dagger in the heart of conjoint family therapy.
When I began to talk with other therapists about the problem of overscheduled kids and underconnected families, I found an interesting divide. Therapists currently raising children often reacted defensively; those whose kids were grown up, or who didn't have children, agreed wholeheartedly and seemed relieved to be talking about the problem. One colleague, bragging about her athletic daughter, told me with pride how she was able to work her afternoon schedule to do a 30-minute dash from the office to take her daughter from gymnastics to soccer, return to see her next client, and then pick up her daughter after soccer to dash home and throw together a quick meal. When I muttered, "What a schedule," she looked at me incredulously, pointing out the opportunities her daughter had that she herself had lacked, and noting that I'd raised my children in an earlier generation. (My kids, it seems, grew up in the ancient world of the 1970s and early 1980s, before the deluge.) This was the busy new world of family life, she observed, as inevitable as long winters in Minnesota.
Older therapists I talk to bemoan what they see in culture and their clinical practice. They're befuddled when their own grandbabies are enrolled in three classes per week and frustrated when they can't get on their older grandkids' schedules. They see their adult children's families as being too focused on outside activities, and too caught up in their children's extracurricular successes, but they lack a language to talk about it without seeming like old fogies. Therapists I admire for their cultural wisdom, such as Peter Fraenkel and Mary Pipher, have begun to speak out about the corrosive influence of frantic schedules and the resulting time famine on family life. In her new book for young therapists, Mary Pipher observes that when she started out as a therapist in the 1970s, she was treating clients' sexual problems; now she's treating their schedules.
Outside the world of therapists, when I speak publicly about the problem of overscheduled kids and underconnected families, the stories and sense of outrage come fast. A Houston mother told me about a friend who recounted with pride a scheduling breakthrough with 6- and 8-year-old sons, Timmy and Matt. Their afterschool and evening schedules were already crowded with sports and music lessons, but Timmy needed tutoring for reading, and Matt had trouble finding time for his homework in the evening. The solution was creative: the mother found a tutor who'd meet with Timmy at 6:30 a.m. while Matt did his homework outside in the waiting car. This allowed for an efficient use of the early-morning hours and no interference with afterschool and evening activities. The mother was proud of this scheduling coup.
What's going on here? Well-intentioned parents are acting like professional agents for their children. Many tell me they don't enjoy this scene that much, but are afraid that their kids will be left behind when the achievement train leaves the station. The result is that for the first time in human history, family life revolves around children's optional activities rather than these activities revolving around the family.
Many parents mourn the older priorities about family time, but feel helpless to get off the merry-go-round. I hear parents complain about running all the time, having one-handed dinners in the car between practices, and losing summer vacations to sports tournaments and specialized camps. Although children get used to whatever family life they're raised in, some are beginning to ask to slow down. A 6-year-old got her first daily planner, and then asked for time to just play. A 9-year-old boy, in his top-10 list of birthday presents, placed "more time at home" as number three. A 12-year-old sheepishly asked her parents if it would be okay not to try out for the traveling soccer team because she's tired and misses playing with the kids in the neighborhood.
Searching for Causes
How did we get here as a culture? There are many explanations, many factors contributing to the problem. I've asked thousands of parents at community events for their explanations of this social change. Here's what some of them say. One straightforward factor is that there are simply more opportunities for children, especially for girls. A mother in Northfield, Minnesota, said that she counted 14 community activities for 3-year-olds. In addition, these activities, particularly sports, are far more intense. Sports used to be seasonal; now many are year-round. Traveling teams were unheard of 25 years ago, outside of varsity sports. As one veteran coach told me, we've lost the distinction between competitive sports and recreational sports. And this has spilled over to activities such as dance programs and gymnastics, which travel to compete. Practices for all kinds of activities now occur three or more times per week, with weekend competitions. And this even for 7-year-olds, who are actually becoming old-timers now that competition has moved to the preschool years! We now have organized soccer for 2-year-olds in St. Paul, Minnesota. I hesitate to ask about diaper-changing breaks!
Another factor is more working parents. Parents need to fill children's time after school with structured activities, although it appears that stay-at-home parents overschedule their kids just as frequently, partly because there's no one for their children to play with after school. Many parents tell me that they've heard that busy kids stay out of trouble, and they'd rather their child be in structured activities than watching TV or playing video games all day. A good point, I reply, but does this require the schedule of a CEO?
Some parents say that they schedule their kids to the hilt because they don't want them to be playing outside in an unsafe neighborhood. While some parents are indeed raising their children in unsafe neighborhoods, for others, the danger is more perceived than real. There are about 130 stranger-abductions in the whole country each year, a figure no higher than 40 years ago, before CNN and Amber Alerts. And the majority of victims are teenagers, not young children. I know parents who won't let their children play in their fenced backyard in safe neighborhoods without an adult present.
A big fear I hear from parents is that their children will miss out on opportunities or fall behind their peers. This fuels early, intense involvement in activities, with parents worrying that delaying the start of a sport or musical instrument may doom their child to not being able play competitively at all in the future (a concern that's often well founded). Contemporary parents feel terrific pressure, not only to have their children succeed, but to have them show promise at young ages. This is a generation of children and parents who are preoccupied with visible signs of success, from having to know the alphabet and colors before going to school, to worrying about a college rÂ´esumÂ´e in sixth grade, to having to compete at high levels in athletics. Three- year-olds leave preschool at 4 p.m. to be driven to their math class because not enough preschools teach about the radius and circumference of the circle. When I was growing up, you needed just one skill before first grade: how to use the potty.
Most of these influences are mediated through parental peer pressure. Parents watch other parents and listen to what other parents say. Look at how holiday letters glowingly describe the plethora of activities the children are involved in--the more activities and successes, the better parent you are. How many say that the family is in more balance this year, spending more time together? And look at the parental pressure on the sidelines at sports events. One father described how another father quietly bragged that his son made the traveling soccer team and was also planning to go out for baseball. Then came the question, "Is your son going to be on the traveling team?" Fortunately, the first father could answer "yes" to traveling soccer, but had to answer "no" to the follow-up question about whether the boy was going out for baseball. The other father smiled and asked, "Isn't he good at baseball?" Later, when the son decided to quit traveling soccer in favor of a less intense league, his father and mother--both psychologists, by the way--worried that he might lack the competitive edge to be successful in life.
The big picture behind this phenomenon is that the adult world of hypercompetition and marketplace values has invaded the family. Parents love their children as much as previous generations did, but we're raising our children in a culture that defines a good parent as an opportunity provider in a competitive world. This is parenting as product development, with insecure parents never knowing when they've done enough. Keeping our children busy at least means they're in the game and we're doing our job. I believe that a small percentage of parents have fully bought this cultural model and drive the intense competition of childhood activities, and that most other parents are just trying to keep pace, worrying that if their children fall behind, they'll lose self-esteem and the ability to compete.
A parent told me recently that in her upper-middle-class community, people no longer brag about the size of their house or the model of their car--they brag about how busy their family is. When one parent, in mock complaint, says, "We're so busy right now," another parent tops it with a more extreme story. And in a market-oriented, money-driven culture, we can point more readily to things we pay for--equipment, registration fees, traveling expenses, coaches' salaries--than for low-key family activities like hanging out together on a Sunday afternoon or playing a board game on a Friday night. It's the same with children's playtime: we don't easily assign ourselves "parent points" for providing our children with time to daydream and make up games to play with the neighbor kids. Parenting has become a competitive sport, with the trophies going to the busiest.
This is what makes time-starved childhood a taboo subject to talk about, even in therapy. If giving our kids more and better opportunities is a good thing, how do we question it without sounding judgmental or appearing to be out of step with the modern world? How exactly did that guy broach the embarrassing observation about the emperor's new clothes?
In the case of Stephanie, the 16-year-old with a CEO's schedule, only the stepmother thought her activities were excessive. Her father was proud of her athletic ability and her stamina, seeing these as important for her success in college and later life. When I asked Stephanie if she'd considered cutting back on her swimming, she replied that she didn't want to quit at this point because injuries had kept her from improving on her times since age 13, and she wanted to see if she could top those times. She had too much invested, she was saying, to quit now. The stepmother wisely noted that Stephanie was weary and needed down time, but what do you expect from a stepmother who doesn't have the same passionate investment in the girl's future success? Stephanie stayed in swimming, the parents got into marital therapy, and Stephanie and the family coped as well as they could with their schedules.
Kathy, a California mother, made a different decision by downsizing her son's schedule, and paid a price in the community. After Little League baseball for 11-year-old Josh reached a fever pitch of scheduling one year, she and her husband said "Enough." Family dinners were vanishing. Evening and weekends were spent on the road and at ball fields. With two working parents, another son's activities to schedule, and a community with overcrowded highways, baseball was putting everyone on "tilt." The parents decided to reclaim family time by not enrolling their son when the new season started. They didn't know that they there were violating a community standard for good parenting, as evidenced by the shock and dismay of other parents that such a good player had been summarily removed from the Little League team. When Kathy told another mother at the local supermarket about the family's decision to pull their son off the team, the stunned neighbor replied, "Can you do that?"
Second-wave feminists faced a similar challenge in getting the larger culture to see a problem in the domestication of women's lives in the post-World War II era. The cultural norm declared women to be privileged if they stayed out of the work force. In writing The Feminine Mystique, Betty Friedan's goal was to show women that their privilege was actually their prison. Today we have the soccer mom, who's likely to be employed, and the hockey dad, who shows his love for his children by coaching their teams. We have parents who brag about their children's exploits in half-a-dozen activities, but who rarely have a family meal or a leisurely Sunday afternoon at home. They've come to define commitment to the team as more important than commitment to the family, or even to a balanced childhood.
Do you think I'm exaggerating? A family therapist told me that when he confronted his daughter's coach about a letter of complaint to his 12-year-old daughter about the daughter's "lack of commitment" because she attended her Confirmation preparation weekend instead of a soccer tournament, the coach was unapologetic. When the father said that soccer was important, but church was too, and that they wanted their daughter to have a balanced life, the coach replied, "I don't believe in balance." The girl was devastated and the parents angry. And then there's the rest of the story: missing her friends on the team and the sport, the girl asked her parents if she could return to the same team and the same coach. And they let her. Parents who'll confront a teacher for the slightest insensitivity to their child's needs become complete wimps in the face of a coach and the "needs" of their children to be on the team.
Naming the Problem
In my own practice and in my community work, I'm now naming the problem that had no name. I'm calling it "overscheduled kids and underconnected families." Then when I listen, the stories come out. A stressed 7-year-old whispers to a neighbor parent that she wishes her mother would let her quit Scouts. A mother remarks ruefully that her family lives so much in the minivan that she should decorate it! A coach, trying to bring balance to his community, is dismayed when he comes upon a schedule for 11-year-old boys who practice at 10 p.m. on Thursday nights, at a facility 45 minutes from home. Parents say they hate these schedules, but don't know how to change them without depriving their children of opportunities. Everyone's afraid to be the first to cut back. A sane lifestyle looks strange in an insane world.
Like sexism and racism, this is a cultural problem that we now know is also a clinical problem. It shows itself clinically in overwrought kids and families, and in couples who have no time whatsoever for their marriage. (If the family gets the dregs left over after individuals are scheduled, the couple gets the dregs of the dregs.) We've got to regard this as a cultural problem with an upstream source, rather than just a clinical problem ripe for our theories about why each family's own pathology got them into trouble.
As clinicians, we influence clients and the wider culture by what we ask about in the therapy room--and by what we choose not to ask about. We have to start inquiring about kids' schedules, and not just our usual suspect--parent work schedules. Does Johnny have any time to hang out and be a kid? Could his ADD be exacerbated by scheduled family hyperactivity? Does Linda ever have the chance to eat a leisurely meal with her parents and siblings? When a father brags about his son's football prowess in an intense program, the therapist, instead of politely saying "good for you," can ask the boy, "Do you like what you're doing?" It took a journalist to inspire me to ask this question. When she asked this question to a star athlete in front of his doting father, the boy replied, "No, I don't enjoy it anymore." Jaws dropped around the room. I'd never thought to be so bold in therapy, but I am now.
When spouses say they feel like ships passing in the night, do they really mean they're chauffeuring their children on diverging highways? Instead of smiling benignly and saying, "Yes, kids can sure take a lot of work," we can ask whether they've chosen this lifestyle or feel compelled to follow it. Do they feel like booking agents for their children? Who created these crazy rules for parents? I tell parents that my own parents never attended my games (the same was true for my friends), and that I'd have been mortified if they'd showed up. ("Doherty's mother is here!") I speculate out loud about when the law got passed--sometime in the 1980s perhaps--mandating that parents attend every game and half of their children's practices. And the same law said to forget about carpooling with other parents so that some parents could stay home and cook a family meal or have one-on-one time with another child.
It's like with sex, money, and race--if we don't ask, our clients usually don't tell. Through our curiosity, we signal what's appropriate to talk about in therapy. The key is to raise these questions first from a cultural perspective, not a clinical perspective. In family therapy, we can comment that today's families seem to be under a lot more scheduling pressure than in the past. We can ask whether little Jessica's friends all seem to be as busy as she is. We can empathize with how hard it is to have time to eat and play together as a family with these intense activity schedules. We can say that we see lots of families struggling with the same level of stress and fatigue, and that we think something's out of whack in today's world. At each point, of course, it's important to pace these comments and questions with how the parents and children are responding. My experience has been that parents often respond with a chorus of "Yes, it's a crazy world now." Kids, who don't know a different way of living, are often open and curious as long as you don't sound like you're making decrees about their schedules. The key is to put the problem on the table in a nonjudgmental way and make it legitimate to talk about. Sometimes, families will continue for a while with a stressful schedule but decide to cut back during the next summer or school year. Sometimes, I suggest taking a sabbatical for a semester or summer from all optional outside activities, to rest, recoup, and learn what to do as a family, and then decide about their subsequent schedule.
In adult and couples therapy, the same approach can be useful: begin by asking questions about schedules, and stop regarding frenetic lives as normal and inevitable. Starting with the cultural conversation can sidestep personal guilt for the moment and open the path to exploration and problem-solving. Instead of suggesting that a couple's chauffeuring pace with children is how they avoid unresolved issues with each other (a ready-made clinical interpretation), we can note that a great many couples today struggle with how to have time for a marriage in a world divided between employment and parental traffic-control. When I refer to parents today as recreation directors on the family cruise ship, nearly all parents light up with recognition. This can lead to a conversation about social pressures to sacrifice everything, including one's marriage, in order to provide opportunities for children in a competitive world. I tell stories of family Thanksgiving dinners yielding to extra practices. We laugh and shake our heads together about the craziness of it all.
By first externalizing the problem in this way, we can join with clients as members of an out-of-control culture that's unfriendly to marriage and other adult unions, rather than meeting resistance by tangling with couples over whether they're running from their relationship by overserving their children. Of course, there are couples who'll do anything to avoid spending time alone, but when the average child-rearing couple in the land is experiencing a problem, there's more going on than clinical pathology. Good therapy must have a good dose of cultural criticism.
Needless to say, we have our own homework to do as therapists before we can be change agents with our clients and within the larger culture. Solidly middle class by dint of our education (if not always our income!), we're swimming in the same river as our clients, teaching our kids multiple swimming strokes, searching for the best instructors, and hoping for that college scholarship at the end of the pool. But if we're prepared to do our own soul-searching, we can stop conspiring with our clients and our culture, and start sounding the alarm in our offices.
If the source of the problem is in the culture, however, it's not enough to talk about it in our offices. We're like physicians treating kids with symptoms of lead poisoning from the paint in their house. We can't be satisfied with just advising individual parents to stop their kids from eating the paint chips; we have to address the environment--the landlords, the paint companies, and the government regulators. But most of us weren't trained to work the streets, and it can feel overwhelming. Keep in mind that by dint of our professional status, we have access to the public arena. We can speak to parents at the local PTA or the adult forum at a local religious congregation. (Believe me, these groups are always looking for speakers.) We can cultivate relationships with journalists and offer to do interviews for local newspapers and radio stations. When we gain this access, the key is to step outside our comfort zone of psychological and family-systems talk to name the cultural pollutants in our communities. If we touch a chord in parents' experience, they'll resonate and feel more empowered to speak up for their children and families. Cultural change occurs one conversation after another, in ripples that we can help start and keep spreading.
There are ways to be even more public, such as participating in activities of Take Back Your Time Day, a national event on October 24, 2003, and partnering with local groups of parents for collective action. The stakes are high. We're facing a new threat to childhood and family life, one disguised in the costumes of fun, achievement, healthy competition, and keeping busy. It's a false cultural god, this colonization of childhood by market forces. If we name it, we can begin to talk about it. If we can talk about it in therapy and in our communities, we can be part of the change that must come.
William Doherty, Ph.D., is professor and director of the marriage and family therapy program at the University of Minnesota. Address: Family Social Science, University of Minnesota, 290 McNeal Hall, St. Paul, MN 55108. E-mails to the author may be sent to email@example.com. Letters to the Editor about this article may be sent to Letters@psychnetworker.org.
by Michele Weiner-Davis
If you've ever thought that a couple's sexual relationship is a barometer of other aspects of their marriage, join the club. And if, because of this belief, your work with distant and warring couples has you shoring up their emotional bond in the hopes that the rest of their marriage--their sex life--will eventually fall into place, you're in good company as well. But there's another, frequently more practical and expedient, way to break through marital gridlock and boost passion. Just do it. I learned this simple lesson from Debra and Tom.
When I met Debra and Tom, they'd been married for 10 years and had two sons, ages 8 and 5. They were strikingly handsome individuals, devoted parents, and were surrounded by loving friends and family. Yet their marriage was precipitously close to ending.
Debra spent much of our time together complaining about Tom. His short temper was like poison to her soul. He snapped at her over the littlest things, and she felt like she was always walking on eggshells. She also complained of his lack of involvement at home. "He never seems to want to do anything as a couple, or even as a family, anymore. He never talks to me or even asks about my day."
Tom had no shortage of negative things to report about their marriage either. He didn't like being around Debra because, regardless of what he was doing, he felt she always found fault with him. He also talked about a deep disappointment in her as a companion. He wistfully recalled their early years of marriage: "She used to be fun to be with. She made me feel like I was the funniest man in the world. Now everything's serious." And after a moment of silence, he added, "We don't have anything in common anymore. She does her thing and I do mine. At this point, I actually prefer it that way."
Over the next several sessions, all my proven solution-based tools--asking about goals, listening carefully to their stories of stuckness, acknowledging their feelings, focusing on exceptions, strengths, and resources--didn't work. Six sessions into treatment, Tom and Debra (and I) were no better off than when we started. Then, not knowing what else to say, I asked them, "What's the glue holding the two of you together?" Tom's response offered the first real inkling of what I now know kept them so stuck. Tom's tone softened considerably as he spoke. "I think I've been holding out hope that some day we'll be able to recreate some of the feelings we had earlier in our marriage." Tom said that when they first married, he was passionately in love with Debra and found her irresistible. Their sex life was wonderful; they made love frequently, and he felt extremely close to her. His ability to satisfy Debra sexually made him feel good about himself as a lover and as her life partner. He recalled how their sexual relationship reverberated throughout the rest of their marriage. They often snuggled on the couch while watching television, held hands when they walked, and kissed each other affectionately. But all that changed after the birth of their first child.
Debra had become extremely focused on her new role as mother, and when she wasn't caring for their baby, she felt fatigued. Sleep--not sex--was the only thing she found herself craving. Tom's need for companionship and intimacy wasn't a priority for her. Tom recognized that the passion so characteristic of early marriage is often short lived, but felt her lack of interest in him went beyond the usual explanations for a drop in libido.
Initially, he spoke to her about his feelings. He told her he didn't feel important anymore. He kept asking, "What's wrong? Did I do something wrong? Do you still think I'm attractive?" Sleep-deprived, hormonally altered, and overworked, Debra found herself having little compassion for her husband's feelings. In fact, she commented, "I couldn't believe he was complaining. I felt like I had two babies, not one."
As the years passed, Debra's repeated rejections of his advances hurt and angered Tom. He refocused his energies on himself, his work, and his friends. And the more he distanced himself, the less inclined Debra felt to be close physically. Now their infrequent sexual encounters, too often tainted by feelings of resentment and hurt, left them both feeling empty. Finally, I understood the roadblocks we encountered in our sessions.
Although Tom and Debra were scheduled to attend their next session together, only Debra showed up. Tom felt that therapy wasn't helping, and he didn't wish to return. She was devastated, very tearful, and eager to hear my suggestions about what to do next.
I told Debra, "The last time Tom was here, he shared how his not feeling close to you sexually made him question whether you love him. My guess is that he probably hasn't felt important to you for very a long time." I wondered whether her being more affectionate and showing interest in sex might satisfy a longing in him and, as a result, prompt him to be kinder and more involved at home. Although Debra understood my logic, she couldn't imagine being physically affectionate, feeling as she did.
Fearful that time was running out, I cautioned her against waiting for him to change first because by then he might be gone. "Why don't you try an experiment?" I asked. "For the next two weeks, even if you're not entirely in the mood, be more attentive to him. Be flirtatious. Initiate sex a few times. Make him feel sexy. Let's see what happens." She agreed. Little did I know at the time that this offhanded, what-do-you-have-to-lose, suggestion would change the way I practiced couples therapy forever.
Debra returned two weeks later. I didn't need a mental health degree to sense instantly that there'd been a marked improvement in their marriage. Debra went on to tell me that although it seemed rather awkward and stilted at first, she began her assignment by giving Tom several prolonged kisses when he came home from work. He seemed surprised. Realizing that comfort rather than fashion had been ruling her life ever since the kids were born, she also made a point of getting out of her sweat suit and getting into a new angora sweater and pair of jeans. Tom commented about her sweater, which pleased her. Debra made more of an effort to be around Tom in the evening, even if it meant just watching television together. He seemed curious about her presence in the family room, but even more curious about Debra's suggestion to head for their bedroom in unison. They proceeded to make love for the first time in months.
Debra's reaction to being sexual with Tom caught her off guard. Feelings of resentment and anger, which had for so long colored every interaction between them, now gave way to feelings of pleasure and connectedness. At one point, Tom gently touched her cheek and looked into her eyes, and she felt closer to him than she had in a very long time.
In the days that followed, she noticed that Tom was noticeably more relaxed and lighthearted at home. He joked with the kids and joined in their activities in the evening. She also happily reported that Tom was more playful with her and seemed more interested in her life. Tom even called her from work periodically just to check in and say "Hi." They were talking more, too. Encouraged, Debra decided to continue with her "experiment." I was relieved to have finally discovered a way to dislodge the logjam that had become their marriage.
Arousal Fuels Desire
I learned several important lessons from Debra and Tom. I'd always assumed that in order to become sexual, one must first feel sexual desire. But this assumption is at odds with other aspects of my practice. For example, because I believe that behavior change often precedes affect or cognitive changes, I often encourage depressed clients to push themselves to become more active, even if they don't feel like it. Getting one's feet moving often helps to relieve depression. Yet prior to Debra and Tom, I'd overlooked this action-oriented perspective in the area of sexuality. Not anymore. Here's why.
Once I began to downplay the importance of one's present mood state when deciding if and when to become sexual, I was amazed at what I was observing in my practice. I wish I had a dollar for every time a person has said to me, "Michele, I wasn't in the mood when we started having sex, but once we got into it, I really enjoyed myself."
This reaction is very much in line with recent research suggesting that countless people don't experience spontaneous sexual thoughts or fantasies. However, when they're receptive to their partners' advances or initiate sexual contact themselves from a neutral state, being physically stimulated often leads to sexual arousal and a strong desire to continue touching. Hence, for many, desire actually follows arousal, a perspective that challenges the conventional model of human sexual response.
There's a distinct benefit to educating clients about this refreshing definition of sexual desire. When people with "low desire" realize that they can and do experience sexual pleasure once they decide to get going, they stop thinking of themselves as "nonsexual" people--a self-concept that tends to perpetuate the problem--and start feeling "sexy" again.
Debra and Tom also challenged another dearly held assumption--that emotional intimacy precedes physical intimacy. At the time, I believed that when distant spouses improve communication and feel more emotionally connected, the rest of their marriage falls into place. But for Debra and Tom, it worked the other way around. Once Debra quit blaming Tom and became more attentive physically, touching unleashed in him a desire to please her and they both felt closer emotionally. I soon figured out that for some couples, touching is the quickest and most effective road back to emotional intimacy, not the other way around.
The Lukewarm Husband
When I discuss this "Nike Solution" in seminars, I sometimes get asked whether the women in my practice object to having to seduce their partners to get their emotional needs met in relationships. This question demonstrates erroneous thinking on two counts. First of all, contrary to popular belief, there are millions of marriages in which the man is lukewarm about sex and it's his wife who longs to be touched. And not surprisingly, the dynamics in those marriages mirror those of Debra and Tom's. Ed and Laura were one such couple.
I clearly remember Ed, a handsome man in his late thirties who was a physical therapist in private practice. He attended sessions alone. His wife, Laura, thirty-something as well, was a top manager for a large company. They argued frequently, causing Ed great unhappiness. At the crux of their disagreements were family-management issues. Because Ed's schedule was more flexible than Laura's, he was the primary caretaker for their four children. Ed attended parent-teacher conferences and doctor appointments solo, made sure there were meals on the table every evening, and looked after the children's emotional needs. He often felt overwhelmed trying to balance his parenting obligations with those of his practice.
Ed told me that Laura resented the fact that she was the primary breadwinner because she wanted to spend more time with the children. Also, she had an underlying physical condition which caused excruciating chronic pain. She thought bed rest would be therapeutic. But for financial reasons, they both agreed that Laura needed to keep working.
Ed complained that when Laura returned home at night, she was irritable and extremely critical of his handling of family matters. Instead of feeling appreciated for the sacrifice he felt he was making, Ed felt ridiculed. After several sessions without much improvement, I asked Ed about their sexual relationship. He replied, "It's nonexistent. When Laura's critical, I want to stay about as far away from her as I can get. I can't even imagine touching her." I asked whether Laura had complained about this and Ed replied, "Oh, all the time." And when she wasn't complaining about the lack of affection, she resorted to angry outbursts about wet towels on the floor, pop cans in the family room, or the occasional work-related call made during "family time," all symptoms of the rawness she felt inside. My advice to Ed echoed my suggestion to Debra--in essence, "Get your feet moving."
Three weeks later, a more relaxed Ed returned, describing how the ice between Laura and him had melted. Ed hugged her affectionately throughout the weeks, initiated lovemaking, and returned to their goodnight/goodbye kiss rituals. Laura was happier, calmer, and gentler with him. Rather than her usual criticisms, she expressed appreciation for his contribution to their family. Because Ed felt valued by Laura, he began to show appreciation for her hard work and became more compassionate about her physical challenges.
What Is Real Giving?
The question about whether women in my practice object to having to seduce their partners to get their emotional needs met is off-base for another reason, too. It reflects a lack of in-depth understanding about the mechanics of all loving marriages. Even when a person isn't the world's most sexual being, rather than objecting to being sexual, he or she might actually derive joy and pleasure from pleasing a more physical spouse. Good marriages are based on mutual caretaking and real giving--but what is real giving?
In most relationships, we tend to give to others in the way we, ourselves, like to receive. If we like our spouses to give us space and privacy when we're down and out, we tend to treat our spouses similarly when they're down in the dumps. If we're extremely sentimental and romantic about holidays and birthdays, we tend to be extravagant gift-givers on special days.
But what if our spouses are "talkers" and prefer sharing feelings rather than being given space when they're upset? Is it really a gift to back off and let them sulk alone? And what if our spouses are less romantic and really prefer that no fuss be made over birthdays and holidays? Is it really a gift to give flashy presents and sappy Hallmark cards? I think not.
When it comes to feeling loved in a marriage, everybody has different requirements. Some people feel loved when their spouses spend time with them. Others feel loved when they've had "good talks." A spouse's kind deeds--pouring a cup of coffee, making a favorite meal, warming up a cold car in advance--can, for some, prompt feelings of love and connection.
But for many, touch says love like nothing else. Making love is love. When you're married to one of those people, try as you may to express love in other ways--by doing kind things, fixing the vacuum cleaner, handling the lion's share of the childcare, paying the bills, being available for heart-to-heart talks, earning lots of money, becoming a gourmet cook, and so on--your words and actions will fall on deaf ears and "deaf hearts." People who feel love through touch accept no substitute. And unless you speak your spouse's language, you aren't doing real giving.
Does this mean that people should have sex anytime their spouses so desire? Absolutely not. But if they care about their marriages, there should be a heck of a lot more yeses than noes. And saying yes doesn't necessarily mean having intercourse (although that should certainly be on the short list of things to do in marriage). There's a whole raft of both subtle and overt behaviors--a flirtatious note left around the house, an x-rated e-mail, regular compliments about appearance, a suggestive comment, touch, or glance--that go a long way toward keeping passion alive and egos intact. People should practice them regularly.
Is It Really That Simple?
As a 26-six-year veteran of marriage to the same man, I can safely say with authority that there's nothing simple about marriage. I know that for many people lacking sexual desire, it's not simply a matter of getting started. Low sexual desire has many varied and often complicated causes, not all of them relational. Hormone fluctuations, underlying physical illnesses, medications (including some antidepressants and even birth control pills), depression, poor self-esteem, prior sexual abuse, and other serious sexual dysfunctions can be, and often are, at the root of a deadening of desire. All the "Just Do-Itism" in the world won't make a dent in cases when other interventions are required.
But having said that, regardless of the causes of low desire, there's no reason that anyone wanting a more robust sex life can't have one, given what we now know about biological, personal, and relationship-oriented therapies. Desire is a decision. People must believe that passion, sexual intimacy, and physical connection are important and when they're missing, decide to do something--get a medical check-up, take testosterone, seek individual or marital therapy, attend a marriage seminar. As therapists, we must remember that while emotional closeness breeds sexual intimacy, it works the other way around, too. Sometimes, all the talking and processing feelings in the world won't break through an impenetrable wall of resistance. Action might.
I now have a homework assignment for self-proclaimed low-desire clients (both male and female) whose spouses are irritable, cranky, or in a cave. I urge them to take "The Great American Sex Challenge," which goes like this: "For the next two weeks, regardless of how you feel, pay more attention to your sexual relationship. Flirt, initiate sex, put energy into your appearance, touch more. And watch your spouse closely for any changes." This works so well that it's become standard fare on many days in my sessions with couples. If you're curious about how this might work with couples in your practice, I say, Just Do It.
Michele Weiner-Davis, M.S.W., is the author of The Sex-Starved Marriage: A Couple's Guide to Boosting Their Marriage Libido and the director of The Divorce Busting Center at 100 North Benton, Woodstock IL 60098. E-mails to the author can be sent to Michele@divorcebusting.com. Letters to the Editor about this article may be sent to Letters@psychnetworker.org.
by Esther Perel
A few years ago, I attended a presentation at a national conference, demonstrating work with a couple who had come to therapy in part because of a sharp decline in their sexual activity. Previously, the couple had engaged in light sado-masochism; now, following the birth of their second child, the wife wanted more conventional sex. But the husband was attached to their old style of lovemaking, so they were stuck.
The presenter took the approach that resolving the couple's sexual difficulty first required working through the emotional dynamics of their marriage and new status as parents. But the discussion afterward indicated that the audience was far less interested in the couple's overall relationship than in the issue of sado-masochistic sex. What pathology, several questioners wanted to know, might underlie the man's need to sexually objectify his wife and her desire for bondage in the first place? Perhaps, some people speculated, motherhood had restored her sense of dignity, so that now she refused to be so demeaned. Some suggested the impasse reflected long-standing gender differences: men tended to pursue separateness, power, and control, while women yearned for loving affiliation and connection. Still others were certain that couples like this needed more empathic connection to counteract their tendency to engage in an implicitly abusive, power-driven relationship.
After two hours of talking about sex, the group had not once mentioned the words pleasure or eroticism, so I finally spoke up. Was I alone in my surprise at this omission? I asked. Their form of sex had been entirely consensual, after all. Maybe the woman no longer wanted to be tied up by her husband because she now had a baby constantly attached to her breasts, binding her more effectively than ropes ever could. Didn't people in the audience have their own sexual preferences, preferences they didn't feel the need to interpret or justify? Why automatically assume that there had to be something degrading and pathological about this couple's sex play?
More to the point, I wondered, was a woman's ready participation in S & M too great a challenge for the politically correct? Was it too threatening to conceive of a strong, secure woman enjoying acting out sexual fantasies of submission? Perhaps conference participants were afraid that if women did reveal such desires, they'd somehow sanction male dominance everywhere--in business, professional life, politics, economics? Maybe, in this era, the very ideas of sexual dominance and submission, conquest and subjugation, aggression and surrender (regardless of which partner plays which part) couldn't be squared with the ideals of fairness, compromise, and equality that undergird American marital therapy today.
As an outsider to American society--I grew up in Europe and have lived and worked in many countries--I wondered if the attitudes I saw in this meeting reflected deep cultural differences. I couldn't help wondering whether the clinicians in the room believed that the couple's sexual preferences--even though consensual and completely nonviolent--were too wild and "kinky," therefore inappropriate and irresponsible, for the ponderously serious business of maintaining a marriage and raising a family. It was as if sexual pleasure and eroticism that strayed onto slightly outreÂ´ paths of fantasy and play--particularly games involving aggression and power--must be stricken from the repertoire of responsible adults in intimate, committed relationships.
After the conference, I engaged in many intense conversations with other European friends and therapists, as well as Brazilian and Israeli colleagues who'd been at the meeting. We realized that we all felt somewhat out of step with the sexual attitudes of our American colleagues. From these conversations, it became clear that putting our finger on what was culturally different wasn't easy. On a subject as laden with taboos as the expression of sexuality,Â each of us is inevitably thrown back on our own experiences.
What struck most of the non-Americans I talked with was that America, in matters of sex as in much else, was a goal-oriented society that preferred explicit meanings, candor, and "plain speech" to ambiguity and allusion. In America, this predilection for clarity and unvarnished directness, often associated with honesty and openness, is encouraged by many therapists in their patients: "If you want to make love to your wife/ husband, why don't you say it clearly? . . . And tell him/her exactly what you want." But I often suggest an alternative with my clients: "There's so much direct talk already in the everyday conversations couples have with each other," I tell them. "If you want to create more passion in your relationship, why don't you play a little more with the natural ambiguity of gesture and words, and the rich nuances inherent in communication."
Growing up in Belgium, a traditionally Roman Catholic society that carries a mixture of Germanic and Latin traditions and influences, I gravitated toward the warmth and spontaneity of the Latin features of the culture. I came here to further my education, and never used my return ticket.
Ironically, some of America's best features--the belief in democracy, equality, consensus-building, compromise, fairness, and mutual tolerance--can, when carried too punctiliously into the bedroom, result in very boring sex. Sexual desire doesn't play by the same rules of good citizenship that maintain peace and contentment in the social relations between partners. Sexual excitement is politically incorrect, often thriving on power plays, role reversals, unfair advantages, imperious demands, seductive manipulations, and subtle cruelties. American couples therapists, shaped by the legacy of egalitarian ideals, often find themselves challenged by these contradictions.
What I'd characterize as a European emphasis on complementarity--the appeal of difference--rather than strict gender equality has, it seems to me, made women on the other side of the Atlantic feel less conflict between being smart and being sexy. In Europe, to sexualize a woman doesn't mean to denigrate her intelligence or competence or authority. Women, therefore, can enjoy expressing their sexuality and being objects of desire, can enjoy their sexual power, even in the workplace, without feeling they're forfeiting their right to be taken seriously as professionals and workers.
Susanna, for example, is a Spanish patient who has a high-level position with an international company in New York. She sees no contradiction between her job and her desire to express her sexual power--even among her colleagues. As she puts it, "I expect to be complimented on my looks and my efforts to look good. If compliments are given graciously, they don't offend, but make clear that we're still men and women who are attracted to one another, and not worker-robots. If a man indicates he likes the way I look, I don't feel he thinks anything less of my professional abilities because of it, any more than I think less of him because I find him handsome."
Of course, American feminists achieved momentous improvements in all aspects of women's lives. Yet without denigrating those historically significant achievements, I do believe that the emphasis on egalitarian and respectful sex--purged of any expressions of power, aggression, and transgression--is antithetical to erotic desire, for men and women alike. I'm well aware of the widespread sexual abuse of women and children. I don't mean to offer the faintest sanction to any coercive behavior. Everything I suggest here depends on receiving clear consent and respecting the other's humanity.
The writer Daphne Merkin writes: "No bill of sexual rights can hold its own against the lawless, untamable landscape of the erotic imagination." Or as Luis Bunuel put it more bluntly: "Sex without sin is like an egg without salt."
The Lure of Fantasy
Many in our field assume that the intense fantasy life that shapes the early stages of erotically charged romantic love is a form of temporary insanity, destined to fade under the rigors of marriage. Might not fantasy, though, and particularly sexual fantasy, actually enhance and animate the reality of married life? Clinicians often interpret the lust for sexual adventure and the desire to cross traditional sexual boundaries--ranging from simple flirting to infatuation, from maintaining contact with previous lovers to cross-dressing, threesomes, and fetishes--as fears of commitment and infantile fantasies. Sexual fantasies about one's partner, particularly if they involve intense role-playing or scenarios of dominance and submission, are often regarded as symptoms of neuroses or immaturity, erotically tinged romantic idealization that blinds one to a partner's true identity. Our therapeutic culture "solves" the conflict between the drabness of the familiar and the excitement of the unknown by advising patients to renounce their fantasies in favor of more rational and "adult" sexual agendas. Therapists typically encourage patients to "really get to know'' their partners. But I often tell my patients that "knowing isn't everything." Eroticism can draw its powerful pleasure from fascination with the hidden, the mysterious, the suggestive.
Terry had been in therapy for a year, trying to come to terms with the shock he'd experienced in the transition from a two- to a four-person household, from being one half of a couple involved erotically to being one quarter of a family with two children and no eroticism at all. He began one session by announcing: "All right, you want to hear a real midlife story? You're going to get one. My wife and I recently hired this young German au pair to work for us during vacation. It's ended up that every morning, she and I take care of my daughters together. She's lovely--so natural, full of vitality and youth--and I've developed this amazing crush on her. You know how I've been talking about this feeling of deadness, my energy dropping, my body getting heavier? Well, her energy has wakened me up. I want to sleep with her and I wonder why I don't. I'm scared to do it and scared not to. I feel foolish, guilty, and I can't stop thinking about her."
As I listened to him, I thought that what was happening to him was an awakening of his dormant senses. The question was how could he relish this experience without allowing the momentary and exhilarating intoxication to endanger his marriage?
I didn't discourage Terry from his "immature" wishes or lecture him. I didn't try to talk reason into him. I didn't try to "explore" the emotional dynamics beneath this presumably "adolescent" desire. I simply valued his experience. He was looking at something beautiful; he was fantasizing. I marveled with him at the allure and beauty of the fantasy, while also calling it by its true name: a fantasy.
"How beautiful and how pathetic," I said. "It's great to know you still can come to life like that. And you know that you can never compare this state of inebriation with life at home, because home is about something else. Home is safe. Here, you're trembling, you're on shaky ground. You like it, but you're also afraid that it can take you too far away from home. I think that you probably don't let your wife evoke such tremors in you." As he left, I told him to keep that thought in mind over the next week.
A few days later, he was having lunch in a restaurant with his wife and she was telling him of her previous boyfriend. "I'd been thinking hard about what we talked about," he told me. "And, while we were sitting at the table, I had this switch. Normally, I don't like hearing these stories of hers--they make me jealous and irritated. But this time, I just let myself listen and found myself getting very turned on. So did she. In fact, we were so excited we had to look for a bathroom where we could be alone."
I suggested that perhaps the experience of listening to a fresh young woman was what enabled him now to listen to his wife differently--as a sexual woman in possession of her desirability. He was viewing his familiar wife from a new distance. I invited Terry to permit himself the erotic intensity of the illicit with his wife: "This could be a beginning of bringing lust home," I said. "These small transgressions are acceptable; they offer you the latitude to experience new desire without having to throw everything away."
Reviving Sexual Imagination
It always amazes me how much people are willing to experiment sexually outside their relationships, yet how tame and puritanical they are at home with their partners. Many of my patients have, by their own account, domestic sex lives devoid of excitement and eroticism, yet are consumed and aroused by a richly imaginative sexual life beyond domesticity--affairs, pornography, prostitutes, cybersex, or feverish daydreams. Having denied themselves freedom and freedom of imagination in their relationships, they go outside, to reimagine themselves with dangerous strangers.
Yet the commodification of sex--the enormous sex industry--actually hinders our potentially infinite capacity for fantasy, restraining and contaminating our sexual imagination. The explicitness of sexual products undermines the power of mystery, the voyeuristic pleasures of the hidden. Where nothing is forbidden, nothing is erotic. Furthermore, pornography and cybersex are ultimately isolating, disconnected from relations with a real, live, other person.
A fundamental conundrum in marriage, it seems to me, is that we seek a steady, reliable anchor in our partner, and a transcendent experience that allows us to soar beyond the boundaries and limitations of our ordinary lives. The challenge, then, for couples and therapists, is to reconcile the need for what's safe and predictable with the wish to pursue what's exciting, mysterious, and awe-inspiring. That challenge is further complicated when the partners are on opposite sides of this divide.
When Mitch complains about the sexual boredom in his marriage, he points at Laura's lack of imagination. "She always does the same thing. It's so predictable, it doesn't even really arouse me. She doesn't kiss me, she has so little imagination. She doesn't know that the mind is the most important sexual organ."
"So what do you do with your mind?" I ask. "Do you go off into the imaginary when you're with your wife?"
"You mean think about other women?" he asked.
"That," I said, "or it could be about yourself when you were younger, or any other places you may go."
"No," he declared, "that would be accepting that she's not enough and that I need to compensate."
"You're talking about reality. I'm talking about fantasy. Fantasies open up the erotic realm. You complain that she's passive, but you're passive, too. You can be wherever you want in your own head, your wife is whoever you perceive her to be. The preservation of autonomy and mystery allows both of you to be apart in your fantasies, and together in your bodily experiences. It's your ability to go off on your own that enables both of you to maintain your interest in each other."
What I was saying to Mitch is that separateness is a precondition for connection. Sex is vulnerable and risky; in this sense, there's no "safe sex." There's a powerful tendency in long-term relationships to favor the predictable over the unpredictable. Erotic passion is defiant and unpredictable, unruly and undependable--which leaves many people feeling separate and vulnerable. As Stephen Mitchell, a New York analyst, used to say, "It is not that romance fades over time. It becomes riskier."
Challenging the idea that security is inside the relationship and adventure outside means pointing out that theÂ familiarity we seek to impose on the other kills desire. What would happen if we allowed ourselves to see our partner from a distance, with a wide-angle lens instead of a zoom? Of course, that distance isn't without risk: it also means stepping back from the comfort of our partner and being more alone. Maybe the real paradox is that this fundamental insecurity is a precondition for maintaining interest, desire, and intimacy in a relationship--bringing adventure home.
The irony is that even the predictability in the marriages of the dullest couples is an illusion. As Mitchell says, "Safety is presumed, not a given, but a construction." The conviction that one's partner is both safe and dull is an invention that both have tacitly agreed to and that give a false sense of security. People often end up in affairs to break from what they imagine is predictable boredom. Often, when the "dull partner" ends up having an affair, the other is surprised. This is because the supposedly familiar partner is in fact mysterious and unknown.
The ongoing challenge for the therapist is to help couples find ways to experience small transgressions, illicit strivings, and passionate idealizations in the midst of their predictable, safe lives. Adam Philips, an English analyst, underscores the point in his book Monogamy: "If it is the forbidden that is exciting . . . then the monogamous . . . have to work, if only to keep what is always too available sufficiently illicit to be interesting."
More Intimacy, Less Sex
It's often assumed that intimacy and trust must exist before sex can be enjoyed, but for many men and, yes, even women, intimacy actually sabotages sexual desire. When the loved one is invested with the fruits of intimacy, such as security and stability, he/she can become desexualized, no longer evoking the desire to pursue the fruits of passion.
Martha and Philip are trying to rekindle that spark they once had. When they met, Martha was the winning prize for Philip. "She was smart, beautiful, sexy. I couldn't believe she was interested in me. I coveted her and we had a strong sexual connection--until I was introduced to her family, that is," he recalls. "Something changed when I became accepted. I didn't tell her about this. In fact, I tried to deny to myself that anything was different. But pretty soon, I couldn't really get turned on by her and I immersed myself in anonymous bar-sex, masturbation, and porn." Needless to say, Martha was very disturbed by the loss of heat in their sex life, and she blamed it mostly on herself. Never very confident about her own sexuality, she, too, had been amazed by Philip's attraction for her, and now assumed he'd simply lost interest in her.
When I ask Philip for a sexual image that includes Martha, he conjures a picture of the two of them kissing romantically in the sunset. He adds that he has difficulty imagining her in a passionate, erotic way. He tells her openly, "I just can't see you in my mind anymore as a sexual object, and I feel bad about it, but it's just the truth."
To understand Philip's sexuality, one has to follow the direct link to his father, whose multiple sexual adventures hurt everyone in the family. "My father pursued pleasure without regard to others. It made me feel that life was out of control and not safe. My mother needed me for emotional support, and in order not to upset her any further, I became an asexual wunderkind. I was intensely moralistic and judgmental, but, somehow, that actually seemed to fuel my obsession with pornography and the urge to break the rules of what's considered proper. Sex, objectification, and transgression became as one for me."
Martha plays her part in the construction of this crucible. She avoids expressing sexual desire for fear of embarrassment and rejection. While Philip seeks affirmation on the outside, Martha's self-affirmation rests solely upon him and his response to her. Martha highlights a common way women order their sexuality, in that she makes him--and his desire for her--the centerpiece of her erotic and sexual identity.
When Martha does get up the courage to make advances to Philip, he feels pressure to be responsive and to take care of her. He fears the aggression in his desire, is ashamed of his need for anonymous, objectified sex, and feels guilty that he can't be more emotionally and erotically involved with his wife. It's his caring for Martha that stands in the way of his sexual desire for her. In the distancing and objectification, Philip seeks to create a separation between woman and mother, the erotic and the familial. After all, who wants to have sex within the family?
I point out the narrowness of their sex lives, combined with Philip's sexual adventures outside their relationship. I ask, "How about if you could bring some of the transgression and objectification into your erotic life at home?" They look shocked--they didn't expect this from a marriage therapist! "Martha, can you open yourself up to the eyes of other men, so that Philip isn't the sole source of your sexual validation?"
I suggest that they begin an e-mail correspondence to each other about their sexuality--their thoughts, conflicts, memories, fantasies, and seductions. This can elicit curiosity, intrigue, and a kind of wholesome anxiety. The built-in distance of e-mail allows space for fantasy and anonymity--a glimpse into the possibility of bringing adventure and unpredictability into the home.
Martha begins to practice seductiveness. She's playful and funny, not only with Philip, but with other men. Philip is intrigued by the new way she talks to him, "her new voice," a voice that sexualizes her in his eyes.
Martha starts off the next session by telling me, "Your urging me to get a sense of myself from other men besides Philip has been very good for me. I've started doing things with other men--going to concerts and galleries with male friends, and generally been more flirtatious. Nothing big, you know, but it's been fun to engage in these harmless encounters. And now, Philip's every word or look is no longer the most important thing in my life."
Martha also talked about her extremely conflicted feelings about Philip's extramarital sex life. "I was really hurt and angry about it, for sure," she said, "angry at him and angry at me. But at the same time, I also have to admit that when he had the affairs, I lusted after him more, because he wasn't necessarily mine. The anger at what he did and the fact that I know I could leave him--even though I don't want to--gives me more freedom and confidence. When I initiate sex now, I can feel almost brazen--and I like that. You want this, Philip? Take it! It doesn't have to be romantic or even particularly personal. I feel free, knowing that I choose to stay with him and, yes, knowing that he could leave me, too. That has freed us up."
Sex in Transition and Motherhood
Susan and Jenny came to see me about their sexual relationship. Susan, a longtime lesbian, set out to seduce Jenny right after she met her. Jenny responded, though it was her first lesbian relationship. They moved in together just as Susan was waiting for the arrival of a baby she was adopting. As soon as they were a threesome, Jenny thought they were a wonderful family, but completely lost any sexual interest in Susan. For this couple, sex was too weighted with meaning; eroticism and sexuality had been undermined by the need to build a safe, secure family unit that would endure. Jenny, already in some conflict about her lesbianism, couldn't be a second "mom" to the new baby, family builder, companionate spouse, and passionate lover all at once.
I said, "If you can divorce the fate of your relationship from having sex, then you may actually be able to have enjoyable sex, which will improve your relationship. Both of you are now mothers for the first time--Jenny is also a mother to Susan's child--and both of you are trying to be sexual with a partner who's a mother. And you're both trying, for the first time, to have sex with a mother as a mother.
"The transition to motherhood can have a desexualizing effect on women," I added. "The mother isn't an erotic image in our culture. 'Mom' is supposed to be caring, nurturing, loving, but, frankly, rather asexual--she's certainly not supposed to be overtly arousing. She represents the reproductive nature of sexuality, not the pleasure principle of eroticism.
"Being new parents can be pretty overwhelming. But can you try to add making love to the list of all the other things you enjoy doing together to unwind and relax?" I asked. "The idea is to make each other feel good. That's an offer you can't refuse."
At the next session, Jenny reported: "That really loosened us up. We can talk about it, laugh and not be instantly scared." Susan added: "I actually felt excited for the first time in a long time." As the session neared its end, I quoted a passage from Adam Philips's book and asked that they reflect on it together: "A sexual relationship is like learning a script neither of you has read. But you only notice this when one of you forgets your lines. And then, in the panic, you desperately try and remember something that you haven't really forgotten. You hope the other person will prompt you. You start to hear voices offstage. You bring on another character."
A Second Language
Physical pleasure offers a unique haven for many men and women; the soothing powers of the body make it the place for freedom of expression. It's only during sex that they're able to escape their anxieties and obsessive ruminations. The physical pleasure tunes out the numbing stress of the everyday. It provides solace and self-revelation, along with a sense of connection.
Returning to Mitch and Laura and their sexual boredom, I see all the drawbacks of their timid sexual imagination. Both describe their own and each other's sexual selves in stereotypical language. Mitch sees himself, and is seen by Laura, as the classic sex-obsessed man, demanding his rights regardless of how she feels. Laura, who is strong-willed and sometimes domineering in their everyday interactions, sees herself, and is seen by Mitch, as a sexually shy, inhibited woman, repeatedly rejecting his advances from some unfathomable feelings of disgust or contempt.
For Laura, sex is the sum of all the personal, cultural, and familial taboos, restrictions, and inhibitions she absorbed as a child. Her mother repeatedly warned her that sex wasn't for "nice girls." And the only comments about her body she remembers from her father were about her developing breasts. As an adult, she wears concealing clothes, including turtlenecks in the summer. Compliments or comments on her sensuality feel demeaning. Sexuality evokes fear in her; she's never been able to enjoy the pleasures of her body.
For Mitch, on the other hand, sex was always the place where he could feel utterly free, uninhibited, at peace. But in his marriage, he's come to feel awful about something he'd always experienced with confidence and pleasure. Meanwhile, Laura has come to feel completely deficient, ungenerous, and guilty.
In couples therapy, Mitch hears her story and understands for the first time that her alienation from her own body, her own pleasure, has nothing to do with him. This eases his sense of rejection, his anguish about being unable to please her. For her part, Laura learns something equally crucial about Mitch--that when the language of words fails him, as it invariably does in the realm of emotion, he communicates with his body. Mitch needs physicality to voice his vulnerability and delight, his yearning to connect; only in sex can he feel emotionally safe.
Laura, as she hears him, begins to realize, for the first time, how important the body can be as a medium for free, creative, and deeply personal expression. She'd always felt that Mitch's desire for sex had little to do with her; it was just crude physical release for him. For instance, when I ask him to say what he'd like and he says, "I want to sit on the edge of a hot tub and have Laura suck me," she recoils. "It's too raw, too coarse," she says. "It has nothing to do with me ." I remind her that it's her he wants to do it with--only her--and it's, for him, a very intimate act. "He's never gone anywhere else; it's you he wants."
By permitting him to speak only in her nonphysical language, rather than in his sensual language, Laura has blocked not only his ability to really "speak" to her, but her own view of her husband as he really is. She can see only the bully, not the yearning lover. And every time he opens his mouth, that bully reinforces her fears. He's reduced to his second, far less fluent, language of words. Meanwhile, her experience has robbed her of the capacity to speak and understand the body's language. For every person, the physical language is the original mother tongue.
As Laura tries to grasp Mitch's erotic fantasies, I try to steer her attention to herself. What are her erotic choices? Can she let her body communicate its wants to Mitch? Can she dare break through the vigilance, the guilt, and the disavowal that surround her sexual desires and the ideas and feelings associated with pleasing her own body? Can she look her mother straight in the eye and still maintain a sense of her sexual self, indulge in her own experience of eroticism without sacrificing her self-image as a "nice" or "respectable" girl?
Like many women, Laura battles the age-old repressions of female sexuality that have trapped a woman into passivity and dependence on men to seduce and initiate her into sexuality, to intuit what she likes and to bring her to fulfillment. Economic and professional independence not withstanding, Laura remains sexually dependent.
Together, Laura and I expose the tortuous conflicts between desire and denial, wanting and not having, fulfillment and repression. I invite her to engage with her fantasies, to own her wanting, and to take responsibility for her sexual fulfillment. I remind her that sex often evokes unreasoning obsessions rather than clear judgment, selfish desires rather than thoughtful consideration.
I suggest to Mitch and Laura that they're trapped in a language with too little imagination, a language too limited to contain their erotic life. Mitch bursts into tears. "I'm not angry," he says of all the times that his frustration has led to mean, hurtful words. "I'm heartbroken." I ask Laura to just hold him and I leave the room for a few minutes to give them the chance to connect through the pure language of physical touch. I think of my two boys, and how often they want me to hold them. No words can match touch; a hug can melt away many ill chosen words.
Laura's challenge--and that of many women--is to be able to eroticize and desire a man who's present, reliable, and needs her. The vulnerability and dependency that she accepts in her children have a desexualizing effect for her in Mitch. She associates potency and sexuality with the strong, aloof, unavailable man/father. Paradoxically, the erotic realm offers Mitch--and many men--a restorative experience of his softer, more dependent, side.
For Mitch and Laura, the issues that generate conflict in their relationship--control, power, dependency, and vulnerability--can yield sexual desire and mutual pleasure when eroticized. Mitch often resents Laura's overpowering personality in daily life, but would like very much to see its erotic expression. Laura, angered by Mitch's apparent "insensitivity," his power ploys, can find this sexuality erotically appealing when she realizes that sex is a language he wants to speak only with her--that it's she who touches him most deeply and personally.
So many of the couples who come to therapy imagine that they know everything there is to know about their mate. In large part, I see my job as trying to highlight for them how little they've seen, urging them to recover their curiosity and catch a glimpse behind the walls that encircle the other. Eroticism is the fuel for that curiosity, the experience of desire transfigured by the imagination.
As Mexican essayist Octavio Paz has written, eroticism is "the poetry of the body, the testimony of the senses. Like a poem, it is not linear, it meanders and twists back on itself, shows us what we do not see with our eyes, but in the eyes of our spirit. Eroticism reveals to us another world, inside this world. The senses become servants of the imagination, and let us see the invisible and hear the inaudible."
Esther Perel, M.A., is on the faculties of the New York Medical Center, Department of Psychiatry, and the International Trauma Studies Program, New York University. She is visiting faculty at the Minuchin Center for the Family and is in private practice in New York. Address: 307 West Broadway, Suite 5E, New York, NY 10013. E-mails to the author may be sent to firstname.lastname@example.org. Letters to the Editor about this article may be sent to Letters@psychnetworker.org.
Barbach, Lonnie. For Yourself: The Fulfillment of Female Sexuality. New York: Signet, 2000. A key reference on female sexuality.
For Each Other: Sharing Sexual Intimacy. New York: Signet, 2001.
Badinter, Elisabeth. XY, on Masculine Identity. Trans. Lydia Davis. New York: Columbia University Press, 1995. This and Barbach's For Each Other are excellent books on the complementarity between the sexes and the exploration of male andÂ Â female identity.
Friday, Nancy. Women on Top: How Real Life Has Changed Women's Sexual Fantasies. New York: Simon & Schuster, 1991. A look at women's erotic choices by a leading figure in the field.
Giddens, Anthony. The Transformation of Intimacy: Sexuality, Love, and Eroticism in Modern Societies. Stanford, Calif.: Stanford University Press, 1992. A clear, concise, historical account of male and female sexual development and perspectives, sexual addictions, and contemporary relational alternatives.
Gilmore, David D. Manhood in the Making: Cultural Concepts of Masculinity. New Haven, Conn.: Yale University Press, 1990.
Paz, Octavio. The Double Flame: Love and Eroticism. Trans. Helen Lane. New York: Harcourt Brace, 1995. Illuminating and provocative essays on the connection between love, sex, and eroticism by the 1990 Nobel Laureate for literature.
Phillips, Adam. Monogamy. New York: Pantheon Books, 1996. Witty, brief reflections on the nature of erotic desire, trust, and transgression.
by Lynn Godzki
One hot summer afternoon John, a psychotherapist in private practice for 17 years, came into my office looking frustrated, complaining that his practice was going nowhere. Not that he didn't like doing therapy--he still loved it--but he felt stuck and frustrated in the practice itself. His income had barely inched upward over the past few years, he wasn't getting his name and practice out in the world as he wanted, and he felt increasingly overwhelmed by paperwork, as if the business part of his practice were running him, not the other way around. When I asked him to explain what he meant, he sighed and described the chaos of his office: journals, newsletters, papers, insurance forms, notes, bills, and whatnot were stacked on the desk, the table, the chairs, the floor, to such an extent that it was difficult to get around. "I know I'm really good at what I do, and I have dreams of expanding my practice and developing more of a reputation in my field," he said despondently, "but I can't seem to get organized to do anything about it. I thought I'd feel more settled and directed by this age, but I don't."
John's experience wasn't at all unusual. Psychotherapists don't go into clinical practice because they're such great businesspeople. They want to be helpers and healers, not entrepreneurs. Although most of them recognize the advantages, in terms of autonomy and income, that working within a private practice brings, the business world and terms associated with it--such as profit, expansion, competition, even "success" itself--tend to make many of them uneasy. In short, therapists tend to regard business as alien to their practice.
I find that, with business coaching, therapists can learn to become very smart businesspeople. Far from being a struggle against their own better instincts or a betrayal of their own best principles, becoming more entrepreneurial can be deeply liberating. I can actually allow therapists to be more effective, less anxious, and less psychically split between their "good" clinical practice and their "bad" business.
After John finished describing his frustrations and the rat's nest of paper that was his office, I asked him to mentally take a step back, so he could better examine not only the state of his practice, but his relationship to it. Therapists tend to overidentify with their practices. As sole proprietors, they frequently do everything and take every role in the business--clinician, CEO, administrator, bookkeeper, secretary, janitor. With so much of themselves wrapped up in their practices, it isn't surprising that they tend to think they are their practices. This overidentification is one key reason why therapists feel unhappy in business. When the business is up, their mood goes up; when the business falls off, they crash, too. In their fused state, they often can't recognize the difference between what they want and what the business needs.
One way to help clients differentiate themselves from their practices is to ask them to imagine the practice as a distinct entity from themselves--another person, so to speak. True, they created the business, but no more than their own child is it an undifferentiated extension of themselves. "If your daughter needs braces," I sometimes say, "you don't refuse her orthodontics because your own teeth are perfectly straight." I asked John if he could talk to me about his practice as if it were a separate being, with its own individuality, personality, needs, and behavior.
He laughed nervously, but agreed to give it a try. "Should I make it a male or a female?" he asked.
"Your call," I replied.
He thought for a moment. "Well, my practice is definitely a she, " he said. "She's timid and boring. She's also pretty rigid--she only knows how to do things one way, and she sticks to it, even when it's illogical. We've gotten along okay, so far; she's a familiar, safe presence in my life. But I've known her for more than 20 years and she never changes. I'm bored with her." John paused, looking ruminative. "It wasn't always this way. When we first met, I was thrilled by her--she got all my attention and energy. But now, my attention is drifting. I want something more."
John suddenly reddened, looked at me open eyed, and barked out a laugh. "I sound like the world's biggest clicheÂ´! I get it now. I'm having a mid-life crisis," he said. "I want to have an affair, but it's not my wife I want to leave, . . . it's my private practice!"
The great thing about working with therapists is that they frequently get the picture very quickly. John looked out the window for a minute. "This is ironic," he said, a little sheepishly. "I specialize in working with couples, and here you're reminding me that when you're in a relationship for two decades, even a relationship with your business, things change. The question for me, I guess, is what the changes mean and how they'll play out. Will I need to leave this timid, messy lady--and all that we've built up together over the years--in order to get what I want now?"
We looked at each other and smiled. "Welcome to business ownership at mid-life," I said.
Finding a Road Map
When seeing therapists who are struggling with their relationship to their own practices, it's crucial to have a broader developmental framework to help break up the logjam keeping them stuck. Certain similar themes consistently emerge in the early, mid-life, and mature stages of a small business. As a business goes through the early stages, its owner is consumed by survival, competition, and stabilization. During the mid-life stages of a business, issues such as organization, expansion, and achievement take center stage. Later, during more mature stages, the "successful" businessperson focuses on renewing personal values, finding more affiliation with others, and incorporating a greater sense of integrity.
The developmental model I use in my business coaching with practitioners like John is adapted from Spiral Dynamics, Don Beck and Christopher Cowan's work on social and organizational evolution. I focus on the specific objectives and tasks suggested by their model, actions that small proprietors need to take at each of the eight, color-coded developmental stages of business development. Working in this way, I recognize the stage a business is in by the themes my clients reveal as they talk to me about their private practices.
Any beginning entrepreneur, including a therapist, in the first (beige) developmental stage, is primarily concerned with survival. Clients in thisÂ stage typically complain of feeling insecure, panicky, and clueless about what to do next to keep the business viable. Inexperienced and driven by anxiety, they operate mostly on instinct, and the best way to help them is by teaching them to replace instinct with intention and planning. I usually begin by helping them devise a business plan that leaves as little as possible to chance. This might mean writing down their short-term goals and long-term vision for the practice, deciding on specific networking steps to take and how many hours each week to network, scheduling time to consult a financial advisor or a computer expert, if needed, and creating a circle of professional support, such as meeting regularly with other therapists, who can be a source of guidance and encouragement. These suggestions are often met with surprise and resistance--"It'll cost too much money!"; "I don't want to get all these other people involved!"; "I should be able to do this stuff myself." It always amazes me that clinicians invest freely and generously in their own clinical growth--paying for clinical supervision, taking advanced training courses, attending workshops, buying textbooks--but consider investing in their businesses a kind of unnecessary extravagance.
The second (purple) stage often reflects a superstitious, even magical, way of thinking, and parallels cultural eras when people feel dependent on rituals and traditions, often without practical or rational basis. At this point, a business may be surviving, but the entrepreneur has no idea why--no idea what he or she's actually doing that makes the thing "go." Not knowing how to keep on being successful, they tend to cling to comfortable rituals and habits, almost from a sense of dread that if they change anything, the success will go away. For example, one therapist told me he had four different bank accounts in three different banks and randomly deposited his clients' checks each week into all of them. "Why?" I asked him, suggesting that consolidating them would make better financial sense. He shook his head and repeated doggedly that this system had just "worked" for him up until then, and things might not "work" if he changed it. Several therapists have told me that when they lose clients, they believe that if they don't allow themselves to worry and just visualize abundance, new clients will show up. They insist that if they think about their situation too carefully, it stops the flow of clients. Many clinicians have no idea how clients discover them, where the referrals come from; the appearance of new clients remains a vast mystery to them--a gift from heaven. Not knowing what they've done to get clients in the first place, they don't know how to keep doing it.
Helping these therapists unravel the myths and mystery of business and implement practical, concrete strategies, while they learn the laws of cause and effect, empowers them. They feel less anxious as they see that can take steps to create their own business destiny. Writing business plans and setting goals; determining how much they want to earn and how to set and raise their fees; deciding what their policies are (about cancellations, for example) and what factors determine client retention; knowing how to effectively market, network, and generate referrals--all this information can help them understand how a therapy business works. Such steps normalize business operation, make it less confusing, and help them become savvier entrepreneurs.
Finally, in the early stages of a business's growth, there's the red stage--what Beck and Cowan call the egocentric phase--when a strong sense of individualism and selfhood comes to the fore. With survival secure, clinicians begin to have some practical sense of what they need to do to keep their businesses afloat and start concentrating more on staking out their own professional identity in the world. At this stage, a proprietor knows she's developed something substantial, worth protecting and preserving, and begins to look around at all the potential rivals she has--how many others in her area also specialize in addictions, or adolescence, or couples' counseling? How's the clinician going to stand out from the throng?
Therapists often have a hard time with competition. While it seems perfectly normal for a car salesman to be competitive, it feels perverse to therapists, who aren't happy to find themselves thinking envious thoughts about colleagues and obsessing about how they can get ahead of the pack. It sounds so narcissistic and unbecoming in a mature, selfless healer!
In contrast, because clinicians often don't understand the normal mind-Â set of an entrepreneur or how to accept themselves as competitive beings, they may overreact to theÂ presence of perceived rivals. OneÂ therapist I saw had identified a colleague in her area--with similar credentials, professional history, and specialty--as someone she needed to match and keep up with, step for step, as if her own career somehowÂ depended upon how her colleague did. She found herself trying to second-guess the colleague--angling to present at workshops where she thought the other therapist wouldÂ also present, for example. What helped her negotiate this particular stage was refocusing on her own personal vision for her professional life, reconnecting with what it was about the work that she loved, what sheÂ wanted for her own career. Getting back in touch with her original vocational foundations helped her stay on course with the goals that wereÂ Â Â important for her professional development and act to determine her own identity as a therapist, rather than react with one eye always on somebody else's progress.
When John described the chaos of his office--journals, papers, insurance forms, and whatnot stacked on the desk and the floor--and showed me his old-fashioned calendar with a jumble of scrawled names and appointments, I knew he was having trouble negotiating the fourth (blue) developmental phase, which focuses on organization. People at this mid-life stage need to create stronger, more functional, business structures to support their dreams of enlarging their business and becoming more profitable. John's frustration came about because he wanted to branch out and pursue greater opportunities, but he hadn't completed the tasks required by the blue phase of his business. He had ideas and dreams, but didn't have the structures in place to make them happen.
Although people have to learn that their businesses stand alone as separate entities, it's also true that because people's businesses are their own creations, they necessarily reflect key strengths and weaknesses within them. However distinct your children are from you, undoubtedly they also reflect your genes, your values, your capacities as a parent. At times, the easiest way to help a therapist change a problem in his business, is to see whether he can make a similar change first, in himself.
I told John that he needed to think of his business as a mirror of himself. What was it in his life or in his childhood that might contribute to the mess of his office and the paperwork that was essentially drowning him? John said he'd never been a well-organized person. As a young child, his parents had moved many times. Again and again, he'd been uprooted from familiar surroundings, friends, and schools, leaving him feeling that nothing ever really belonged to him. Nothing, that is, except what he could physically carry with him from house to house, state to state. Rather than teaching him to pare down his belongings and travel light, the constant moves made him ferociously attached to his "stuff." Once John understood the connection between the origins of his pack-rat mentality and their effects on his business, he could begin, with difficulty, to take steps to change his business practices. Reluctantly, he admitted that this problem was more entrenched than he thought; he needed to bring in someone to help him fix it and agreed to hire a "clutter consultant," a professional he found in his local paper, who came to his office and completely banished the clutter and reorganized it.
John focused on other "blue" issues of organization, including how to use what I call a Practice Upgrade Plan--which I developed to help a small-business owner bring more stability and substance to the business and enhance its reputation in the community. Through the Practice Upgrade Plan, I encourage proprietors to build into their daily schedules time for planning and actions that will strengthen the long-term prospects of their practices. For example, this is the stage for a therapist to decide his top five business goals for the next year and to take one action every day toward these goals.
After several months, John found, to his delight, that his business was easier to operate: his billing was done on time each month, he'd collected past-due receivables, and his clean office and new, computerized calendar made his weekly administrative tasks a breeze. With his newfound energy, he was ready to move into the fifth (orange) stage and focus on expansion and achievement. John was jumping with at least three new ideas each week for expansion that interested him. Once people acquire a new set of eyes for gazing on a world of sparkling possibilities, they also need a filter for sorting all those opportunities. I suggested that he develop a set of six questions that would help him evaluate each potential opportunity. His questions were:
1. Is it, or will it be, profitable, and when?
2. Will this allow me to do better work as a therapist?
3. Will I have fun doing this?
4. What's my gut feeling about this opportunity?
5. What do I gain if I say no?
6. What do I gain if I say yes?
How did these questions help John sort through the onslaught of possible opportunities? One of his colleagues who had many legal contacts had built a practice of couples therapy with court-referred families. He asked John to join him in setting up a partnership to offer workshops and training for other mental health therapists who do the same kind of court-referred counseling. The colleague said the referral rate from the courts and lawyers was substantial, but many therapists didn't know how to do strategic, effective counseling with this population; he and John would show them. Using the six questions above, John thought that it could be very profitable, but only after about two years of hard work and marketing the workshops. He was expert in couples counseling and enjoyed training others, but decided that this project, while interesting in itself, wouldn't actually help him become a better therapist. As to whether it would be fun and what his gut feeling was, John said, "I'm not sure. I like the guy quite a lot, but the 'fun' part of the deal would probably be outweighed by the sheer drudgery of getting it off the ground." What would he gain from saying no? More time to pursue interests that he really knew he liked. What would he gain from saying yes? Possibly a new income stream--training could be a good profit generator down the road. In the end, John decided against the offer since the negatives seemed to predominate.
Marketing is itself a daunting word for therapists, who generally loathe any suggestion of self-promotion. To help them conquer this hurdle and begin taking marketing steps networking, becoming involved in community activities, teaching courses at local adult ed colleges, writing articles for local newspapers, etc.--I imbue them with the basic principle that should undergird all their business-building efforts. Base your actions on love, not fear. Fear-based marketing, for example, would be a therapist who grimly settles down to make phone calls to people he doesn't know well, detesting the whole process and saying, "I loathe doing this, but if I don't, my practice won't survive." In coaching sessions, we talk about these feelings, and I ask, "Is it possible to imagine a way of doing this that might not seem so bad, might even make you like it?" Generally, we get into a discussion of the clinician's love for her own work and pride in her vocation, her deep belief that she does have something good that will truly help people, her realization (beneath the reluctance to make the call) that the person she's calling might be glad to hear about what she's offering and welcome collaboration.
One clinician I worked with called an oncologist she knew. She told him how much she admired him and his reputation for kindliness and patience with scared, desperate patients, and said she wanted to let him know that one of her own specialties was working with very sick or dying people and their families. This clinician made the call in a spirit of love for her work, for the good she knew she could do, and from a conviction that she and the physician might make a very good team. The doctor felt both flattered and receptive--here was someone to whom he could refer people for the kind of help he didn't have the time or expertise to give.
At this heady stage of entering orange territory, feeling an upsurge of personal power and emotional zest, many therapists become aware of a small, tough little worm gnawing away at their euphoria, signified by the words ambition and profit. These terms, along with competition, so normal to the business world, are often anathema to therapists. John, for example, would be energetically talking about potential new opportunities when suddenly, looking crestfallen, he'd say something like, "Boy, I'm beginning to sound like a real estate developer, not a therapist."
Again I asked him what it might be in his family of origin that made him so uncomfortable with ambition and profit. "My father was in sales and worked for a variety of bosses," he began. "He often complained about his current boss and how owning a company gave a person a swollen head. We weren't poor, but he was always worried about money and it was a constant source of tension in our family. I want to be able to retire someday, and I need to make more money. It's now or never. But I get a lot of negative thoughts and feelings when I try to stretch too far in the direction of seeing this as a real business and making more money. I begin to feel that I'm selfish and attention-grabbing, and I can hear my father saying I'm getting too big for my britches and setting myself up for a fall."
I often invite proprietors to "embrace their ambition"--clearly a tough sell for therapists, who think that too much emphasis on ambition and profit signify self-absorption and greed. So I suggest to clinicians that they think of ambition as a kind of emotional fuel, a motivating force that frees their passion, imagination, and creativity. Ambition is really a synonym for desire, emerging from the same impulse that helped get them through school, then into training internships, and, finally, into their own private practices. I suggest they ask themselves what they fear about ambition and then allow themselves to do a little daydreaming about their ideal future. What--no matter how apparently improbable, grandiose or Walter Mitty-ish--would they most like to see happen to themselves and their businesses? They don't have to act on every ambitious thought or fancy, but allowing their minds to wander in this way helps detoxify ambition and gets them in touch with their own aspirations.
After orange, there's another swing of the pendulum to a third, latter-life evolutionary stage with its own phases, the first of which is green. If orange is characterized by the drive for achievement and material success, green represents a move in the other direction, toward the integration of more humanistic values into one's work life. The characteristics of this stage are a desire for deeper personal or spiritual connections, a yearning to experience again the soul-deep inspiration that brought them to the work in the first place. People signal they're ready for this stage when they complain that, for all their material and professional success--the practices (perhaps several offices) purring along at full occupancy, the workshops they're asked to conduct, the book chapters they're writing--they feel something lacking. Green is the color of congruence, when any incongruity between professional success and personal identity becomes painfully obvious.
John, who'd just entered the orange stage and was exuberantly enjoying the world of prospects and achievement after having been in a safe, but confined business situation, wouldn't be ready to shift into the next (green) stage for a while. But another client, Clara, is experiencing "symptoms of green." A social worker with many years of experience, she no longer sees clients. Instead, she owns and operates a healing center that she built from a solo operation to a prosperous, 15-person organization housed in a large commercial property that she owns in a busy Midwestern suburb. She employs mental health professionals, massage therapists, and physical therapists. She's an excellent businesswoman and a natural marketer, who actually enjoys calling total strangers to talk about her practice. She considers each call a kind of adventure into the unknown.
But when Clara called me, she said that, in spite of her obvious success, she was feeling dissatisfied and burned out. She felt tired much of the time, and although she had a heavy workload, she thought this tiredness was from feeling less personally connected to what she'd built. More and more, she felt less like a healer with a real gift for connecting with people in pain and more like the harried CEO of, say, an expanding widget plant. "As each year goes by, I feel less sure about my direction," she said. "I'm always marketing, planning, or thinking about some business problem--staffing, expansion, leveraging our space needs, or looking for increased areas of profitability. I wanted to create something meaningful with this center, something that would genuinely help people and contribute something to the community. I've done that, I think. But I've kind of lost sense of what it means to me. I feel I've lost something important, which I had when I was just struggling to make ends meet.
"And besides, " Clara said forlornly, "I feel lonely. I don't know any nearby therapists in my situation that I can talk to for support. All the professional clinicians I know imagine I couldn't possibly have any complaints or needs. It sounds like a joke, but I'm a case study of 'lonely at the top.'"
Sometimes, in the midst of material success, we forget that even though we've "made it," we're still evolving. The pendulum doesn't stop swinging just because we now command a six-figure income and a staff of subordinates. Since the classic signals of a business owner who's entering the green stage are concerns about isolation and lack of meaning, the objectives of that stage usually include building a deeper community, relaxing boss-employee hierarchies by sharing more power, and taking steps to renew old passions and explore the spiritual dimensions of life.
For clinicians in this stage, I've created a checklist of 60 evocative words that elicit core values--including, for example, "creativity," "learning," "enlightenment," "sacredness," "compassion," "adventure," "inspiration," "accomplishment," "understanding," "wholeness," "connection," "fairness," and the like. I ask therapists to pick their top four that they feel define them and their work at some fundamental level. Which words, I inquire, draw from them an almost automatic sense that "this is really me?" Next, we look at whether those values are now reflected in their practice. What would bring more passion into their work lives? How can they make their professional lives more deeply congruent with their deepest values? Because the hallmark of coaching is to help people take action--not just speculate about personal philosophies--we then work on concrete steps to bring their practices more in line with their ideals.
Since one of Clara's core values was "healing," she began to realize that she missed the hands-on experience of doing therapy. So she hired a part-time operations manager to take on some administrative tasks, freeing her to see a few clients every week. At the end of the year, she reported feeling exhilarated again about her work, having rediscovered her fascination and passion for doing therapy itself. During this time, she also created a professional network of about a dozen business leaders who met regularly to talk about their concerns, and a smaller, more intimate, circle of entrepreneurs who became friends as well as associates. She now felt the "connecting" instincts that drew her to the field in the first place had been reborn.
There are two stages beyond green--yellow and turquoise--which represent, each in its own way, a leap into a transcendent kind of thinking and feeling about work and professional identity. The yellow stage--a phase of deep creative regeneration--occurs when a seasoned, mature, successful entrepreneur makes a profound life change and breaks away entirely from his or her old route to explore new territory, just for the sake of newness.
At one workshop, for example, I asked attendees to talk for a few minutes about their practices--where they felt they were in the trajectory of profession and career, given the eight, color-coded stages of evolution. After several practitioners had spoken about their aspirations and frustrations--most were in the early and middle stages--one woman raised her hand and said that she and her husband had built a successful group practice. "I feel now that I've achieved every professional goal I set out to achieve, including what many here today are still seeking," she said. "Now I'm ready to do something completely different. Next year at this time, I know I'll no longer be associated with this practice. I don't yet know exactly what it is I'm going to do--though I've got some ideas--but I know it'll be a departure. My husband and the group aren't happy about my decision, but I feel very deeply that it's time for me to go off on my own, in an entirely new direction." As she spoke, the room became very quiet; she was clearly at a different crossroads than any of the others. When I asked the attendees what stage they thought she'd approached, they shouted out, "yellow." A therapist at this stage is willing to provoke some chaos, relying on her flexibility and the synchronicity around her. Her knowledge and competency as a therapist and businessperson are retained and integrated as she ventures into this new phase of life and work.
The last stage is the rarefied turquoise stage, an idealized "holistic" domain, in which business owners see all the many levels of interaction possible and utilize the state of "flow" for the best, easiest performance from individuals. Turquoise businesses are attuned to the delicate balance of interlocking life forces and aspire to spiritual connectivity. As exclusive a coterie as this stage represents, many people nonetheless can experience turquoise moments--states of flow, when thinking, feeling, and action seem united.
Marla, a psychologist in private practice for a decade, says there are months at a time where she feels that her therapy business operates effortlessly. In the early years, she did a lot of hard work--making contacts, finding the right office, getting her policies to reflect her values, building her reputation and her skills. She joined associations to keep her name out there, spoke at any conference that would have her, and learned how to fill a practice with referrals so that she could side-step managed care and stay independent. "My practice stays as full as I want it to be," she says. "I make good money, I gross over $100,000, which is enough to support myself and my family and to have the life-style that I want. I love the clients I work with. I love the work I do. I get to take whatever training appeals to me to stay fresh and motivated. I feel very connected within my community and have a lot of professional support around me. I don't have to hustle or promote myself in any way. Good referrals come in regularly, from all the contacts I so carefully made in the past. I can be very selective and only see clients I want to work with. After a long day of seeing clients, I don't feel drained. Instead I feel full, as though I just finished a very satisfying gourmet meal."
Meanwhile, back on planet earth, we therapists are mostly still trying to reconcile the ethics and values of our chosen profession with what we often feel are the unsavory truths of the business world. And yet, it's the business itself, our own business, that gives us the most freedom to practice our vocations with the greatest degree of integrity and personal choice. As therapists, we often consider ourselves to be masters of change. If we can begin to see that our businesses are themselves evolving organisms, with their own identities and strengths and weaknesses--just like our clients--we might be better able not only to master the process of their change and development, but to enjoy watching them, and ourselves, grow.
Lynn Grodzki, L.C.S.W., P.C.C., is a psychotherapist and business coach in private practice. She's the author of Building Your Ideal Private Practice and 12 Months to Your Ideal Private Practice: A Workbook and editor of The New Private Practice: Therapist-Coaches Share Stories, Strategies, and Advice . She can be reached at her website: www.privatepracticesuccess.com. Address: 910 La Grande Road, Silver Spring, MD 20903. E-mails to the author may be sent to email@example.com. Letters to the Editor about this article may be sent to Letters@psychnetworker.org.
by Mary Sykes Wylie
Martin Seligman reports spending much of his life as a "walking nimbus cloud enduring mostly wet weather in my soul." Former president of the American Psychological Association and about as famous as any research psychologist is likely to get, he admits he never much liked doing therapy. He usually felt relieved when sessions ended ("I was always itching to leave the room," he says) and thought he wasn't much good at therapy, anyway. So how did this admittedly depressive man of science--someone who'd rather conjure up research projects than meet real, live clients face to face--come to be known as the "father" of something called positive psychology, a movement that could change the face of psychotherapy as we know it?
For those who haven't looked at a psychology journal or even a newspaper for several years (Seligman's work has been featured on the front pages of The New York Times, Time, Newsweek, U.S. News and World Report , and USA Today ), positive psychology--the hottest new trend in the field right now--is basically the scientific study of what makes people happy and good. Its proponents believe that positive psychology not only has the potential to shake clinical research to its roots, but may directly challenge some of the most basic attitudes that psychotherapists bring to the practice of their work.
Accenting the Negative
To understand just how novel this perspective is, positive psychologists ask you to consider the field's history. For 50 years, they say, professional psychology ought better to have been called victimology, so obsessed has it been with the study of what's wrong with people--what's wrong with their emotional lives, their relationships, their physical brains, why they fail and feel bad and do terrible things to each other. The entire so-called mental health establishment has become a giant public edifice dedicated to mental illness --from the National Institute of Mental Health (which only funds studies geared to treating mental diseases) to the Diagnostic and Statistical Manual of Mental Disorders ( DSM ), an 800-page, quasi-scientific classification of human unhappiness, to virtually every textbook a student therapist reads in training.
In the meantime, what makes for good, healthy, and happy human functioning has not only been ignored, but considered an unscientific and virtually disreputable academic pursuit, like researching astrology or psychic phenomena. "We know a great deal about the psychology of conformity, cowardice, and prejudice," says Laura King, associate professor of psychological science at the University of Michigan, "but we don't have a good take at all on generosity or heroism--why, for example, ordinary people on flight 93 on 9-11 could become heroes in rising up against the hijackers."
However promising the new science of positive psychology, it probably wouldn't have achieved its current high level of visibility and apparent success without the formidable Seligman persona behind it. "Marty is a big, big person, with a big personality, a powerful, booming speaking voice, and an authoritative style," says King. A can-do kind of guy, he has established something of an empire devoted to positive psychology. Among other accomplishments, he has set up a scientific foundation, three distinct research centers and a training institute to promulgate the faith, launched a book series, led numerous conferences featuring various academic stars, gotten the American Psychological Association behind his efforts, fired up platoons of young research psychologists around the country, and generated enough grant money to fund a host of studies in universities around the country of what, empirically, constitutes the good, the true, the wise, the spiritual, and even the merely pleasurable in human affairs. To cap it off, he has gone beyond the academic world to attract national attention for positive psychology with his just-published book, Authentic Happiness , a neat counterpart to Learned Helplessness , the book that helped make his reputation more than 25 years ago. Not too shabby for a movement that's only about four years old.
A few tiny shadows dog this expansive and, well, optimistic enterprise, however. First, some humanistic psychologists grumble that there's nothing remotely new about positive psychology--they've been ploughing the same field for 40 years, ever since pioneers like Carl Rogers, Abraham Maslow, Rollo May, and others broke with psychoanalytic tradition to emphasize their clients' potential for growth, wisdom, love, pleasure, and creativity. Then there are the critics from within academic psychology, who say that positive psychology isn't and never can be real science. These skeptics argue that the terms of positive psychology are too vague and susceptible to individual interpretation ever to be defined, let alone measured, by the methodologies of empirical science.
Learning to Feel Good
Seligman, now Fox Leadership professor of psychology at the University of Pennsylvania, was catapulted to prominence in the field as a graduate student in the mid-1960s, when he and several colleagues discovered the phenomenon of learned helplessness in dogs. They found that dogs given shocks while restrained and unable to escape soon "learned" that trying to escape pain was futile. Even when the restraints were removed, the dogs refused to run away from the shock, or go on to learn any other tasks, but simply remained where they were, whimpering and passively enduring whatever happened to them. This and other experiments confounded standard assumptions of behavioral psychology--that animals (including humans), when conditioned, respond noncognitively, reflexively and involuntarily to pain and pleasure, trying to avoid the first and get at the second. Seligman's work showed that even dogs could actually learn a generalized state of expectancy that went beyond a response to any particular stimulus and paralyzed their capacity for any action.
If dogs can learn to feel too helpless and hopeless to make any effort to change their plight, Seligman wondered, why not people? The theory of learned helplessness--the acquired attitude that "nothing I do matters, or ever will"--along with systematic techniques for treating depression developed by psychologist Aaron Beck, gave a tremendous boost to the nascent movement of cognitive psychology, emphasizing the vital role thinking played on subsequent feeling. What we learn to expect from ourselves and others can determine our emotional experience of the world and how we deal with life. Over the past 25 years, cognitive behavioral methods for treating a range of clinical problems, grounded in this perspective, have come to constitute the core of empirically-supported therapy practice.
For Seligman, the next step after developing the concept of learned helplessness was obvious: if people can be taught to feel bad , perhaps they can also be taught to feel good . He began work on what would be his real vocation: not just studying optimism and well-being, but devising successful methods for teaching the skills of optimistic thinking to potentially depressed adults and children. "Seligman showed that you can literally change the minds of pessimistic people in a relatively short time, thus getting really good outcomes for preventive therapy," says psychiatrist and resilience researcher Steve Wolin. "It was elegant work."
In 1995, Seligman acted as consultant on a huge national survey done by Consumer Reports , which showed that most of the respondents felt they benefitted very substantially from therapy, and those whose therapy lasted the longest felt they had benefitted the most. Although academicians roundly denounced the survey for its lack of scientific rigor, psychotherapists loved Seligman for it. In 1996, thousands of clinical psychologists helped elect him president of the American Psychological Association by the largest margin in the organization's history.
As APA president, Seligman brought positive psychology front and center to the attention of field. The spotlight, however, also provoked criticism. In response to the special 2000 issue of the American Psychologist on positive psychology, a group of irate humanist psychologists charged that positive psychologists had "hijacked" the humanist movement, "stolen its premises," ignored its predecessors, "derided its history," denied its legitimacy and "cancelled" its right to be considered a Âserious player at the mainstream psychology table. Solution-focused and resilience-oriented therapists also protested that they, too, have long underplayed pathology and focused instead on helping clients bootstrap themselves up on their own strengths and abilities.
The Science of Happiness
What sets Seligman apart is his determination to ground positive psychology in tough-minded, grown-up science. Unlike the humanists, who wanted to jettison standard research techniques as too mechanistic and reductionistic to measure experiences like happiness, creativity, spirituality, and the like, Seligman and company want to subject these soft concepts to the hard science of empirical tests and statistical analysis, take them out of the woozy realm of pop psych and inspirational platitudes and give them intellectual backbone. They've produced reams of reports that, on paper, reduce inchoate ideas about happiness into orderly categories and subcategories. So far, they define three major branches of the positive-psychology tree: subjective happiness (positive emotions and mood), human excellence (positive personal strengths and virtues, like optimism, wisdom, and knowledge, courage, spirituality, love and humanity, justice and temperance) and positive institutions (democracy, family, a free press). At universities around the United States, researchers are beavering away, trying to ground amorphous concepts in valid research designs to determine what they mean operationally and how they objectively affect the way people behave.
Compared to studies of psychopathology, these sun-drenched efforts can sound quixotically cheerful--Academic Psychology Meets Mary Poppins. Different "pods," as they are called, of positive psychology researchers are studying, for example, the factors associated with a happy, satisfying Christmas, the emotional consequences of overconsumption and greed (one major focus of the movement is "finding alternatives to materialism"), and the impact of feelings of awe and transcendence on cardiovascular physiology. Other projects seem more mainstream: how positive traits and life events promote immunity and health; how positive emotions and social interactions protect students from loneliness and depression (a prospective study of Stanford University's entering class of 2000); what sorts of school-based interventions can promote Âoptimism, hope, perseverance/resilience, courage and duty/citizenship in students.
This blossoming of research projects doesn't cut any ice with academic critics, who maintain that much of positive psychology still remains on the squishy side of scientific legitimacy. In an upcoming issue of Psychological Inquiry , psychologist Richard Lazarus and several colleagues take positive psychology to task for shallow and overly casual research methods, oversimplifying the meaning of basic concepts, ignoring individual differences and changes over time in individuals, and failing to show real causal relationships among emotions, health, and well-being. Positive psychologists respond that every one of the critiques leveled at them could just as well be made of virtually all psychology research (the behavioral sciences aren't physics, after all) and that, if anything, positive psychology has gone overboard to make its studies as unimpeachable as any research in the field has ever done.
Critics are particularly unconvinced by Seligman's classification schemes, his assumption that foggy, philosophical terms can someday bear the weight of empirical science. How can inescapably qualitative concepts like "wisdom," "joy," "judgment," "courage," and the like be rigorously defined, much less objectively analyzed and quantified? Even more to the point for therapists, how can such vague entities become relevant to any practical, down-to-earth interventions with real clients? Steve Wolin remembers being astonished when he first saw the list of qualities--wisdom, courage, humanity, justice, temperance, transcendence--Seligman intended to turn into universally valid scientific constructs. "This is all well and good," he wrote in an e-mail message to Seligman. "But this is not what my patients are interested in. My patients are interested in sex, shopping, drugs and rock 'n' roll."
Wolin thinks Seligman is so focused on the definitions of universal strengths and virtues--untainted by relativistic, culture-bound, everyday human context--that these terms risk languishing in the realm of meaningless abstraction. "People use their human strengths like creativity, humor, relationship in specific contexts, to overcome particular adversities, hardships, and struggles--but Marty doesn't seem to be interested in that--he's interested in their pure, Aristotelian essence. I want to see his work make sense to those of us in the trenches. How can I use what he is doing?" In response, Seligman and his colleagues concede that positive psychology is still baby science, but point to such achievements as devising eight-week training workshops that, when given in controlled studies to school children and college students at risk for serious depression and anxiety, reduced the development of symptoms as shown in follow-up studies three years later. With hundreds of young adults and schoolchildren at risk for depression, their research has shown that learned optimism programs used preventively halve the rate of depression and anxiety disorders over long-term follow-up.
Positive psychology may remind people of "positive thinking," the feel-good/get-happy movement most often associated with uplift gurus like Norman Vincent Peale in the 1950s. But positive psychology has a paradoxical side, which could only emerge from the mind of a born pessimist, someone deeply familiar with the dark side of life. Seligman not only knows firsthand about human unhappiness, he has come to accept and respect it. "Evolution stamped dysphoria pretty indelibly into the psyche of the human species," he said in a Slate online debate with evolutionary psychologist Stephen Pinker last October. "It was the dysphoric hominids that survived the bad weather of the Pleistocene, not the blithe ones." Sadness, anger, and anxiety are built into the human frame--some frames more than others--and no amount of therapeutic tinkering or positive affirmations is going to turn a natural-born Grinch into Goldie Hawn.
If negative emotions are a necessary part of human nature, so too are the positive ones--with one big difference: it's probably far more feasible, not to mention more pleasant, to expand and build up our capacity for good feelings than it is to eliminate the bad ones. The underlying message of positive psychology is that we can to some extent make ourselves happier, even when we can't entirely rid ourselves of our miseries.
But this happiness-building project is not a walk in the park (though a walk in the park may be a very good happiness-building project). Feelings of joy, contentment, love, awe, even physical pleasure don't consistently "just happen," particularly to those of us who, like Seligman, are more naturally inclined to emotional twilight or even foggy drizzle than brilliant sunshine. These good feelings evolved as emotional rewards humans got for the kinds of activities that make decent civilization possible--hard work, cooperation, self sacrifice, child care, learning, teaching, seeking transcendent meaning in ordinary life. In other words, pleasure and satisfaction most often don't come without previous expenditures of will power, courage, applied intelligence, and damn good attitude. Not normally found in psychology textbooks or therapeutic interventions, nor reducible to popular self-help bromides, these qualities used to be encapsulated by the term good character .
Indeed, Seligman writes in Authentic Happiness , "the notion of good character is a core assumption of positive psychology." Which brings us to a surprising feature about Seligman the scientific psychologist--his deep commitment to a very old philosophical quest: understanding the nature of goodness and virtue. He asks questions that would have been familiar to thinkers in Athens 2500 years ago: what constitutes the good life? how do we define happiness and pleasure? what role do virtue, morality, and ethics play in finding happiness?
For individuals pondering these imponderables, wondering how to make them relevant to their personal lives, Seligman offers both a question and a route to the answer: what personal abilities, strengths, and potentials within our own natures can we draw on to create the good life? Seligman has devoted himself to giving this age-old project the full treatment of modern science. In the end, he believes that happiness is a pursuit, as Thomas Jefferson suggested, not an automatic benediction; it doesn't come easily or without struggle for most people. Seligman has been known to say at the end of his talks, "All my work can be boiled down to the one-word answer to a single question. The question is: 'What is the word in your heart?' Is it yes? or is it no? "
In the following interview with Networker editor Richard Simon, Seligman explores the implications of positive psychology for the psychotherapy field.
Mary Sykes Wylie
Psychotherapy Networker: As a therapist and researcher who has spent three decades trying to build a bridge between the world of science and the world of everyday practice, are you impressed with the hard evidence of psychotherapy's effectiveness?
Martin Seligman: Not really. Over the past 20 years, it looks to me like we have hit something I call the 65-percent barrier.
MS: If I average all the therapy outcome studies that I've ever read--which by now is probably in the four figures--and I take the percent relief provided by both drugs and psychotherapy across all the disorders, I'd say the average improvement is around 65 percent. That means that, by and large, we produce only mild to moderate relief.
PN: So let me make sure I understand what you're saying. If cure is 100 percent--a touchdown--then 65 percent is a field goal?
MS: Yes. And also that, overall, about 65 percent of the people who come in for therapy see some degree of symptom relief. And 50 percent is what a placebo typically does. And by placebo, I mean either a drug with no known effect on a particular condition or, in the therapy context, an interaction that isn't designed to have specific treatment effects. In other words, both through drugs and psychotherapy, we're dealing with doing 30 percent better than placebo. Of course there are wonderful cases in which there are complete cures, and I'm a collector of those, and you can find those in some of my books. But the average is 15 to 20 percent better than the placebo.
Now that prevents a lot of suffering and you could argue that it's worth the $20 billion investment in drug companies and the psychotherapy industry. But let's look at it in another way. Over the past 25 years, I've been regularly revising a formal textbook about abnormal psychology that has gone through five editions. Over that time, the 65-percent figure hasn't changed. That means to me that we may have reached the limit of progress for our current approaches through psychopharmacology and psychotherapy.
PN: Do you see a lot of difference between the results of drug studies and therapy studies? Are the two approaches generally comparable in their effectiveness?
MS: It all depends on what you're treating. For things like obsessive-compulsive disorder, I think psychotherapy's better. For panic disorder, I think psychotherapy's better. For depression, I think they're about equal. For bipolar depression, I think the drugs are better. I can take you through each one of these, but what is important is that I haven't seen a lot of change over our lifetime, and that says to me that some natural limit has been reached by these procedures.
PN: Why do you think that collectively the therapy field has hit this wall?
MS: First of all, I think that negative emotions that are the product of evolutionary constraints are a big part of the reason there are limits to our therapeutic effectiveness. Evolution has been very concerned to give us only limited conscious control over our survival mechanisms. From an evolutionary perspective, negative emotions like fear, anger, and even depression are just too closely tied to survival, and voluntary attempts to gain exert control over them have upper limits.
PN: For example?
MS: Take phobias. I think they are evolutionarily prepared to help us avoid situations that may be dangerous. Some phobias are curable, but if you are agoraphobic, behavior therapy may make you less avoidant and less afraid, but I don't think you're ever going to really love going to a big shopping mall. I think the dirty little secret of biological psychiatry is that it's given up the notion of cure. All the medications being prescribed for depression and anxiety and other negative states are all cosmetic and palliative--when you stop taking them, you're back where you started. Similarly the advances in psychotherapy have been palliative. For example, the most that cognitive therapy can do is help a depressed person dispute the inner critical voices, but there's nothing in cognitive therapy about getting rid of the voices.
On the other hand, Freud and the psychodynamic therapists really had a vision of cure. But after 100 years of therapy, it's hard to find much evidence for that sort of cure. Of course, if you believe some of the great clinical anecdotes, when a client gets enough emotional catharsis and insight into the source of a problem, it's gone. That's a cure. And there are enough cases on record to think that that happens some of the time, although no one's ever been able to bottle it. So bottling it up would be the great advance. My guess about the future would be that if we see major advances in therapy, it won't be on the palliative side. I think we've kind of run out of tricks to relieve symptoms.
PN: So where are the advances going to come from?
MS: I think the positive side of life is where the big potential for growth lies. Because positive emotions are much less tied to survival issues, they are much more plastic. When you begin to deal with the human capacity to create things that weren't there before, you are moving out of pre-wired survival mechanisms into a different arena.
PN: So, concretely, what does that mean for the future of psychotherapy?
MS: Working on weaknesses and doing remediation is an uphill battle. After all, words like "intervention" and "therapy" are all appropriate to working out of weaknesses. Let's say we're conducting this interview about my weaknesses. I think it would be an uphill battle and neither of us would have a very good time, and we'd both be waiting for the interview to be over. But when you approach people about what they're good at, they like to talk about it. Time really zips along when the subject is how to use more of what you're good at in your life. What I'm saying is that spending more and more time on strengths is not only a rapport-building technique, it's a natural therapeutic buffer against our troubles.
PN: What you mean by a "buffer?"
MS: Okay. Take me. I consider myself a depressive, so I could see that in a different life course, I could wind up a basket case, but, fortunately, there are a few things that I'm really good at--verbal skills, writing, listening to both sides of an argument--that kind of thing. And I've chosen a life course--marriage, a way of parenting, a job--in which I get to maximize my strengths, and therefore I think I'm protected against depression. And I think, in general, our best protections against the kinds of conditions listed in DSM are our strengths.
In the Consulting Room
PN: So how might you then apply that kind of positive psychology approach in a therapist's consulting room?
MS: Let's imagine that a waitress who's got moderately high depression comes to see you and, after she goes through a litany of complaints, you conclude that the core of it is how much she hates her job. You do a very careful assessment to determine her highest strength, which turns out, among other things, to be her social intelligence. At that point, the task becomes helping her to recraft what she's doing at work to better use her strengths. So although she hates being patronized and hates carrying heavy trays, she redefines her job to make her customers' encounter with her the social highlight of their evening. And while she doesn't succeed in that all the time, that keeps her level of challenge and interest up to give her an experience of flow at her work, which now becomes fun, something she's good at.
PN: The concept of flow seems to come up again and again in your work. Say more about it.
MS: Flow, of course, is my friend Mike Csikszentmihayli's signal contribution to psychology. It refers to those activities in which time seems to stop, the moments when you find yourself doing exactly what you want to be doing and never wanting it to end. For most people, perhaps the key to the good life is developing interests and discovering activities that enable you to experience flow regularly in your life. You can probably best understand flow by understanding the reverse. From the first day I took up skiing to the day I gave it up five years later, I was never in flow. Skiers call it "fighting the mountain." So instead of the flow experience, of being comfortable letting yourself ski downhill, I was always worried about falling and trying to figure out what I should be doing. Right now, I think too much of the experience of psychotherapy, for both therapists and clients, involves fighting the mountain.
PN: And that's where what you call positive psychology comes in.
MS: Yes. Positive psychology is a lot more like the flow experience of downhill skiing, and it's my hope for getting therapists out of the remedial business. Positive psychology doesn't involve manipulation or much of what we think of as standard therapeutic interventions. You don't need to use clever techniques to get people to change. The focus is on helping people identify what they're really good at, with the premise that doing what they're really good at buffers them against their weaknesses. So when a person finds out that they're really extraordinarily kind and they like being kind, and you suggest to them, "Maybe in your daily life you should take opportunities to display kindness more often." And when they start to do that more, it's self-reinforcing. So, in my case, I don't know how to dress, and if you tried to make me a snappy dresser, I wouldn't have any fun doing it. But even if I don't dress well, I talk well. So it kind of makes of up for the fact that my socks don't match.
PN: Lots of therapists today are turned off to DSM and share your position that therapy should focus on clients' strengths. What's distinctive about positive psychology?
MS: That's a good question. I'm still working on a full answer to it. Basically positive psychology is devoted to giving a solid scientific legitimacy to the interest in strengths. For a weakness-based psychology, we've got a DSM . We've got all kinds of ways of measuring things like depression, and we concentrate on training people in graduate school how to undo the weaknesses people bring to therapy. But up until now, we haven't had a classification of the strengths that make a real difference in people's lives, and we haven't explicitly trained people in interventions that produce well-being. Most therapists decide if a client is depressed by seeing if they have five of nine symptoms, but, from the viewpoint of the science of therapy, it will make a tremendous difference if we had a systematic nosology of strengths that gave them equal weight with DSM diagnoses.
So we've developed a 800-page classification of strengths and virtues that will soon be published by the American Psychological Association that I hope will become psychology's un- DSM . It's what we need to bring us out from under the yoke of medicine, which is about undoing illnesses, not buffering strengths. Now undoing illnesses is fine, but it's just part of what the therapist's job should be.
Along with a classification system, we've developed a panoply of validated assessment tools for measuring the positive side of life. We started with tests for strengths and virtues, but there are also tests for well being, tests for amount of meaning in life, tests for strength of relationships, tests for gratitude, tests for forgiveness, tests for optimism. Those are all free on the web (www.authentichappiness.org). So there are now all kinds of materials to help clinicians measure where a person's weak and to find out where they're strong.
PN: What about treatment applications?
MS: What we're doing now is developing a set of positive interventions that we've been testing on normal people and ninth grade-students to see what difference they make. One example involves gratitude. One of the best correlates of life satisfaction is gratitude. So we ask people to take someone in their life that they've never properly thanked and write a testimonial to that person and then visit that person to deliver it. Personally, I'm a pretty ungrateful sort, but I've done that assignment and it had a profound effect on me.
PN: Can you say something about that experience?
MS: I did my own gratitude exercise on the morning of my 60th birthday. My wife and I had invited 50 people to celebrate with us and when I woke up that morning I suddenly had a very clear realization about two different ways of looking at your life--the autobiographical and the biographical. It became so plain to me that my story about myself had been veryÂ autobiographical-- I got this award, I wrote this article, I did this, that, and the other thing. It was all about my fighting one obstacle after another and overcoming it. It was filled with I and about accomplishments as something I did . And, of course, that's so common--ourÂ own will and our own actions are often in the forefront of the drama of our lives, and we put into the background things like the sacrifices of parents, the loyalty of friends, like a wife who reads every word you write and critiques it, children who create a background of happiness, a mentor who, in the beginning of your career, approves everything you do until just the right time comes and then starts to critique it. But as I thought about all the people coming to my birthday party, I found myself filled with gratitude and moving from an autobiography of an I to a biography, in which my life was a part of many more lives that had me possible.
PN: Do you think that therapy can encourage people too far in the direction of the autobiographical consciousness that you're describing?
MS: Our evidence is that gratitude is strongly related to subjective well-being, and so a question for therapists is how they can better promote gratitude. But at the moment, the area of interventions is the least validated in positive psychology. The validation of diagnostic categories is way ahead of evidence-based interventions. That's why I want to encourage your readers to dream in this direction. They're much better at developing interventions than researchers like me, who spend so much time sitting in front of computers.
Science and Therapy
PN: It sounds like you're encountering one of the limitations of science. The strengths of science is in measurement and being systematic, but you're saying that there's a big role for the creativity of the clinician in what you're trying to develop.
MS: Absolutely. Before yeoman scientists can go to work and see if things really work, you need the imagination of clinicians to provide something to test.
PN: Do you think that positive psychology will one day do away with psychotherapy as we have known it?
MS: Not at all. Positive psychology is not remotely intended as a replacement for all of therapy. I've been a therapist for 35 years and I'm proud of it. Whatever its limitations, I think therapy has important effects. What I'm describing as positive psychology's contribution is intended as another arrow in the therapist's quiver. I feel the same way about it as I do about drugs--it's another arrow in our quiver. More specifically, teaching our clients optimism, gratitude, forgiveness, identifying their signature strengths, and moving them in the direction of recrafting their lives to use them everyday--these are some of the new arrows for the positive clinician.
PN: But all in all, you sound like a bit of a skeptic when it comes to therapy and the results it has achieved so far.
MS: No, no. I'm tremendously impressed by the 50-percent symptom relief that most therapists are able to bring about using so-called "nonspecific" treatment factors. What they're really talking about are things like listening and taking an interest in people. The secret of therapy as a profession is that it draws in people who are just naturally good at helping other people screw their heads on straight. We could probably put most therapists through four years of learning how to make great coffee and they would still help 50 percent of their clients, whereas if we took the kind of people who I play poker with, I don't think the results would be anything like that.
So I think whatever we're doing in selecting and training clinicians, and whatever they do in the consulting room, is 50 percent of the wonderful stuff that helps people. So far science has added another 15 or 20 percent to it. That's good, too. But the biggest thing the psychotherapy field has going for us now is the people who do it, who without using science a lot of the time, bring about change 50 percent of the time, and sometimes do much better.
While the clinician's job is to alleviate troubles, I also think the development of things like character, positive emotions, and strengths are an end in themselves, completely independent of alleviating troubles. But the science isn't there yet. We don't yet have clear empirical demonstrations that if you work hard on developing your strengths, then your troubles fade into the background. When we get that kind of data, it could change the future for psychotherapy.
Mary Sykes Wylies, Ph.D., is a senior editor of the Psychotherapy Networker HASH(0xc85a294)
Richard Simon, Ph.D., is the editor of the Psychotherapy Networker . Letters to the Editor about this article may be sent to Letters@psychnetworker.org.