Tuesday, January 24, 2017

On Mindfulness Meditation

It seems that everywhere we look these days, we encounter yet another person or study underlining the various benefits of mindfulness mediation. While to some, the idea of meditation conjures up yogis in a cross-legged positions, spending hours inside their heads, those that have any intimate familiarity with mindfulness know that the practice of mindfulness meditation leads to the exact opposite of being in one's head. In fact, practicing  mindfulness meditation can lead to a more direct and in-the-moment interaction with the world around us.

The idea behind mindfulness is learning to tune in to the present moment, and becoming fully aware of one's inner sensations and the environment, while trying to avoid unconscious or habitual activity. [1] If we stop to think about how much time we spend in our heads, trying to think through, prevent, predict, or understand some sort of event that is either in the past or in the future, we start to realize just how much we may be missing in the present moment. While we may feel that doing all of this mental gymnastics may lead to better outcomes, thereby giving us a sense of control over our day to day lives, many of us know all too well that this type of rumination actually reinforces already established, often negative thinking patterns.

The practice of mindfulness meditation trains our minds to notice what we are doing mentally and physically in the moment, a process that may be so mechanical that it may seem unconscious. By giving ourselves the space to notice what may feel to be automatic, we are actually acknowledging that what we are experiencing is, in fact, under our conscious control, and is most likely learned. And we all know that anything that is learned, with some effort and understanding, can be unlearned, albeit not forgotten.

While there are a number of great ways to start a mindfulness practice, I have found the app "10% happier" to be very clear, helpful and dare I say, "mindful" of a busy schedule.


1. Hyperion Books. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. Accessed athttp://books.google.com/bookshl=en&lr=&id=QnYBXlX2bPwC&oi=fnd&pg=PR13&dq=mindfulness+meditation&ots=iaiedsPYPb&sig=eUtL03wBBA9CSgxAcmTF7yVi3NM#v=onepage&q=mindfulness%20meditation&f=falseon May 1, 2014.

Tuesday, August 9, 2016

In Individuation and Culture

Individuation is no simple task. In fact, individuation can be seen as one of the most important developmental tasks to work towards in order to attain self-knowledge, self-realization and even personal freedom. Individuation is defined as "a process through which a person achieves a sense of individuality separate from that of others..." (GoodTherapy.org, 2016 ). While this process is certainly ongoing, it can be particularly difficult in young adulthood, when the overarching questions sound something like "who am I now that I am an adult " and, perhaps more importantly, "who do I want to be?"

At a time when most people are faced with mounting personal and professional responsibilities, it can be quite trying to figure out how to manage everything and prioritize that which is important. This is an even more daunting process when one does not know what exactly is important, how to get it and perhaps most problematically, how to feel good about it. Even more challenging, is when one's most salient role models on how to be "a successful adult" have different priorities and very different rules of how to go about attaining them. 

This is where the process of individuation comes in. Namely, learning how to recognize ones' own inner voice and differentiating that from the internalized opinions or values of others. While learning to recognize one's own voice is a crucial step to self-realization, the trickiest part, in my experience, is learning how to trust and be guided by this voice, so that it is heard above those of all others.
While this process is challenging for most people, individuation is particularly difficult for those folks who come from more collectivist cultures, where the opinions of the family, and particularly, of the elders are valued more than the opinions of the self. In this case, choosing one's own path in life, no matter what it is, can lead to feelings of betrayal and abandonment on both sides. Additionally, in collectivist cultures individuating from one's family of origin not only can be seen as a form of disrespect, but is often deemed to be quite unwise. In the words of Otto von Bismark "only a fool learns from his own mistakes, a wise man learns from the mistakes of others".

These powerful messages can be quite difficult to disavow, particularly for those who have been conditioned to please and value the wisdom of the collective, above their own. It is precisely this invalidation of the self that can lead to a grave and debilitating fear of making mistakes, no matter how valuable the lesson within. The process of individuation then, requires tremendous courage to not only recognize, trust and pave one's own path, but to make a few mistakes along the way, in hopes of finding that which is truly one's own.

Thursday, March 10, 2016

Just Breathe

There certainly is a lot of evidence out there suggesting the myriad of health benefits of cultivating a mindfulness meditation practice. For some of us, however, anything that requires practicing may seem rather daunting, and may feel like just another item on the list of things that we "should do", like exercising or eating healthy. As such, meditation can also be one of the things that we berate ourselves for not doing, or not doing right, and thus making it all the more difficult to initiate.

It does not have to be that complicated, however. Surprisingly often, all it takes is a few minutes of slow deep breaths to slow down our heart rates, loosen our bodies and connect with whatever is right in front of us. The breath is our vehicle to sync back up with our bodies and disconnect from our thinking, planning and judging minds. It gives our bodies the opportunity to relax and brings our systems out of the highly-taxing fight or flight mode, that is characteristic of any stressful work or personal situation. When our inner resources are no longer being taxed by needing to either flee or proverbially and/or literally go to battle, we naturally shift into a more balanced and spacious mode of being, where more of our inner resources are suddenly at our disposal.

By simply taking slow, deep breaths we are literally sending our systems the much needed resources of reassurance and support in order to keep on going! Furthermore, slowing down our breathing gives us the space to truly engage with whatever is physically in front of our eyes, instead of forsaking our only tangible reality for the often-demanding and intangible plans in our heads.

Thursday, September 10, 2015

On Psychogenic Pain

When I first picked up Dr. John Sarno's book Healing Back Pain, I thought that there was a chance that I would learn something that would help me feel better, but I never imagined that it would offer me a newer and deeper way to look at certain types of chronic pain. 

Dr. Sarno's theory posits that certain types of chronic back, neck and limb pain, as well as some gastrointestinal issues, which are not relieved by standard medical treatments are largely psychosomatic in nature. Dr. Sarno's belief is that while the pain is certainly felt in the body and physical examination will confirm corresponding areas of tightness, the root cause of the perseverance of the pain stems from one's psychological and/or emotional functioning. The reason for the pain, according to Dr. Sarno, is that this physical pain acts as a type of distraction from the more systemic and less easily identifiable repressed psychological, emotional and oftentimes unconscious issues. 

The treatment for this type of pain (Tension Myositis Syndrome) involves verifying the TMS diagnosis (thus ruling out any abnormal structural causes for the pain), thorough patient education about the way that TMS works, and perhaps most importantly, getting in touch with whatever conscious and unconscious emotional material may be causing discomfort and distress. Many TMS sufferers will attest that once their distressing repressed issues have been adequately addressed, the physical pain no longer has the purpose to distract from the underlying emotional pain and begins to subside. 

To put it another way, with psychogenic pain it is not necessarily one's body that is hurt, although that is certainly where the pain is felt, but rather one's emotional and psychological state has been in some way troubled, hurt or disregarded. Unfortunately most people can go a long time repressing their hurt feelings, often not wanting to or not being able to identify the true source of the pain.  However, trying to identify and treat physical pain, particularly in our highly medicalized society, is less stigmatizing, more widely accepted, and appears, at least on the surface, easier to achieve. It is not surprising then that some of us tend to experience our internal distress in a physical form!

While this type of chronic pain is likely not uncommon, before assuming that one is suffering from such psychogenic pain, it is important to first rule out any structural physical causes of the pain by a qualified medical professional. Here is a list of physicians and therapists who often work with TMS and other mind-body disorders who can help in establishing a diagnosis. Additionally, this TMS forum is a wonderful online community established specifically to support and educate those who may be suffering from TMS. 

Tuesday, August 4, 2015

Where Does Hate Come From?

I was on vacation in Tremezzo, Italy at a favorite hotel on Lake Como which had a floating pool in the lake complete with an artificial sand beach.  In order to get to the beach you had to cross the main road around the lake.  Once we got across the road the person who took care of the lounge chairs was about to lead us to virtually the last available chairs.  At the same time another couple came down and was taken to the last two lounges, which were next to ours.  By American standards the chairs were more or less on top of each other.

At any rate, as we all settled in my wife realized she forgot something and had to go back to the room.  The other couple also realized they forgot something.  My wife and the husband from the other couple left to navigate crossing the road together, and the wife of the other couple seemed quite friendly and asked me some standard where are you from and what to you do, getting-to-know each other questions.  I told her that I’m a psychologist.

She became extremely attentive and told me that she had always wanted to ask a psychologist a question that profoundly troubles her.  She was Jewish and from Iran, which she and her husband had to leave and emigrated to the U.S.  She always wanted to understand why the Shah hated Jews.  I made some reasonably half assed out-of-the-book comment about prejudice, but she did not accept it as a terminal statement.

She told me I didn’t understand what she was asking and I asked her to explain more.  She told me that the way children in Iran were taught how to count  was to ask them if they killed 5 Jews today and 4 Jews tomorrow how many Jews had they killed.

I was stymied by the power of the story and the intensity of her need to know.  I clearly did not have an answer.  At that time I was an adjunct professor at Columbia University teaching doctoral students in their clinical psychology program how to do psychotherapy.  I decided to bring up the question about hate at the next meeting I attended, thoroughly expecting to get either an answer or at least a clear path to one.  What I got instead was not a lot better than my initial response to the woman in Lake Como.  This surprised me since the faculty at Columbia were clearly outstanding scholars as well as outstanding therapists.

So the question still stands: where does all this hate come from? 

In my travels in the world of psychology I actually believe I found the answer.  Stick with me through some more stories and I hope you will be as struck by this answer as I have been.

The answer comes from people studying developmental psychology – how minds develop.  Specifically, from an enterprise called “Object Relations”, which is about as misnamed as a field could be.  The enterprise is definitely about relations, but has nothing to do with objects but rather with people.  It should really be called People Relations. The theory is about how children learn to build up a notion of the external world, how they learn to differentiate between self and others.  As an infant develops feelings develop. Part of what the mind does is to split off parts of the self and project them into the external world.  Good feelings are split off and projected out, as well as bad feelings.

Any of us who have had children are aware of the profound changes in development as a child develops and builds up their image of the external world.  From the perspective of the parent, they go from an infant who takes over your life to a toddler who engages you like nobody else can (as well as scares the hell out of you as they put themselves into potentially dangerous situations), to two-year-olds.

At this two year stage (often called ‘the terrible twos’) a funny thing happens.  Your beatific, engaging, endlessly learning, wonderfully cuddly child learns the concept: NO.  All of a sudden all kinds of contrary behaviors manifest themselves.

 I used to send the doctoral students who came to my office for supervision on their first patients down to West End Ave. to observe mothers crossing the street with their children.  The two-year-old drama was remarkably repetitive: the mother starts crossing the street holding the child’s hand (West End Ave. is unusually wide with 4 lanes plus parking on each side of the street street and a large amount of fast moving manhattan traffic).  The lights give you enough time to cross, but not much time left over because the street is so wide.  The scene is that the child stops somewhere in the middle of the street, doesn’t want to move, and often sits down.  Meanwhile the light is about to change and the mother has to do something to prevent disaster.  After a brief negotiation, possible yelling, comes forcibly grabbing the child and scurrying to safety on the other side of the street.

From the parents’ perspective something has certainly changed in their loving cooperative child.  The notion is that what has happened is two things.  One is that the child is developing autonomy.  The other is that whereas children develop and have loving and positive feelings, at this stage of development negative feelings need to be dealt with. The task for the child is to figure out what to do with these unpleasant feelings.  The virtually universal solution is to project them out to others so that they do not have to be experienced as belonging to ourselves.  We all have learned to do this at a very early age.

Projection is a defense mechanism, a way of protecting ourselves from dangerous feelings.  We take those internal feelings and experience them as coming from somebody else instead of being inside of ourselves.

You must realize that projection is an unconscious phenomenon:  we do something very dramatic but absolutely do not realize we are doing it.  Unconscious means the same as unaware.  Human minds, all of our minds, are constantly and fervently doing things to protect us from thoughts, from feelings that would threaten our ability to function and to be at peace.  These things are things we are not aware of.  To use the jargon of psychology, they are unconscious.

My background is in neuroscience – I love neuroscience…I love science.  Some of my most exciting experiences have been in that world.  The truth is I don’t really believe something until I see it – until I witness an experiment supporting the existence of whatever it is that is being talked about.  As interesting as these notions are, I need to see it in order to believe it.

So how do you see this operating in the world?  Well, look at child literature, fairytales, the beginning literature.  What do we see?  The good guys and the bad guys are always there.  There’s the evil witch (holder of the bad feelings that need to be projected out somewhere) and the hero fighting the witch.  Here we have an external representation of an internal process of mind.

Early on in my practice, when I was just beginning to learn about these things, I had agreed to do one session with the child of a single parent in therapy with me. Even though I do not work with children, I thought meeting them would help me figure out a way to help them.   She was particularly troubled and how to help her had become of great concern to her parent.  As best as I can remember she was about 10 or 11 years old.

She came into the office wearing what looked like army fatigues, had each hand in one pocket of her jacket, and sat down in the chair just like that – with her hands still in her jacket pockets.  After talking to her for a little while to try to understand how she was seeing his world I found myself asking her what was in her jacket, since she seemed to be holding onto whatever was there for dear life.  It had become very distracting for me. 

She proceeded to take one hand out that was holding a GI Joe figure – the good guy.  When she took out her other hand she was holding some sort of ‘creepy crawly’ weird somewhat slimy looking creature – the bad guy.  My thought was holy cow – here it is – she’s carrying the two separate domains of feeling separately - and she can’t figure out how to put them together.  She can’t deal with her own bad feelings, projects them out, and is constantly playing it out with someone in the external world.  At school she is always fighting with someone.  Hopefully someone will be able to work with her to own her own feelings so she doesn’t have to be in an eternal external struggle.

Owning our own feelings is what it is about.  To whatever extent we are unable or unwilling to do that, we are destined to project them out and struggle with them by a conflict with whomever we have projected them to.

More evidence for this notion in our fantasy world:  the most successful modern day literature is all about such a struggle.  Literature today often takes the form of plays which takes the form of movies.  Star Wars is an amazingly engaging struggle of  The Evil Empire versus Hans Solo.  Yoda, incidentally, is the guru showing the power of being in touch with your feelings.  He is the voice saying not to worry about the bad feelings, to confront them, and the good ones will prevail.

More evidence in the real world:  Nixon described Russia as “The Evil Empire” in one of his television appearances.  It was clear that he really believed it and couldn’t understand how anybody on the planet could see it any other way.  When the cold war ended psychologists who were interested in the notions we have been discussing brought up an interesting question.  If, on a societal level, the bad guy, the place we had put all our own bad feelings, was Russia – what happens when the cold war comes to an end?  Where are all the bad feelings going?  One hypothesis back then was that it would go to Aliens.  We would see aliens as the new bad guys.  Indeed for a few years after the end of the cold war there was a clear increase in the interest in worrying about being invaded by aliens (although I’ve never seen any actual data).

What happens after a war when the hated enemy becomes a neighbor we interact with politically, economically and socially.  It is amazing how all that hate dissipates and the vacation industry thrives on bringing people to Germany, Japan, Vietnam, etc.  However, the notion is that the hate has to go somewhere, and of course today there are endless candidates in the Mideast.  Politicians, I think, are really good at mobilizing reservoirs of hate towards countries for their own political goals.  This is not to say that evil does not exist – of course it does, unfortunately it does.  However, it behooves us to understand how to separate real evil from ‘convenient’ evil.  Awareness is the key to this ability.

Whenever politics takes advantage of the hate reservoirs, whenever religion takes advantage of it to tie people to it, whenever any individual or culture does that, we see bizarre episodes of seemingly senseless hate do great destruction.  It is a profound challenge to own our own bad feelings, to not project them out, and for sure not let them be manipulated by individuals or by crusading groups.

One of the rewarding parts of doing psychotherapy is seeing people become aware of their feelings and figure out how to deal with them.  Many people have told me that one of the reasons that they came to therapy was because they did not want to repeat a negative family experience like the one they grew up in.  In couples therapy people have often said that they want their children to grow up in a much better environment with much less conflict and anger than the one they grew up in.  It is extremely gratifying to watch people figure out their own unconscious reflexes, come to terms with their feelings, and not have to repeat the same mistakes they have made themselves or seen in others.  As one person put it, to become a more evolved human being.

Tuesday, May 19, 2015

The Combination Approach to Psychotherapy

After having recently listened to this Invisibilia Podcast titled Entanglement, I thought it would be a good idea to share my thoughts on where the major schools of thought on psychotherapy have been and perhaps where the field may be headed...

A portion of this Podcast neatly outlines the three major schools of thought on thinking and feeling, the first being Freud's theory of the unconscious. In part, this theory posits that most, if not all, of our thoughts and feelings in life stem from our childhood experiences. The predominant change occurs when we can get in touch with the origin of these thoughts and feelings and begin to understand that the circumstances that may have governed their formation way back when, may no longer apply to our daily lives.

The second major school of thought on therapeutic change is Albert Beck's theory of Cognitive Behavioral Therapy, which states that our behaviors and emotions are very much connected to our thoughts. The theory posits that if we are able to notice, change and/or retrain our thinking patterns, our feelings and actions will follow suit.

The third major school of thought on therapeutic change is generally referred to as Mindfulness Based Approaches, and is currently receiving a lot of attention and research. Such practices focus on teaching individuals to become aware of all thoughts and feelings that may come up and help us learn to accepting them without judgment, hence letting go of ensuing reactions and assumptions.

All three schools of thought mentioned above are widely viewed as helping bring about therapeutic change in different ways. The first school of thought focuses on understanding where the uncomfortable thoughts and feelings come from, in hopes that this insight will update the unconscious thoughts and feelings and make them conscious, thus making them amenable to change. The second and third schools of thought on therapeutic change focus instead on deauthorizing the power of thoughts. Namely that by actively changing thinking patterns, or by accepting our thoughts and suspending judgment, our cognitions will have less power to affect our feelings and behaviors. 

In my experience, there is no one correct way to enact therapeutic change, but instead there is a combination of techniques and methods that can be used in order to help each individual achieve long-lasting change. This I believe, is largely based on where (with thoughts, behaviors, acceptance practices or feelings) the individual feels more comfortable starting their therapy. I do, however, feel strongly that feelings are more basic than thoughts (feelings are preverbal, thoughts are contingent on language), and hence when thoroughly understood and updated, can lead more directly to a more holistic and sustainable change. However, meditation and mindfulness practices as well as retraining one's thoughts and behaviors are wonderful ways to appease certain symptoms and contribute to greater comfort in achieving the insight and understanding that will lead to a come comprehensive paradigm shift.

If you would like to learn more about modern psychotherapy concepts please visit this blog of my dear friend and colleague, Dr. Richard Kestenbaum.

Wednesday, April 29, 2015

On Modern Psychotherapy

First of all, welcome to the students in Ted Coons’ NYU psychology course. Please feel free to email me any questions and I will try to integrate them into my upcoming lecture on May 5th. 

It may also be helpful to anybody interested in this blog to go to my homepage and read about my background in order to understand where I’m coming from. That background has led me to, as far as I can tell, a different perspective on psychotherapy.  I am both a scientist (neuroscience) and a psychotherapist (trained in a host of different psychotherapies).  From the moment I finished my psychotherapy training, I have been interested in figuring out how and why psychotherapy works, and how that relates to basic laws of how the human mind works. What this blog, which will be ongoing and evolving, is about, is just that: how psychotherapy works and what the basic laws of mind are that enable it to work.
WHY DO PEOPLE COME TO THERAPY?Symptoms such as anxiety, depression, obsessive compulsive behaviors,  problems forming and/or maintaining relationships with others are some of the usual reasons.  However, the underlying reason is that whatever someone is doing to try to deal with the symptoms is not working.  People find themselves repeating the same patterns without being able to change them.  They come to a realization that something is missing that they need to find in order to regain control over their own lives.  Whatever their reflexive behaviors are to try to deal with things is not only not helping, but actually perpetuating the problems.

Psychotherapy is a process which enables people to get in touch with parts of themselves they are not in touch with.  Its goal is to help people become aware of stuff (thoughts and feelings) that they are not aware of.  In terms of exactly how to do this, there are, as the saying goes, many paths.  For any given individual, part of psychotherapy is to figure out what that person’s path is.  As the field of psychotherapy has developed and expanded the number of techniques (paths) available has increased dramatically.  They have increased from classic talk therapies to behavior therapies to gestalt therapies, to cognitive behavioral therapies, to mindfulness therapies and many many more. The goal of all the therapies is to break up reflexive patterns that one is trying to change so that these perhaps unwanted patterns, can be replaced with whatever may work better for the individual. In the language of psychology, the unconscious is made conscious so that a person can regain control of their own destiny.

I have often thought of psychotherapy as a postgraduate course in feelings.  The human mind consists of thoughts and feelings.  We are highly educated in terms of how to use our thoughts to learn, to communicate, to understand.  However, feelings work differently from thoughts.  It often takes a while to figure out exactly what our feelings are to say nothing of what they mean or what we want to do with them.   I have come to believe that feelings are more basic than thoughts and that in fact it is feelings that give birth to thoughts – sort of like nebulae give birth to stars.  There is, therefore, a great deal of power in being in touch with and understanding feelings.  How to decipher them and stay in touch with them is a large part of the work of psychotherapy.

The way we are built is to protect ourselves from thoughts and feelings that are dangerous to us.  The way we do this is to not let them come into consciousness.  Instead we remain unaware of them – they are in our unconscious.   When they are in this state the avoidance of them produces reflexes that are often not in our own best interest. The avoidance often produces the symptoms described above and generates reflexes that are counterproductive.
The thing about it is that these unconscious avoidance reflexes are generally created very early in life. Whereas one would think they would be replaced with more adaptive reflexes as development occurs, it is often the case that this is not so. In fact, it appears that there is a basic law of mind that the unconscious does not know time.  Therefore, to our unconscious, we are still the vulnerable child in need of protection! The process of becoming aware of these feelings and of our habitual reflexes enables us to gain control over them and decide our own destiny.

One institute where I was teaching put up a sign in the office saying “We Update The Unconscious”. Indeed this is a prime objective of psychotherapy.

Understanding what the experience of psychotherapy is can, of course, best occur by being in psychotherapy, which is a requisite of anybody who enters the field.  However, a goal of teaching is to get as close as possible to communicating what the process actually ‘tastes’ like, feels like, actually is.  Hopefully those of you attending the NYU lecture will, in fact, walk away with such a taste. Additionally, this blog will operate on a continuous basis to explore facets of psychotherapy and the underlying laws of mind.

It is an old saying that if you become a teacher by your students you’ll be taught. One of the joys of teaching is meeting such students, seeing them graduate, and then becoming colleagues.  One such student of mine is Dr. Inessa Manevich.  She and I will be offering podcasts by the end of the year, and I will post the name of these talks here.  We also have a joint blog called the “East West Blog” –which we will update regularly to include any material that we find intriguing and helpful.

We look forward to getting feedback from you!