 How do we find ourselves? If you have ever watched a "good" mother and baby pair, where you get that warm feeling in your chest as you watch them volley back and forth with expressions dancing across their faces, you have seen the formation of the authentic self. As babies we simply "are". We cry when upset, coo when happy, sleep when tired. And if our caregivers respond with love, admiration, attention and acceptance we thrive. We learn that we have a self inside of us and that it is valued. Later as toddlers we also learn that there are aspects of that self that come into conflict with our world, like the self that wants to use mom's lipstick to paint flowers on the wall or the self that wants cake for breakfast. If we are lucky and have adequate parents they set loving limits with us while also helping us feel accepted as a whole person even when individual behaviors are problematic.
However if you have ever witnessed a parent shaming a child by saying things like "you can do better than that" or "why aren't you more like _____?" or "girls (or boys) don't do that", etc., then you have also witnessed the destruction of the authentic self. Once the authentic self is under regular attack from parents who are unwilling to accept the child for who they naturally are a false self begins to form. It starts with the realization that they are not meeting their parent's standards and feelings of inadequacy and shame begin to spawn. Over time children internalize the shame of feeling that they are a disappointment to these parents and create a "false self" that is more in line with what they think their parents want. However this self is not authentic and does not represent the true inner world of the child. The child has betrayed itself in order to maintain the attachment relationship, which sadly is the only option a child has in this situation due to their complete dependence on their caregivers. As they grow up, however, these kids are plagued by feeling inauthentic and consequently don't establish relationships that contain true intimacy. They may also harbor deep feelings of rage at being asked to abandon themselves in order to please the other, even if in the current relationship this is not being asked of them. It's as if they have decided that this is the price of admission to relationships and they do it reflexively. Living life as a false-self also predisposes one to depression since you cannot experience true vitality and aliveness if you are not being authentic. This pain of being estranged from one's authentic self can often lead to acting out behaviors designed to "force" the self to feel something. Years ago a patient told me that she could only feel something when she was doing dangerous things. The rest of the time she felt deadened. She had sacrificed her authentic self as a young child to please overly perfectionistic parents who demanded straight A's and perfect manners. She became, as one could predict, an alternatingly depressed and angry adolescent who rebelled with drugs and high risk behaviors as a way to not only punish her parents for rejecting her authentic self but also as a means to feel alive. Living as a false self can also lead one to make decisions that are ultimately not fulfilling, from choosing the wrong major in college to getting into the wrong relationship or taking the wrong job. One's true self is a compass and should steer you towards things that nourish your deepest soul. People living from the false self have no such compass and often drift, feeling confused, depressed and empty. They move through life "doing" things but find no fulfillment in them. I often see these folks in therapy and their refrain is "I have everything but I feel depressed/lonely/empty-- what's wrong with me?" Thankfully therapy is a great place to discover one's authentic self. Through therapy a person can begin to explore what really matters, how one really feels and how one is essentially "wired". Therapists, because they are not invested in you turning out any particular way, can offer encouragement for the process of re-discovering your nascent true self and bringing it into your daily life. There are several authors who have written quite poingnantly over the years about issues of the false self and the therapeutic process of repairing this type of damage, such as Alice Miller's Prisoners of Childhood: The Drama of The Gifted Child and the Search for the True Self, Karen Horney's theory of personality, D.W. Winnicott's concept of "true" and "false" selves, or Tian Dayton's article in Huffington Post. All agree on the fact that personal happiness and well-being is only achievable through a re-claiming of the true/authentic self when a false self has come to be dominant. If you have been struggling with issues that you suspect may be related to developing a false self consider seeking therapy. It's never too late to be the person you were meant to be. Wishing you health and happiness, Dr. Jordan
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 When I was in graduate school a wonderful mentor (Marc Rathbun, Ph.D.) told me "marriage isn't about being happy, it's about growing up." At the time I thought he was just a cynic and figured that when I found my prince charming all would be different (!) Here I am 20 years later and married for 16 of those and I now whole-heartedly agree. It's not that I don't have fun in my marriage. I took the advice of my best childhood friend seriously-- she said "never marry anyone who does not make you laugh." So I married someone who I find very funny and we definitely laugh together. And he makes me laugh. And it's still a lot of hard work and part of that work has been me really, truly and deeply "growing up." Learning to put another person first even when I don't feel like it. Making sure to consider my partner in ALL of my decisions and actions, even those he may never know about. Learning to forgive AND forget. All of this has made me a much more mature person and I am thankful for it. And I am relatively sure none of that would have happened without marriage.
That may not be true for everyone. I am stubborn and I think if I had not had a marriage at stake I would have just ejected partners who did not see eye-to-eye with me. Or been by myself so that I did not have to compromise. For those of you who are able to grow without the threat of your partner leaving, I applaud you. I know for me it took my husband being that dreaded mirror, reflecting back my shortcomings in order for me to grow. One big part of growing up around relationships was learning what they are and what they are not. Dr. Stan Tatkin, author of Your Brain On Love and other great books, taught me these 10 "unfortunate truths" that I would like to pass on to you and yours: 1. There are no low-maintenance people. All people are high maintenance because all people have needs and all people are imperfect and no one sees the world exactly the same way you do all of the time. This will make people seem "high maintenance". If someone seems low maintenance you just don't know them well enough. 2. To your brain and nervous system there is nothing more complex than another human being. On the one hand this is why we crave relationships. On the other hand it's why we sometimes would rather watch Netflix than talk to our partner. Try to remember that the human brain, as great as it is, makes mistakes. It may misunderstand a facial expression, a tone of voice, a gesture or a comment. Human's are actually terrible at communication, despite thinking the inverse! So remember that your poor brain is trying to understand the most complex organism in the known universe and be patient with yourself and your partner. 3. Love relationships are burdensome. That's kind of the point. We need another person to help us with the things we cannot do for ourselves. And not just holding up the other side of the shelf while we put the screw in. We need someone else to take care of us when we are sick, to hear our secrets, to deal with the spider we are afraid of. To help us because humans are PACK ANIMALS. We are not designed to be alone or be fully autonomous. The reason that this burdensome quality is not a problem in love relationships is because it is supposed to cut both ways. My husband deals with the spiders I am scared of and I cook for him because he burns toast. We both "win". But we are each other's burdens in the process. Thinking that loving someone is not going to be a pain in the neck some of the time is naive and leads to feeling frustrated and disappointed. So be prepared for the burden aspect and don't forget you are a burden too! 4. In love relationships no one comes pre-trained. He does not know that she needs to be held when she's feeling angry. She does not know that it drives him crazy when she leaves the house without saying goodbye, even if she is only going to be gone briefly. We don't know what our partner's need and so we have to work hard on finding that out. And we should not expect them to know what we need either. We need to "train" each other in the relationship to take good care of each other. 5. Romantic partners are responsible for each other's past. If I marry someone who was neglected, I am going to need to take extra good care of them to help them feel nurtured and to heal that wound. It's not fair to complain about that, to think "why should I have to pay for his parent's mistakes?". Because honestly, who else is going to do it? That's what you are there for, to heal what was hurt when your partner was small and vulnerable. And they are there to do the same for you. 6. What we don't know we confabulate. Human's are actually pretty terrible at communicating. We also want to feel that we know what the heck is going on, so we fill in any blanks without even realizing it. Sometimes the blank we fill in is in the direction of "I know what that look means" (which you may not!) and sometimes it is in the direction of trying to explain why you did something (when in reality most of the time we are operating on autopilot during the day). Don't assume you can trust your brain. Be open to being curious about what you may have gotten wrong. Assume that your partner is also filling in a lot of blanks and don't take it personally if s/eh comes to the wrong conclusion. 7. Our brains are built more for war than love. Mother nature cares more about survival than courtship. If you are dead you simply cannot reproduce. So as much as courtship and mating is important to the survival of the species, not dying is even more important. So our brains literally have more circuitry designed to keep us alive than to help us communicate, bond, negotiate, take another person's perspective or even understand people. So biology is stacked against us. That's why you have to put EFFORT into keeping you brains from going to war with each other. The fact that it requires effort does not mean you have picked the wrong person, or that you are not cut out for relationships, or that this relationship has run its course. It only means that you are dealing with brains that are predisposed to see threat and respond defensively. 8. All people are annoying. This includes you. I know, I know, you honestly believe that other people are MORE annoying than you. But that's subjective. Realistically we are all annoying and probably about the same amount. So stop thinking that you are easy to get along with, or "low maintenance", or that your partner is more annoying than most people. Our neurobiology has set us up to only see the world from our perspective, colored with our own unique history, and reacted to through our own unique nervous system. What are the odds that with everyone being fundamentally different things are always going to go smoothly? Get over it and cut people, especially your partner, some slack. And spend some time making a list of the way that YOU are probably annoying to other people, too. Especially your sweetie. Because I promise you, you are. 9. Most of the time we don't really know what we are doing or why. Again this goes back to brain science. Our brains automate as much as they can to free up processing power for other stuff. If you had to really fully be aware of moving your legs and maintaining your balance whie walking while you also were aware of taking in visual stimuli to make sure you did not get hit by a car while crossing the street while at the same time thinking about decoding the words coming through your cell phone so that you can respond to the person on the other end you would never get anything done. We automate walking, driving, brief responses ("How are you? Fine, how are you?"), navigating getting places, scratching our ear when it itches, etc. We also start to automate our partners, assuming we know what that expression means or how they will respond to a certain request. Of course sometimes we are right but sometimes we can also be WRONG. And then we may be asked to explain ourselves, and we can't. Because we weren't even aware of what we were doing. So don't assume that your partner knows why they are doing what they are doing. They may be on autopilot. You may be as well. Don't get so invested in theories about WHY people do what they do. Be willing to accept that they may not know and if you press them they may just make stuff up. 10. The need to be re-parented never ends. Parenting involved a lot of things. Help when you are hurting. Kind words when you are down. Advice when you have to make a big decision. Cheerleading when you are anxious about doing something new or hard. And on and on. We don't stop needing these things when we get to be 18. We all need parenting all of our lives. Marriage is great in this regard because once again we get to live with someone who can do all of this for us. They are available much of the time. They know us deeply. They can do for us what our friends or colleagues really can't. So I find it curious when people act as though they "should" not have to do this! Being parented is such a wonderful thing (if done properly), why would you want to do without it? Or force your partner to do without it? When my partner rotates my tires he is parenting me. When I make him breakfast I am parenting him. We can benefit from continuing to do what good, loving parents should do, even if (and especially!) we never got that in our own childhoods. Don't miss out on this opportunity to give something wonderful to your person and to receive it in kind. I hope that when you read this list you see the theme. That love heals. That it's also hard and takes effort. And that it may not come naturally to all of us but that does not mean that we can't learn it. And it is worth it. Love can revolutionize your life. Physically. Emotionally. Spiritually. So suit up and roll up your sleeves and get to work on it. I can promise it won't be easy but I can also promise that if done well it makes all the work worthwhile! Wishing you the best in your relationships, Dr. Jordan  First a note on semantics. The "Island" under consideration is a romantic partner who has what would, in research, be called an "avoidant" attachment style. Attachment research goes back many years (to the 1940's) and involves classifying people into different categories based on how they relate to their primary caregiver in early childhood. For more information on attachment see my earlier blog on the subject.
As some of you know when I work with couples I use the PACT model of therapy (the Psychobiological Approach to Couples Therapy). The PACT model has re-labelled the attachment styles as follows: Islands (avoidant), Waves (resistant) and Anchors (secures). It would be too complicated to explain the model here but see earlier posts of mine on the classification system and how our attachment styles impact our romantic relationships. Dr. Stan Tatkin's audio program, "Your Brain on Love", provides a wonderful explanation of the theory and how to apply it to your relationship. OK, now on to those islands. For those of you who love someone who is often island-ish it can be confusing to understand them if you are not one yourself. Now of course to be fair, island-ish people often don't understand non-island-ish people either! However, human behavior is often predictable if you know what to look for. So if you know that your partner is "island-ish" then you can predict what is going to bug them and what will really make them purr. I am summarizing here points made by Dr. Stan Tatkin in his wonderful audio program Your Brain on Love. If you haven't listened to it I strongly suggest you give it a try! While I have provided a link via Amazon above you can also buy it on iTunes, Audible and soundstrue.com. Now before proceeding I need to make something REALLY clear. What I am about to say may make you think "sheesh, why would I want to commit to an island if it will turn out this way?". So PLEASE understand something-- everyone, regardless of their style (Island, Wave or even Anchors) will get harder to handle after commitment. Dr. Tatkin refers to this as the "marriage monster". It's the unstoppable dynamic that gets activated when we pledge ourself to someone for all eternity. This just naturally turns up the heat and starts to show the cracks in our structure. So if you are wave-ish please realize that commitment also makes you more wave-ish and therefore harder to handle. It's not that island-ish people are worse than you. There is enough bad behavior to go around ;-) OK so as long as you proceed without judgement, here are a few things that are predictable about people who are island-ish (or avoidantly attached):
Remember that all of the above is NOT personal, NOT conscious and NOT immediately under their control. Like any human being island-ish partners can learn about themselves and can learn new behaviors. But this often takes time and some professional coaching. And one final tip on not triggering your island-ish partner--
I hope these tips have been helpful. Look for my upcoming blog on "The Care and Feeding of Your Wave". Remember, about half of us have "insecure" attachment styles (meaning we are not "anchors" or "secures"). So if you find yourself relating to the Island or Wave types don't feel bad. There are plenty of folks in your company. And if your partner is willing to learn your style they can take great care of you (and vice-versa!). Best wishes, Dr. Jordan  I have blogged about online pornography before and am putting that same information here, but I am also adding some new links of updated information. As the mom of a a tween and teen I find this issue to be EXTREMELY important. This generation of kids is growing up in an environment that has never existed before, where their introduction to sexuality is often through high-speed internet. This is an experiment that we already know will NOT end well. Parents need to take the initiative and talk to their kids about online pornography and DO THIS EARLY! I find that most of my younger clients (under 30) first found online pornography anywhere from age 8 to 10. Given that our brain does a lot of rewiring and pruning of brain circuits between age 8 and age 26 this online pornography is actually programming our kids brains before their brains are fully formed. This can be extremely dangerous and have serious and devastating emotional and physical consequences. I have many men in their 20's and 30's come to me with PIED, Porn Induced Erectile Dysfunction. This can be terrible for the man's self-esteem, mood, productivity at work and relationship confidence not to mention the obvious sexual performance part. I recommend talking to kids about how pornography, while exciting and appealing to most kids, can damage young brains. I recommend learning about the basics by looking at a great website, www.yourbrainonporn.com. While broaching this conversation with kids can feel awkward it's as important as teaching your kids about alcohol, tobacco or heroin. Online porn is a very intense form of stimulation to a developing brain, one that a young brain is not equipped to handle. While I know it's hard to bring up this difficult subject, you may be surprised to find out that kids are often grateful when parents can talk openly about sex. I assure you if you have a computer in your home and your kid knows how to get on google or youtube they have seen porn. Not talking about it will not reverse that fact but it may put them at risk for developing life-long problems.
Don't assume that you only need to talk to your boys about porn, either. Rates of women as consumers of porn is on the rise. A study published in the journal CyberPsychology and Behavior reported that 62% of women have seen pornography by the age of 18. This same study also noted that 1 in 7 teenage girls interviewed view online pornography for a half-hour or more at a time and have done this on multiple occasions. So girls also need to know that porn can damage their brain also. Not only does porn damage the circuitry that helps us have satisfying sexual responses to real live partners, it also alters people's expectations of what those interactions are supposed to look like. Kids, teens and young adults are growing up thinking coercion, violence, disrespect and increasingly extreme sexual acts are normative. I am all for the healthy exploration of one's sexuality, but what is reflected in today's online pornography is not mutually attuned, mutually enjoyable sex that takes into consideration the different sexual arousal patterns of males and females (more on that in a future blog). Sex is great and natural to be interested in. Age-appropriate sexual exploration of one's own body is also great and healthy. Kids need positive, non-shaming messages about sex but that does not include sanctioning pornography, especially high speed internet porn. Go talk to your kids. They need you. They need your help to protect their brains from porn just like crack cocaine or heroin. It's toxic and destructive and can lead to very dark places. Help them understand that so they can take care of themselves even when no one is watching. Here are a few resources on the web that can help you learn more about pornography so you can feel more prepared:
So with that giant preamble what follows is the original post of mine from a few years ago, plus links to some new information that was not available at the time. My blog from 2014: You may not know it, but the porn industry has figured out how to hijack your brain's normal circuitry to make you addicted to their product. And they are quite successful! Just as McDonald's uses our brain's cravings for calorie-dense food (that came from eons of living through food shortages), the porn industry uses our brain's natural mechanisms for bonding and procreation to make us crave highly sexualized, ever changing pornographic material. Here's how it works (I am paraphrasing from Sam Black, author of The Porn Circuit): Your brain has a natural chemical (dopamine) that is released when you do something pleasurable. This is to make sure that you continue to do things that are good for you, like eating or having sex (good for you in the survival-of-the-species sense of the word). This dopamine "reward circuit" is responsible for many kinds of addictions, from gambling to sex to alcoholism. According to Black, when dopamine is released into a certain part of the brain responsible for "emotion and learning, [it gives] the viewer a sense of sharp focus and a sense of craving" as well as pleasure. This causes the brain to create a pleasant memory of the experience, so that if circumstances arise that predict that the experience is near, the brain will release the dopamine again. It creates a learning loop where the brain tells the person (according to Black). “Remember where you got your fix last time. Go there to get it.” Another brain chemical that we normally think of as being used for attention is also at play. This chemical is norepinephrine. This chemical helps us to stay focused and pay attention to what's important. It is also released during sexual response, again reinforcing the idea that sex is important. And for the survival of the species it certainly is. But again the normal sexual response and the brain's response to that is hijacked by pornography, which the brain cannot differentiate from healthy sex. As if that was not enough, the brain also releases two more powerful chemicals, oxytocin and vasopressin, during the sexual response. Oxytocin has been called "the bonding hormone" and helps us feel close to, and protective of, the person we are engaged with. It is the hormone that is released during nursing. However in combination with vasopressin, according to Black, they "help to lay down the long-term memories for the cells." In effect they tie the sexual pleasure memory to the person or thing that caused the sexual response. Again in terms of mating and reproduction this is a good thing. It makes the couple stay together to raise offspring. However, in terms of pornography, it binds the person to the porn that they are using in very powerful ways. We have all heard of endorphins, the chemicals that our body produces in response to pain. They are the bodies natural opiates and much more powerful than anything man-made thus far. This is what produces a "runner's high" or causes the injured soldier on the battlefield to not feel the pain of his wounds so that he can run to safety. This powerful chemical is also linked to sexual response and is released into the brain after orgasm. This can create a strong sense of well-being and pleasure that makes one want to repeat the experience, much like how the "high" of opium creates addicts. In love we become "addicted" to each other, a positive experience that can fuel a relationship. However when porn is the stimulus for this response, it creates a powerful craving for more porn! And finally, orgasm also changes levels of serotonin. This is the chemical that is altered by antidepressants and is linked to mood (among other things). After orgasm, changing levels of serotonin create a feeling of calm and relaxation that is quite pleasurable. Again this causes us to want to repeat the experience. If the experience is having sex with a partner in the context of a healthy emotional bond, that can be very positive. However, if the experience is after viewing pornography, again the system gets hijacked to make sure you want more porn-- and soon! So you can see how our brains are wired for partner sex. Each sexual experience, which based on mother nature was supposed to happen with another person, was designed to bond us emotionally to that person. To create powerful feelings of pleasure, excitement, affection and desire/craving. But that system gets hijacked by porn and turned into a powerful reinforcement system which leads the person back to porn for more and more "fixes". For more information brain circuits involved in pornography, download The Porn Circuit for free. Below are other findings from brain researchers that illustrate how the brain responds to pornography: Cambridge Neuropsychiatrist Valerie Voon, in the UK documentary Porn on the Brain, demonstrates that the brains of chronic porn users closely resembles the brains of alcoholics. She explains that her research has shown that a particular area of the brain, the ventral striatum, “lights up” when a porn addict sees porn. This is the same area of the brain that responds when an alcoholic sees a drink. So the same areas of the brain that get hijacked in alcoholism, leading to addiction, are being hijacked in people who repeatedly use pornography. And in an interesting book by Dr. William Struthers (Wired for Intimacy) brain research is quoted as demonstrating that viewing pornography and masturbating changes the cingulate cortex. This area of the brain is responsible for helping us have willpower and make hard moral and ethical choices. The cingulate cortex is actually weakened in people who view pornography habitually. The sad fact is that pornography habits make it harder for us to avoid going back to pornography! It becomes a self-perpetuating cycle. Gary Wilson, in his TEDx talk, explained why people who use porn frequently eventually have to find more and more extreme images/experiences to get the same result. As noted earlier, porn causes a release of dopamine in the brain. After using the same kind of porn over and over again the brain actually begins to wear out! It stops the production of dopamine to that stimulus (or anything that is too similar), which leaves the person craving their dopamine "fix" but unable to get it. The only way to get the high back is to find something that is more extreme than the original porn. Think of this like an alcoholic developing tolerance to drinking-- at first two drinks gets them tipsy, but in a year or two it takes 4, then 6, and so on. So the tolerance to the original level of stimulation drives them to more and more extreme types of porn just to get the same feeling of pleasure. For more information on the consequences of this particular aspect of porn addiction see the article "Why Does Porn Seem Hotter Than Your Partner?" (http://goodmenproject.com/featured-content/why-does-porn-seem-hotter-than-my-partner/) One of the most important things I have learned as a therapist in this situation is that chronic pornography usage can actually cause impotency in real-life sex! The brain gets so used to responding to porn that it gets confused when we have a real-life partner. Men can actually experience impotency or other erectile problems when they try to have sex with a real person, because they have conditioned their genitals (and brain) to respond only to a virtual person! For more information on how to undo the porn habit and the hold it has on your brain (and your body), you may want to look at The Porn Circuit: Understanding Your Brain and Break Porn Habits in 90 Days. The take home point is that Mother Nature never anticipated the internet. So our poor brains are not doing a very good job of keeping up. Circuits and chemicals that were designed to help make us get together to procreate and bond to partners are going haywire when exposed to types of stimulate they never anticipated. If you want your relationships to last you may need to learn more about the detrimental aspect of pornography and how to put those same circuits and chemicals to use in favor of your relationships rather than against them.  Contrary to what many of us thought growing up expressing anger is not the same as yelling, breaking things or slamming doors. In fact if the person you are interacting with is doing things that trigger your fight or flight system (make you sweat, shake, want to retreat, raise your blood pressure and/or heart beat, etc.) then you are not witnessing someone's anger, you are in the presence of abuse. Yep, that's right! And the normal human response to being abused is to want to hurt the other person back. So we yell, stomp our feet, throw things or say mean hurtful stuff back. Now WE are being abusive as well.
I think this is a very important distinction to make. Anger is actually NOT a damaging emotion. Abuse is damaging treatment. I repeat, anger and abuse are NOT the same. I can sit down calmly and tell you that I am angry because you borrowed my car and ran it out of gas. If you feel embarrassed, guilty, sad or contrite but NOT fearful, nervous, threatened or like you need to yell at me then I have NOT been abusive. I have just been angry. Anger is an indication that our boundaries have been violated. I don't like it when people do not show appropriate respect for my things and so if you use my car and don't put gas in it I am going to be angry. But that's OK. By conveying that I am upset it shows you that you have crossed a boundary and so you will try not to do that in the future. Many of us who grew up in dysfunctional homes confuse anger and abuse. We think that if someone is red-faced, yelling, shaking mad, throwing things or hurling awful accusations at us they are "angry". I would argue it is much more useful to see this as abuse. That way both people can see how unhelpful and inappropriate this behavior is. Abuse never leads to anything good. Anger, when expressed without turning in to abuse, should ALWAYS lead to something good. It is a communication about what you need to feel respected, cared for and even loved. It is essential for you to communicate this so that you are taking care of yourself and protecting the bond you have with that person. It is important for them to hear this message clearly and take corrective action. That is the purpose of anger. The purpose of abuse is to discharge physical energy and to hurt the other person. That is not anger. The expression of anger is about trying to identify and solve a problem. Venting, which many people mistake for the expression of anger, is about hurting the other person in an effort to make yourself feel better without any regard for the other. One of the most well-known authors on anger is Harriet Learner, who wrote The Dance of Anger. In an interview on the Relationship Alive podcast Ms. Learner suggested that the worst time to communicate your anger is when you are angry. She recommends calming down first and then discussing your anger. What? Yes! Talk about your anger when you are NOT angry. I know, mind-blowing. It makes me think of when a toddler has a temper tantrum and we tell them to go calm down. Then we ask them to use their words to talk about why they were upset. The same applies to us. When you are activated and angry you need to NOT talk but rather step away briefly and do some deep breathing or other things to get your nervous system regulated. Then you can engage the person who made you angry and explain what they did that was so offensive. In thinking about positive expressions of anger that are clearly not abuse think about the sit-ins of the civil rights movement in the US. There was plenty of anger on the parts of the protestors who saw the racial oppression and abuses going on. However the play-book of those sit-ins was literally that "not a hair on the head of [the oppressors] would be disturbed". The protestors wanted to convey their anger appropriately and NOT allow it to turn into abuse, which would have spurred an abusive reaction on the part of the authorities. Abuse begets abuse. Anger, if expressed appropriately and without abuse, should beget positive results and heightened mutual understanding. Anger can teach us things about ourselves and reveal things about our partners or other loved ones. If the anger seems out of proportion to the event (you bring my car back with no gas and I calmly tell you we can no longer be friends) then there is likely some "unfinished business" being triggered from the past. In this example perhaps I had parents who used my property, resources or accomplishments for their own selfish purposes and I felt used and mistreated. I am, therefore, naturally sensitive to feeling that others don't care how they treat me and are going to take advantage of me. So my anger in this situation, if I can see that it is out of proportion, will direct me to look at areas of my past where maybe I have some unresolved wounds. That in turn provides an opportunity for healing. Understanding the purpose of anger can help us to not suppress or deny it. Understanding the difference between anger and abuse can help us learn to express anger in an appropriate way that can lead to increased knowledge, understanding and harmony for ourselves and in our relationships. If you find yourself confused about or uncomfortable with anger I encourage you to think about tackling that problem. Anger turned inward/suppressed can lead to depression, loss of motivation, difficulties in achievement, addictions, poor self-care and even self-attack or self-abuse. Anger expressed as abuse can lead to shame, loss of relationships and/or jobs and even legal problems. Therapy can be an excellent tool for learning more about anger and how to comfortably express as well as witness it, as can the 12-step group Adult Children Anonymous (which focuses on people from any type of dysfunctional childhood) or books such as The Dance of Anger. Regular exercise and/or mindfulness mediation can help stabilize the nervous system so that when you feel angry you are better able to prevent it from veering into abuse. Proper sleep and not over-using stimulants like caffeine and energy drinks can also be helpful in keeping one's nervous system stable. Classes on anger management can help you learn the physiological signs of anger and how to manage the feeling when it arises and stay grounded when you see it in others. There are many options for working on this problem and I hope you consider trying some of them. Wishing you health and happiness, Dr. Jordan  Perhaps no other death carries as much stigma and pain as suicide. Family and friends wonder what they could have done, how did they miss the signs? They grieve the loss of not only the person but all that they could have become, the life spread out before them unfinished. Suicide has become a larger and larger problem in our country, claiming young and old, rich and poor, crossing boundaries of gender, color and religion.  And yet despite most of us knowing of a suicide in some way -- a classmate, a relative, a friend of a friend, we don't as a society talk about it openly most of the time. So here are some questions you may have wondered and some "straight talk" about suicide. Please remember to take ALL suicidal gestures and comments seriously. If someone is talking about suicide call the Suicide Prevention Lifeline at 800 273 8255. You can also take the person to any hospital emergency room or if you are in Texas you can call 911 and ask for a Mental Health Deputy. These are police officers with additional training in mental health evaluation. They are mobile and can go to the person in crisis.
Hopefully you will never need this information but it's better to be prepared to deal with this potential mental health crisis in case it happens. If you are feeling suicidal PLEASE contact a hotline, the police or a mental health provider immediately. Suicidal feelings can be treated but only if you ask for help. Best wishes, Dr. Jordan  I recently published a blog on the "Care and Feeding of your Island/Avoidant Partner". Since one of the main principles of successful relationships is that they are fair and equal it only makes sense to talk about how to take great care of wave-ish partners. So here goes...
Wave-ish folks, like the rest of us, are subject to becoming more wave-ish once married. This has to do with breaching that final level of commitment to where our partners are now also family. We all carry around inside of us memories of how we were treated in childhood, and how we observed our family members treating each other. These templates are more flexible and less evident in our relationships with our friends and co-workers. Once someone enters into the realm of true family these templates are often re-activated in powerful ways and they tend to amplify our natural tendencies learned as children. So as with Islands, once Waves are truly committed you may see the following tendencies emerge more strongly: Fear abandonment, even in ways that seem more minor. Wave-ish folks experienced inconsistent parenting, such that they were sometimes coddled and given lots of attention but then sometimes unexpectedly rebuffed or pushed away and even shamed for being "too needy" or "too much". They intuitively expect the other shoe to drop and expect to be rejected. This gets worse with commitment for the reasons mentioned above. Your wave-ish partner may start reacting to you leaving, even if you are just running some errands, leaving you feeling bewildered and frustrated. Know that departures can be triggering for them and depart with an extra dose of love. Let them know that you are leaving but will be thinking of them while you are gone and look forward to seeing them when you get back. Give them a hug before you leave. Send them a text (doesn't have to be fancy, a heart or smiley face will do) while you are out. Think of them as a kid who gets nervous when their mom or dad are suddenly unavailable. They need reassurance around both departures and reunions. Can get prickly when you reunite after being apart. Again this can be VERY confusing for their partners, who have no idea that the separation was stressful. They come home from running some errands to a wave-ish partner picking a fight. Crazy, I know. But remember that they fear you leaving and when you do they may feel a surge of anger at being left. Since they tend to have trouble letting go of the past they may think about this the whole time you are gone. Then when you get back, wham! they let you have it. THEY DON"T DO THIS CONSCIOUSLY OR ON PURPOSE. Please, please, keep this in mind. It is no picnic for them either. No one likes to feel upset, so if your wave-ish partner is being cranky or downright mad remember that what is underneath that is emotional pain. They are hurting. One of the most fool-proof ways to soothe a wave-ish person is to hold them. They usually melt under touch. They also tend to love eye-contact. So hold them, gaze lovingly into their eyes and tell them that they can depend on you to never leave them. Can ramp up their emotional intensity, especially if you are island-ish. Remember the opposite styles amplify each other. So if you are island-ish, after marriage or deep commitment you will tend to move away a bit. This is likely to bring about protest behavior from your wave. It may be more clinging or it may be more frustration and accusations about how aloof you are. Or both. Try to remember that a wave-ish person is like a fussy baby. They make a lot of noise and you may be inclined to simply leave rather than deal with the fuss. But just like a crying baby they need your help, love and soothing. They tend to calm down MUCH faster than their partners think. So moving in, using touch, soothing words and eye contact can usually get a wave-ish person to get some emotional equilibrium pretty quickly. Even if you are not an island your wave-ish partner may get extra emotional after the deep commitment. Be prepared for this and don't blame them or tell them they are crazy. They are expressing their fear that you are not going to connect to them. Waves need a lot of connection and get more dramatic and emotionally messy when they don't get sufficient connection. Sadly they often unconsciously drive people away with their "fussiness", depriving themselves of the connection they need to get calm again. So know this and help them. It will pay you back tenfold in that you will not only have a more calm partner but you will have a partner who is eternally grateful to you for knowing what they need and giving it to them. Like islands, waves are often misunderstood. Your job is to not fall into that trap, to know them and take care of them. May "spoil" things you try to do for them. This one is bound to make you feel crazy but remember they are not doing it intentionally. They want to be happy, just like any person does. However, since they have a childhood history of having the other shoe constantly dropped they anticipate being disappointed. So if you do something nice for them they may just turn around and "spoil" it somehow. If you take them out to dinner they may complain about the restaurant. If you buy them a gift they may tell you it's not their style, or the wrong color, or whatever. While the natural reaction to this would be to tell them to take a hike, you need to remember that they are acting from childhood pains. Tell them how much you love them and that you know they have been disappointed in the past. Tell them you don't want to disappoint them and you are open to hearing what they need from you. Don't take it personally when they try to spoil a gift or kindness. I know it's a tall order but you will be healing a deep and very painful wound from their childhood. Which is really, in my opinion, what marriage is all about. And that's a two-way street, so when you heal your wave's painful childhood issues they will do the same in return. Everybody wins, which is why marriage is so great! Tend to respond with a negative a lot of the time. So if you propose a vacation to the beach they are likely to tell you the five reasons that's a bad idea. Don't bite. Just let them know that you know that they tend to find "what's wrong with the picture" before being willing to see what might be right. Tell them you are going to overlook their first response and give them another chance. If your partner is good with humor, you can say something like "OK my beautiful nattering naybob of negativity, now that you have gotten all the no's out of your system, can we revisit the idea?". Then flash them a loving smile. When used with love and kindness humor can be a great way to re-boot an activated wave. May get really preoccupied with being "too much" or "too needy". Remember that wave-ish folks had childhoods where people alternately showered them with attention and told them they were too much and rebuffed them. So they are naturally afraid of overwhelming people. Paradoxically this leads to a lot of anxiety, which can make them more emotional, more clingy and more negative. Which has the unintended consequence of making their parter get exasperated with them! Be on the lookout for your wave-ish partner feeling judged as too needy or rejected. A wave-ish partner may misinterpret signals like you looking away during a conversation or sighing when they tell you something they need. Be careful to let your wave-ish person know they are NOT too much for you and that you have no intention of leaving them. Help them feel safe and secure and you will find their wave-ishness will actually diminish! May have trouble ending an argument or letting it go afterwards. Wave-ish folks have trouble with endings, even arguments! They may keep it going because closing up something feels in a way like loss. They may also hold on to hurts from the past to act as a bulk-wart against being vulnerable towards you in the future, which they fear will be rewarded with more hurt! Help your wave let go in an argument by reminding them that while there may be a part of them that tends to hang on their body and mind deserve relief. Hold them tight at the end of a rough conversation and reassure them that if they let go they are not going to be setting themselves up for additional injury. May not look out well for their partner in social situations. If you go to a party or event your wave-ish partner may wander off and socialize and "drop" you. This is because their parents dropped them (emotionally) as kids. Don't take this personally and remind them before you go out to social events that you would like for them to keep track of you and circle back at predetermined intervals to keep you feeling connected. Waves are not any more difficult than islands. And like islands they do not do these things "on purpose" or with the intent of making their partner crazy. Learn to love your wave and help them to manage their emotional reactivity. They will greatly appreciate your help in containing some of their intensity and you will feel calmer knowing you are not about to be plowed under by a tsnumami! Wishing you happiness and health, Dr. Jordan  For the last several decades physicians and mental health workers have theorized that there is a link between difficult childhoods and physical health. Many clinicians noticed that the patients who reported abuse or serious neglect in childhood seemed to have very poor health. The ACEs study actually found a link between traumatic events in childhood and the following illnesses: That link has finally been fleshed out in a very (more than 17,000 participant) study called the Adverse Childhood Events Study (ACEs). According to the Adverse Childhood Events Study (http://attachmentdisorderhealing.com/the-greatest-study-never-told/) 66% of people surveyed had one or more types of childhood trauma and 38-42% had two or more. And this is in a study of middle-class people living in San Diego, California. Certainly children in more impoverished or desperate settings fare far worse. For those who had childhood events that were traumatic, they suffered more ischemic heart disease, cancer, chronic lung disease, skeletal fractures, liver disease, autoimmune diseases, depression, suicidality, chronic anxiety, amnesia, and hallucinations. Some of these links are intuitive. For example if you suffered physical abuse in childhood it's not a stretch that you may have broken bones as a result. Also if you were emotionally abused you may end up trying to cope by using alcohol or drugs, causing liver damage. But things like heart disease or cancer seem more elusive. Is the link the immune system? the inflammatory response? Scientists are still working out the direct linkage but the fact that early childhood traumatic events stay with us now has scientific support. So what can be done about this? We cannot go back and change our childhoods. However, we can recognize that childhood trauma can create responses in the body, such as heightened fight-or-flight responses, that warrant accommodation. If one has had significant abuse in childhood, for example, one may want to take extra care to incorporate relaxation strategies to encourage the body's relaxation response. These strategies include techniques such as diaphragmatic breathing, guided imagery, self-hypnosis, progressive muscle relaxation and meditation. By doing some of these on a daily basis one can counter-act the body's heightened fight-or-flight response that can contribute to stress related illnesses such as hypertension, diabetes, insomnia, obesity, skin conditions, headaches, stomach problems, irritable bowel syndrome, depression and anxiety. Even 10 minutes each day can help re-wire the brain to maintain a more relaxed stance throughout the day.
Psychotherapy can help as well. By reviewing one's history (which, incidentally is NOT the same as re-living it!) and coming to terms with it people can reduce some of the physiological reactivity that had previously been attached to those memories. Techniques like EMDR, Somatic Experiencing or Sensory Motor Psychotherapy can be especially helpful in re-setting the bodies response in order to avoid the constant fight or flight response. If you have had adverse childhood events in your life, even if you do not feel that you are being negatively effected on an emotional level, it may be advisable to discuss your history with your physician. As medicine and psychology become more integrated we can all benefit from the intersection between these two disciplines. Yours in health, Dr. Jordan  What exactly is the difference between co-dependency and interdependency? This is a question that comes up a lot for folks who are familiar with the idea of co-dependency. Many of us have an idea that we are supposed to "love ourselves before we can love others" and "be the source of our own happiness." We may feel that if this is not happening that we are being "dysfunctional" or "co-dependent." One of the interesting things to me about the re-focus on attachment research in the past decade of psychology has been the re-realization that humans are inherently dependent on others. We are born some of the most vulnerable babies of all species, requiring a full decade if not more of intensive parental involvement. Our brains do not actually finish maturing until halfway through our second decade of life. We have always, and continue to, live in groups or "packs". We use solitary confinement as the worst punishment for the worst humans. So how many of us got this idea that depending on others was bad or pathological seems curious indeed. I recently encountered a podcast with Dr. Stan Tatkin, a prominent couples therapist and author who utilizes attachment theory as a foundation of his work. Among other things in this interview Dr. Tatkin shows how his model is representative of healthy interdependency versus the pathological idea of co-dependency. It would take several pages for me to summarize his theory on this point and he does a perfectly fine job on his own. So for those reasons rather than try to explain his viewpoint to you I suggest that you listen yourself: http://www.neilsattin.com/blog/2015/12/19-recipe-for-a-secure-healthy-relationship-with-stan-tatkin/ He gets to the topic of codependency around 20 minutes in to the podcast. While you are there you may want to check out other topics in this podcast which specializes on relationships. The podcaster has many excellent guests on his shows and seems to cover a lot of important ground. And if you are interested in learning more about healthy relationships, as always I also recommend Dr. Tatkin's audio program, Your Brain On Love, as well as his books, Wired For Love and Wired For Dating. Wishing you happiness in your connections, Dr. Jordan
A thought occurred to me the other day in the midst of counseling a couple. One of them had recently adopted a dog from the animal shelter. She was talking about the history of the dog and why it had certain habits and fears. To all of us in the room it went without saying that since the dog had been mistreated by it's previous owners it came with "issues". I think many of us have had those experiences, like raising your hand to pet a dog and watching it flinch or cower. Our first thought in that situation is "oh dear, I bet this dog has been abused!". We generally don't get mad at the dog for misunderstanding us. Nor do we expect the dog to know that we are not the same person who previously hurt them. We are generally concerned and patient and understand it will take the dog time to trust us. We also would not be surprised if a dog trainer told us that there were some things we could do on our part to not create fear in the dog. So while all of this is usually pretty obvious to humans in regards to dogs, the corollary to understanding our relationship partners is sadly not all that intuitive. We are often upset to find that our partners, who had previous "owners" (parents/caregivers) have baggage and a host of unconscious expectations that cause them to misunderstand us and sometimes act in ways that don't make sense. By the way, they are seeing the same behaviors in us! It's as if one dog from the pound (with their own history of having been neglected or hurt in the past) adopts another dog from the pound (with their own history also). You can imagine the problems that ensue. If you have read my blog posts or website you may know that I practice a particular style of couples therapy-- PACT. In that style of therapy we find it useful to look for certain patterns of behavior that arise from particular histories of interactions with our early caregivers. These patterns are called "attachment styles". There are two basic styles that represent the majority of us who end up having relationship problems-- "Avoidant" (which Dr. Stan Tatkin calls "Islands") and "Resistant" (which Dr. Tatkin calls "Waves"). These two predominant patterns can be described in terms of types of dogs you may encounter at your local pound. The "Avoidant" or "Island" type of partner is like the dog at the pound who, when you approach the cage smiling and holding out a treat, backs up and hopes you will go away. You may feel hurt or rejected, even annoyed. You may think to yourself "hey, I'm the good guy here!", "c'mon buddy, give me a chance!" If you are patient and give the dog a little space in time he or she will likely relax and may even show some interest. If you open the cage and again give the dog space it will, in it's own time, come out. But don't expect this type of dog to jump into your arms in the first few minutes! He or she will need to move past you and walk around a bit, making sure that you do not represent any danger or infringement on their free will. Once the dog has established that you are OK letting it walk about freely it will likely approach you, in it's own time, and perhaps make a gesture of interest. If you move too quickly or with too much enthusiasm this type of dog will back away and then you are back to square one for a bit. If you try to imagine what kind of history this dog has it's not hard to conjure: This dog was neglected. It had the kind of owner who put out food and water but did not show the dog much affection. The dog is not used to being engaged or approached much. When this owner did approach the dog it was likely for the dog to do something for the owner rather than the owner doing something for the dog. Perhaps it was an older dog who was too tired to run much, but the only time the owner came to it was to drag it out for a run because that's what the owner wanted to do. The owner missed the cues from the poor dog that this was only fun for the human! The owner simply threw a leash on the dog and dragged it around the block, perhaps even chastising the dog for going to slow. Then upon returning home the dog is put back into it's corner and ignored again. This dog will come to see his owner as a task-master who is only really interested in him or herself. The dog will be mistrustful of approach because it only means that the dog is now expected to do something that the dog may have no interest in. The dog has learned that the owner is not sensitive to it's needs or wants and most of the time leaves it alone. So the dog learns to entertain itself and gets pretty good at this. It can stare out the window and watch birds or run around alone in the back yard chasing squirrels. But the dog does not expect the owner to partake of these activities or show any interest in what the dog is doing. In fact, the dog comes to prefer not being noticed by the owner because the owner is only interested in their own needs and the dog finds that unpleasant and unfair. Notice that this dog is not necessarily abused. It's just emotionally neglected. Therefore when you show a lot of enthusiasm and rush forward to give it a big hug at the pound this dog is not comfortable with that. It will try to avoid that kind of effusive contact and get more space from you. In time, if you are patient, it may become more comfortable with you and the dog may even come to enjoy a certain amount of attention. But it may also never be the kind of dog that you can scoop up and hug and smooch all over. The dog has baggage. Now compare that to a different kind of pound pooch. This dog has been intermittently abused and praised by its owner. Confusing, right? This owner was a bit moody and wrapped up in their own dramas. On a good day they would lavish the dog with treats and hugs and then on bad days might yell at the dog or even give it a kick. The dog was not able to know from day to day what was coming. So the dog also learns to be guarded. Only when you approach this dog at the pound they don't necessarily want you to go away. Part of them is thinking "well, this could be good...you may have a treat for me". But the other part of the poor dog is thinking "yeah, but this could be bad!". So the dog may approach but with ears back and a slightly open jaw, ready to bite if things turn ugly. When you see the dog approaching you in this way you might think "geez! Here I am trying to be nice and it looks as if you may bite me!" This type of dog may even approach you and growl, only to then lick your outstretched hand. Their behavior is likely to be a confusing mix of pleasure at your attention and fear and even anger at what they perceive is potential backlash. Even more confusing is that this dog, right after growling at you, will likely follow you into the next room. The dog does not seem to want to be alone, even though half the time when you try to engage it the dog may snarl or bark at you! And even more frustrating this dog may tear up your furniture in protest if you leave it alone for too long. This dog is certainly a confusing fellow! But, if treated with love and patience, this dog will eventually growl less and lick more. However it may always be quick to curl it's lip and look like it's about to bite. It's up to you to know how to help the dog feel safe and loved and to not take it too personally when the dog seems scared or testy. This dog would, if it were human, correspond to the attachment type of "Resistant" or in Tatkin's terms, a "Wave." This dog too has baggage. When we meet our life partners they are not newly birthed puppies. They are middle-aged dogs with histories of having been, much of the time, mistreated in some way or another by someone in their formative years. It may not have been out and out abuse (although that is certainly possible), it may have been mild emotional neglect or moderate mis-attunement or confusion behaviors from distressed or overwhelmed parents. Whatever the case, they have baggage (as do we!). We need to come to expect this and not take it personally. We need to try to learn about our partner's histories and figure out how we can offer corrective experiences that will, over time and with patience, reduce their problematic behaviors. And we need to be reasonable about our expectations, knowing that while you can teach old dogs new tricks, you may have to use some pretty persuasive treats and even engage your friendly (PACT certified!) "dog trainer". Wishing you the best in your loving connections (both human canine), Dr. Jordan  I've heard it said that Freud's definition of the goal of therapy was this: to transform neurotic suffering into ordinary suffering. One might infer that his definition of mental health was the capacity to suffer "normally" rather than "neurotically". Freud is also purported to have said that mental health was the capacity to love and work. While I like both of those concepts I have a definition of mental health that I like even better: response flexibility. What exactly does that mean? To me, response flexibility means tht whatever situation you are in, you are able to respond in the best manner given the circumstances. Many of us actually respond to situations based on a surprisingly limited repertoire of alternatives. For instance, if you were raised in a family where conflict was avoided, when you encounter conflict I can predict you will try to avoid it if at all possible. But what if in that situation the best response is to actually engage in the conflict? What if the conflict is a conversation with your boss about why you, versus your co-worker, should be given the promotion? By avoiding conflict or discord you may sell yourself short of some important opportunities. So in this example what can you do? If you have good mental health you would be able to respond assertively or move in to the conflictual conversation without being overly intimidated. This would predict you had either grown up in a pretty healthy family or you had worked hard to overcome your default response of avoiding conflict. In either situation if you can respond adaptively rather than reflexively you have good mental health. Too many of us, however, don't have this kind of flexibility. We are on auto-pilot much of the time, running via default programs that we learned in our family of origin. I would argue that this is not "good" mental health! I believe all people can learn to un-do unhealthy or limiting patterns and enlarge their repertoire of behaviors. This does not mean giving up the old patterns but rather layering on new ones to allow for more flexibility in responses. While that is my favorite definition of mental health (which incidentally also guides my work as a therapist) there are certainly others worth considering. For instance, in the Shedler Westen Assessment Procedure (SWAP–200; Shedler & Westen, 2007) mental health is defined in much more detailed terms: ● Is able to use his/her talents, abilities, and energy effectively and productively. ● Enjoys challenges; takes pleasure in accomplishing things. ● Finds meaning in belonging and contributing to a larger community (e.g., organization, church, neighborhood). ● Is able to find meaning and fulfillment in guiding, mentoring, or nurturing others. ● Is empathic; is sensitive and responsive to other people’s needs and feelings. ● Is able to assert him/herself effectively and appropriately when necessary. ● Appreciates and responds to humor. ● Is capable of hearing information that is emotionally threatening (i.e., that challenges cherished beliefs, perceptions, and self-perceptions) and can use and benefit from it. ● Appears to have come to terms with painful experiences from the past; has found meaning in and grown from such experiences. ● Is articulate; can express self well in words. ● Has an active and satisfying sex life. ● Appears comfortable and at ease in social situations. ● Generally finds contentment and happiness in life’s activities. ● Tends to express affect appropriate in quality and intensity to the situation at hand. ● Has the capacity to recognize alternative viewpoints, even in matters that stir up strong feelings. ● Has moral and ethical standards and strives to live up to them. ● Is creative; is able to see things or approach problems in novel ways. ● Tends to be conscientious and responsible. ● Tends to be energetic and outgoing. ● Is psychologically insightful; is able to understand self and others in subtle and sophisticated ways. ● Is able to find meaning and satisfaction in the pursuit of long-term goals and ambitions. ● Is capable of sustaining a meaningful love relationship characterized by genuine intimacy and caring. ● Is able to form close and lasting friendships characterized by mutual support and sharing of experiences. The World Health Organization defines mental health as "as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community." They go on to elaborate that "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." The question of what defines good mental health is certainly worth entertaining. How do you know if you need to work on yourself if you don't know what the goal is? I encourage you to give some thought to what definition of mental health appeals most to you and then check yourself accordingly. Not to skewer yourself for failing that standard in some ways (after all that would not be very mentally healthy!) but rather to see areas where you may want to change and grow. None of us can be 100% mentally healthy all of the time, but all of us are capable of improving. Therapy is an amazing tool for growth, as are 12-step groups, meditation practices, support groups, spiritual practices and even yoga when the philosophical aspects are included. I encourage you to think about ways that you can assist yourself in growing towards more mental health. Best wishes, Dr. Jordan  Many people who contact me are suffering from anxiety. Anxiety can cause a number of problems ranging from irritability, depressed mood, lack of productivity or insomnia.
The first thing I always want to know is are they exercising? Most of my patients who have anxiety find that exercising vigorously most days of the week will reduce their anxiety a considerable amount. That said exercise is not usually sufficient to remove all anxiety from someone who struggles with it. We almost always need to look at other lifestyle factors (like reducing caffeine and other stimulants) as well as other techniques such as diaphragmatic breathing, guided relaxation practices and mindfulness meditation practices. What follows are some basic videos that people can watch in order to learn how to use these techniques to help with anxiety. The first link is for teaching diaphragmatic breathing. Some people call it "belly breathing". The reason it's helpful to learn this technique is that if you can fully engage your diaphragm by doing this type of breathing it stimulates the parasympathetic part of your nervous system. That part of the nervous system is what causes your body to relax. If you have been stressed out then your nervous system most likely is sympathetically activated, meaning that the sympathetic branch of the nervous system is dominant. This part of the nervous system (the sympathetic branch) dumps a lot of adrenaline and cortisol (stress hormone) into your bloodstream which causes symptoms of anxiety like shallow breathing, sweating, hot flashes, increased heart rate, stomach upset, headaches, muscle tension, etc. The way to stop this stress response is to activate the parasympathetic nervous system by doing diaphragmatic breathing. This link will give you a super simple explanation of diaphragmatic breathing : https://youtu.be/0Ua9bOsZTYg This link will show you a person doing diaphragmatic breathing so you can follow along and practice it: https://youtu.be/8-_NNCrrdus This next one is a specific pattern of breathing that also activates the relaxation response and this is another good tool for turning off the stress pattern if you have started to feel anxious: https://youtu.be/YRPh_GaiL8s You can also do the diaphragmatic breathing with a 4-7-8 pattern, or if you prefer you can use any pattern where you exhale longer than you inhale (so for example inhale for 5, hold for 2, exhale for 6, or any other variation as long as the exhale is longer than the inhale). In order to maximize benefit you should try to practice some form of relaxation breathing at least 2x/day for at least 5 minutes each time. Once you have the hang of it you can increase to up to 10 min each day. Many folks make one of those times when getting ready to fall asleep. It can help you relax and fall asleep if anxiety tends to keep you awake. The next tool in the anti-anxiety arsenal are mindfulness meditations. These have been shown to reduce anxiety and depression, improve concentration and attention and even improve control over your emotions. Studies show that doing this just 11 minutes each day will produce actual structural changes in the brain (increased activity of the frontal lobe). It helps reduce symptoms of ADHD, depression and anxiety as well as increasing emotional control. At first you should probably just try 3-4 minutes of mindfulness at a time. Doing too much at once can make it annoying and then you might get turned off to it. Try to start with 3-4 minutes each day and after a few days add another minute, do that for a few days, then add another minute and so on. Eventually you will want to do at least 11 minutes each day of mindfulness meditation. All of the following videos have good technique so you can try them all and see which ones you like. You can also search yourself on youtube for other ones. But remember even if the video is 20 or 30 minutes just do 3-4 minutes at first. You will not be able to empty your mind, it is totally normal to have thoughts intruding constantly. That's fine. The goal is just to notice the thoughts and then let them go. I think of them like people walking into the room and I notice them and say "hi" and then let them walk away and I let them go. The goal is not really to empty your whole mind because the human brain does not work that way. It's just the process of acknowledging the thoughts and letting them go that builds the brain in the areas that benefit you. https://youtu.be/8v45WSuAeYI https://youtu.be/Fpiw2hH-dlc https://youtu.be/7nTzx5V6oFU And finally here are links to guided imagery for sleep. These are great to help you fall asleep. You just start playing it when you lay down to sleep and usually folks fall asleep before the whole program finishes. https://youtu.be/l4r6r2lGKgU https://youtu.be/zOFxVMlnNdw https://youtu.be/Z94V5-K-1bA If you don't like any of these you can search with keywords "guided imagery for sleep" or "hypnosis for sleep" to try some other ones. You can also specify in your search male or female voice, music vs. nature sounds, etc. If you have other youtube videos that you have found useful for managing anxiety or for falling asleep I would love to hear about it! Send me an email or post your comment below. Thanks and stay tuned to more ideas on managing symptoms of anxiety without medications. Best wishes, Dr. Jordan  Have you ever wondered how a text stands up to a phone call? Or a phone call to an in-person meeting? What about emails? How have all of these modern developments affected our human relationships?
There is new research coming out now that these forms of electronic communication are NOT equivalent to the old-fashioned face-to-face talking/interacting. Which makes sense when you consider that the human brain would have a lot of trouble evolving at a pace to keep up with the latest iPhone app or emoticon. Our brains were wired for in-person interactions in which we can use data from the visual stream, and vocal tone, volume and pitch. We intuitively know what a frown means even when no words accompany it, and we also know that even if said with a smile certain words uttered in a snarly tone mean a fight is brewing. These kinds of nuances cannot be parsed out by the human brain when the message is communicated via text or email and may only be partially correctly decoded in a phone-call or audio message. Furthermore not only is it likely that the message can be mis-interpreted but our poor brains also can't derive the type of support that they need from these relationship proxies. In one study done with girls who were put into a stressful situation it was shown that being able to either talk to a comforting person (their moms) over the phone or meeting up with this person after the stressor reduced physical signs of stress (levels of cortisol) compared to texting, which did nothing for stress. Additionally being able to talk on the phone or in person with the support-person caused a release of oxytocin, a hormone that helps us bond and mitigates the effects of stress. Again this effect was not seen with texting. In another study done on adults over 50 researchers found that the probability of having depression increased as the frequency of in-person contact with other people decreased. Meaning that the less real-live contact that these people had with other humans increased the likelihood that they would suffer depression. Humans need other humans and we need to be with each other in ways that are not purely viritual. So keep those you love close-- close enough to see, touch and hear without the interloping of wires and circuitry. And reach out to them frequently for contact and connection. Save the less personal forms of communication for business and less significant relationships if you want to be happy and healthy. At least until Mother Nature comes out with thehumanbrain2.0. But I'm not holding my breath. Wishing you happiness and connection, Dr. Jordan  As you may know I am a big fan of Dr. Stan Tatkin and have been been training with him since 2009. Dr. Tatkin did a very nice interview with Ms. Morisette about his theories of attachment, arousal and regulation of the nervous system and relationships. As always he was articulate and clear and fun to listen to. If you have not yet been introduced to Dr. Tatkin's ideas this would be a great way to get started. The interview is about an hour. If you have already read or listened to some of Dr. Tatkin's works (Your Brain on Love, Wired for Love or his newest work Wired for Dating) I still think you will enjoy hearing him discuss his views on things like mother-infant relationships, pair bonding and how to successfully find a mate. Here is the link:
http://pca.st/3RbA Happy listening! Dr. Jordan  Holidays stir in most of us a desire to feel loved. To be wrapped in the warm embrace of hot chocolate, sugar cookies, eggnog and holiday cheer. Whether or not you come from a family that can provide that emotional warmth you can still work on improving your ability to create loving relationships in the present time.
The following is taken from Diane Poole Heller, a pioneer in the field of attachment therapy. Dr. Heller is a somatic therapy and trauma specialist who trains therapists world-wide in helping people to heal from traumatic events, including dysfunctional childhoods, and learning to establish more safe and secure relationships with those they love. I have found her work to be extremely helpful and relevant. Below is a post that she sent to clinicians on her list-serve: 1. Send your loved one a Beam Gleam! This is a wonderful way to say “I Love You & You Are Special to Me” and establish a deeper connection with the ones you love – it's one of the techniques I teach in the Healing Early Attachment Wounds module I of the DARe/SATe program. You can do it with your partner, friend, child, even with your pet. Here's a link to the “Kind Eyes” exercise which enhances our innate ability to connect with others. 2. Got Oxytocin? Share hugs ~ we don't get enough hugs! They stimulate the release of the “bonding hormone" oxytocin, and promote intimacy and dissolving anxiety. They also increase your contact nutrition, are non-fattening and very satisfying. Initiate, hug, and repeat. Watch this video for inspiration. 3. Increase your Play Time! Just do it! 4. Plan to have quality time to spend with your special ones this holiday season. Couples or parents and children should try to double their playtime–or make sure they have at least one day a week dedicated to play. I love this quote: “Young Souls Play Hard to Get Mature Souls Play Hard but Old Souls Just Play – La, La, La…” The Universe. 5. Give gifts the way your partner likes to receive them. We all have different ways that we like to receive and give love. Learn more about this in DARe 1 – Healing Early Attachment Wounds, Dare 2 – Creating Healthy Adult Relationships, and the book: The 5 Love Languages by Gary Chapman. 6. Make a date with yourself to nurture yourself with some personal “alone time” to contemplate your New Year's vision. Having time alone is important to recharge and reconnect with your inner center. In DARe 3 – The Neurobiology of Loving Relationships, we learn that people have too little uninterrupted time to have an intimate connection with their core Selves and source. 7. Be with friends and family that you love. Being with others affirms our belonging. Part of Secure Attachment is an easy flow between aloneness and connection. 8. Find your voice to sing your heart out in togetherness. Here is a lovely example of a community sing-out that you will love: SINGING TRIBUTE IN THE MARKETPLACE. Try it in person - it will bring release to you. 9. Make a sincere apology or repair a "broken" bridge with someone. 10. Give three positive, affirming gifts of love each day. Verbal or non-verbal. Pay attention to unspoken signals and notice the results. 11. Turn off your computer and TV and make personal contact. “Real” contact can be much more nourishing than “virtual” contact even as much as we value our email, Facebook, and Skype exchanges. We've gotten so used to technology that sometimes we need a reminder of the nourishment of the authentic, face-to-face connection and hearing the sound of our loved one's voices, or giving and receiving safe touch. 12. List 3 of the BEST things that's happened to you this year. It's a great exercise to learn the art of gratefulness, which has an added benefit of expanding our capacity to give and receive. Keep this list handy in your purse or wallet. Read. Smile.  To err is human....so where does that leave us? Especially where our life-partners are concerned. Since we can guarantee that we WILL hurt those we love most, we all need to know how to repair the damage. One of the places we get stuck is when we don't fully understand the experience of the injured partner. When working with couples I tell them that the ace up their sleeve is empathy. If you can show your partner that you understand how they feel, without making the mistake of trying to simultaneously explain or, worse, defend your position, they will melt like butter. And the funny thing is, once your partner really feels that you know how they feel, and they melt, they quite often will almost immediately open up and ask you to express YOUR side! So if you can hold off on trying to explain your position and just empathize for a few minutes, you are often rewarded with them actually asking you for your perspective. Only now they are in a calmer position where they can hear what you have to say rather than be defensive in response.
There is brain science behind this. When both of you are in a heightened state it is much easier to see the other as a threat. So when you try to present your side of the story, if you have not first calmed your partner down, they are NOT going to be listening! If you can connect to your partner using the social engagement system of the brain, including mirror neurons, and create a feeling of syncrony between your two brains, then you have a much better chance of being heard. CALM YOUR PARTNER'S BRAIN before you try to tell your side of things. For instance, in a heated argument even if you manage to convince your partner that you are right through your brilliant arguing skills, he or she is likely to later feel bullied or disregarded and hold that grudge. So you really haven't won anything. Much better to stop trying to prove your point, empathize, and then make a repair. Once your partner's brain is back together (see "Flippin' Your Lid") and they have invited you to share your side you can express your opinion. And since you did such a great job in helping your partner to feel heard they are likely to reciprocate the favor. So how exactly does one achieve this mysterious thing called "repair"? Well, as mentioned already the first thing is to STOP TRYING TO PROVE YOUR POINT. Set that agenda aside. Then look at your partner (this is really done best in person and within the attachment distance -- 18 inches or less) and tell them, as best you can, what you understand are their feelings about what has happened. For example, if the fight was about you coming home from work late, which s/he has told you drives them crazy, you could say "I know it really seems to bother you when I come home late and I know that last night I got home an hour after I said I would. I could tell that you were really upset. I wonder if ___________ (and insert your best guess as to why it bothers them, such as "you were a latch key kid and so waiting at home alone feels really lonely and sad). Or if you don't have a clue as to why they have such a strong reaction, say "I really want to understand why this bothers you. Can you help me understand that?". Say this with your most loving voice (human's threat appraisal system is very attuned to pitch, tone and volume). Also make as much eye contact as you can muster (this makes the message get in on a deeper level of the brain). If you are too grumpy to jump right in to this part, then tell your beloved "hey, I want to work this out but I am really activated/triggered/upset right now and I need to go away for _____ minutes (no more than a few hours). I will come back at ____ and we can talk it through. Then your job is to go somewhere and GET REGULATED. This is not just time for you to take a break and go watch TV or hang out with friends. You have a job to do, which is to get YOUR brain back on track. So go meditate, exercise, be outside in nature, listen to calming music, practice a relaxation technique or whatever helps you let go of stress. Now once you are calm go initiate the repair and empathize. Tell your partner what you have observed and show your desire to really feel what it's like to be in their head/heart. Once you have done that it's time to apologize. I know, I know, maybe you didn't really do anything that you thought was wrong. But you can still apologize for hurting your partner's feelings. Say something like "I am so sorry that I caused you pain. You are the most important person in my world and I really don't want to hurt you." Remember, if you do this right your turn to tell your side of things will come very soon! Hang in there. It's VERY important to "check your work" after you have attempted to make a repair. Look at your partner's face and body. Do you see them relax? If you have done your job you should see a softening of the face, relaxing of the neck and shoulders, maybe even a big sigh. If your partner still looks like s/he wants your head on a spike then you need to double back and keep trying. Once you get good at this you will be amazed at how quickly you can de-escalate your partner and get back to "friendly" status. The pay off of learning to do a good repair is multifaceted. Your partner will love you more for working so hard to understand him/her. You will feel proud and accomplished that you have learned how to "tame your lion". You will be able to enjoy your partner feeling loving towards you again instead of worrying they are going to kill you in your sleep. And you can salvage the rest of the evening/weekend/vacation without having to have the fight ruin things. Most importantly though you stop this event from going in to long-term storage and becoming another brick in the wall between the two of you or ammunition to be brought up months or years later when they are wanting to exit the relationship. Remember, most relationships don't implode over night. It's the slow accumulation of misunderstandings, unrepaired fights, feelings of being dismissed or disrespected that over time kill most of our failed relationships. Taking care of business right away and doing a good job of it is practicing good relationship upkeep. Best of luck to you and yours in your relationship journey. Dr. Jordan
What has been most impressive to me is that mindfulness literally changes the way that the brain is structured and functions. Areas such as the amygdala, often activated in fear or high states of stress, becomes less active for those who consistently meditate. The frontal lobe of the brain also becomes more active in consistent practitioners, allowing them to have more emotional control, attention, concentration and focus.
An excellent resource for trying out different mindfulness practices is Dr. Ronald Siegel's website mindfulness-solutions.com, where he has follow-along audio tracks like "Stepping into Fear", "Thought Labelling" and "Breath Awareness". For someone interested in trying different forms of mindfulness I strongly recommend this resource. Remember, while the more mindfulness you do the better, even as little as 11 minutes a day has been shown to cause positive brain changes. So give it a try and see if you can find a form that appeals to you. It's free, totally portable and does not require an appointment or even getting in your car. As much as I am a BIG fan of psychotherapy, in those ways mindfulness has therapy beat hands down (which is not to say that mindfulness is a substitute for therapy, but surely practicing mindfulness reduces emotional symptoms and can accelerate the course of therapy also). Best wishes in your search for health and happiness, Dr. Jordan  Guilt and shame are bad, right? Well, certainly no one wants to feel either. Some of us, especially therapists, seem to be "guilt magnets" and "shame prone". We cringe at the slightest sign that we may have hurt or offended someone and spend hours thinking about it afterwards. We may even avoid that person in the future for fear that they are upset with us even though they never explicitly said so. Psychology has long made a distinction, however, between guilt and shame. Guilt is actually considered to be a desirable emotion as far as society is concerned. Guilt is defined as feeling bad for something you have DONE. That is different from shame, which is feeling bad for WHO YOU ARE. Consider this-- if we lived in a world where no one ever felt guilty, i.e. never felt bad for hurting someone or cheating or stealing-- then what would keep people from doing whatever they wanted? If you knew that whatever you were going to do would not upset anyone in the slightest then why not do whatever you want? So if guilt has a function, then what about shame? While I am not an anthropologist, my personal theory is that shame is just overshooting the mark of guilt. I think that Mother Nature gave us the capacity to feel guilt for the reasons stated above, but sometimes that feeling grows too large and instead of being just about our behavior it becomes about our identity, about who we are. Shame does not serve any positive function. While guilt makes us want to move towards people in order to repair the damage, shame makes us feel so bad that we isolate and move away. As shame researcher Brenee Brown puts it "shame corrodes the part of us that thinks we can do better [and therefore is willing to go and say we are sorry]". Shame leads to self destructive behaviors and isolating from others. Shame is toxic. So what are we to do if we find that, like many patients who come to my practice, we seem to be "shame prone"? What if we tend to feel shame about even small things? Working on shame resilience is an excellent goal for therapy. Shame can only survive in secrecy and shadow. If you share your shame with someone, almost always you will find that the feeling diminishes. When we can see that the other person does not run screaming out of the room after we make our "confession", we don't feel so bad. And sometimes we are even lucky enough to talk to someone who reciprocates our shame tale with one of their own. Hearing someone say "oh, I've done that too" or "I did something else that made me feel the same way" we feel tremendous relief. We feel that we are not alone and perhaps we are not the worst person on the plant. Psychotherapy provides a regular opportunity to talk about shameful experiences and feelings. It gives us the opportunity to shine a light of objectivity and neutrality on the shame-drenched sludge that we have been harboring in the deeper recesses of ourselves. And in that light of objectivity and through the compassion of another person we find that the shame shrivels and retreats, growing smaller and less powerful. Keeping the secret of shame is what keeps it alive. Sharing the secret of shame is the antidote. Researcher Dr. Brene Brown has written several Ted Talks and written several books about shame. She notes that "shame happens between people and needs to be healed between people". I could not agree more. Fortunately for us Dr. Brown has made a career about researching shame and has come up with four common characteristics of people who are "shame resilient":
If you are interested in learning more about shame I recommend any of Dr. Brene Brown's work on shame and shame resiliency. Another great resource is work on self-compassion, which is another way to fight shame. For more information on self-compassion see Dr. Kristin Neff's website on the subject. She has links to her Ted Talk as well as information about self-compassion and even a self-quiz you can use to see how you rank on self-compassion. One of the services I offer in my work is to assess your level of "shame-proneness" with a paper and pencil test developed by shame researchers. This test can be administered and feedback given all within a 45-minute appointment. If you are interested in talking to me more about shame please feel free to send me an email using the form below or call me at 512-293-3807  Loving the Wrong Person We’re all seeking that special person who is right for us. But if you’ve been through enough relationships, you begin to suspect there’s no right person, just different flavors of wrong. Why is this? Because you yourself are wrong in some way, and you seek out partners who are wrong in some complementary way. But it takes a lot of living to grow fully into your own wrongness. And it isn't until you finally run up against your deepest demons, your unsolvable problems--the ones that make you truly who you are--that we're ready to find a lifelong mate. Only then do you finally know what you're looking for. You're looking for the wrong person. But not just any wrong person: the right wrong person--someone you lovingly gaze upon and think, "This is the problem I want to have." I will find that special person who is wrong for me in just the right way. Let our scars fall in love." --Galway Kinnell *Emphasis and spacing added by Dr. Jordan
 David Richo's book How To Be An Adult In Relationships: The Five Keys to Mindful Loving is a very worthwhile read. The main hypothesis for this book is based on what he calls “The Five A’s”. These are: · Attention · Acceptance · Appreciation · Affection · being Allowed the freedom to live “in accordance with our deepest needs and wishes” According to Richo these are the basic ingredients needed to grow healthy self-esteem. I agree that these are all very valuable things and that without them we are likely not to feel loved or cared for. And I absolutely believe that humans have an innate need to feel connected to others, preferably in a way that feels loving and positive. Although if that is not available we will make due with connection through negativity rather than none at all. According to Richo, we come into the world needing the 5 A's from our parents. And, he argues, in adulthood we need these same “5 A’s” from our romantic partners. More profoundly he states that these are also the things we seek to have in our spiritual practice/relationship with our higher power. He feels that through a spiritual practice one can cultivate the 5 A’s in a way that brings these essential elements into our lives through a spiritual plane.
Whether or not you are spiritual I do think these 5 A’s are worth thinking about. According to Richo, “our work is not to renounce our childhood needs but to take them into account, work on them, and enlist our partner to help us do this, if s/he is willing…to unite with a partner who can join us in our work.” I wholeheartedly agree with this. These deep, basic childhood needs never go away. We crave our lover’s attention, their acceptance, their appreciation and their affection. And we thrive when they allow us to “live in accordance with our deepest needs and wishes.” A partner who can help us heal any wounding in these areas is a most precious and prized gift. They deserve our deepest loyalty, respect, care and cherishing. Treating them in this way is also a natural outflowing of having these childhood needs nourished. This is true, mature and lasting love. According to Richo there are also 5 “mindsets” that tend to interfere with providing the Five A’s to our partners. These are: · Fear · Desire · Judgment · Control · Illusion Richo believes that these mindsets interfere with our authentic experience of the present moment. He states that “Each is a minimization that imposes our personal dramas upon reality and makes fair witnessing impossible.” Or in other words, these are states of mind that will keep you from being able to see your partner clearly and convey a sense of understanding to them such that they feel truly connected to you. They become the interference in the radio signal such that a beautiful melody sounds like a cacophony of static and notes. As you have probably already surmised, Richo’s book covers a lot of ground. He explains how the Five A’s manifest differently in relationships with introverts versus extroverts. He talks about how to handle complex emotions like fear, grief and anger. He has an excellent chapter on whether or not committed partnerships are actually “for you”. He contrasts romance and addiction. He gives numerous suggestions on how to work through un-grieved losses and become one's own parent. All this in little more than 250 pages! In addition to all of these topics we might expect given the title of his book, Richo touches on a very bizarre phenomenon common to human relationships. He notes that if we have some wounding or deficits in these 5 A’s we are likely to be very sensitive to that area in our romantic relationships. That makes sense. But where things get tricky is when we seek to re-enact the deficits, wounds and deprivations of our childhood with our current partners. You may be familiar with the idea that a child of an alcoholic is likely to (unconsciously) marry an alcoholic (or someone otherwise addicted—sex, drugs, work, food, etc.). From the outside this seems “crazy”. Why would you set yourself up for this type of familiar pain? Richo states that we unconsciously try to revive our earliest unmet needs in an effort to see if our partner can help us heal them. So if I was emotionally abused as a child I may gravitate towards that dynamic in my adult relationships in an attempt to “revive my earliest unmet needs”. In some way I am hoping that my partner can save me from the dynamic that I have co-created with him/her. Or, as a former supervisor of mine used to say, “we either marry our parents or we marry someone who is not like our parents but we unconsciously coach them to act like our parents. Or we marry someone who is not like our parents and stubbornly resists being coached to act like them, so we project our parents onto them, believing they are like our parents despite evidence to the contrary.” While this is not a very flattering portrayal of human nature, I have to say that in 20 years as a therapist I have seen this pattern played out numerous times in astoundingly creative ways. Ultimately we want to be healed. We often don’t really know the ways we have been hurt, having grown in in the only environment we knew. As the expression goes, the fish does not notice the water. But as an adult we can take stock and look back to evaluate “what was missing?” Which of these 5 A’s do we need to work on in our adult life? And how can we do that? Richo would seem to answer that we can do that through a spiritual practice as well as our love relationships. Being a psychotherapist I try not to advise on spiritual matters! But I can absolutely endorse the idea that not only can your primary relationship heal these wounds but you will TRY to set things up to work them out whether you realize it or not. I would argue it behooves all of us to figure out our wounds and/or areas of neglect so that we can look for how we are re-creating them in our current romantic partnerships. All in all I think that Richo has some great wisdom in his book. I would encourage anyone interested in creating more healthy patterns in their love lives to take a look at it. While it is clear that he is devoted to mindfulness as a discipline and drinks deeply from that well, his ideas are useful even if you don’t ascribe to the eastern-philosophy threads that run throughout. As always wishing you health and happiness in your connection to others-- Dr. Jordan  Okay the truth is a you can't really "read" this and I listened to it over a year ago. But I should have posted about it then so I am trying to make up for that now. This is Dr. Stan Tatkin's masterful audio program explaining the Psychobiological Approach to Couples Therapy, or PACT. I have been using this approach with couples for the past 6 years and cannot offer enough endorsement of it's principles and techniques. PACT has helped me help countless couples of all races, religions, sexual orientations, economic classes and with every problem you could imagine. The best explanation I can give about PACT is that it addresses the "bios" level of programming (patterns) in our hard-drives (brains) so that everything we do in relationships runs more smoothly. For those of you who are technophobic (which I am but I just happen to have had the "bios" thingy explained to me once), the bios level of your computer is the level you are almost never aware of. It is operating all the time in the background, quietly running the show. If it gets messed up though, look out. None of your other programs will run. The whole computer will seize up. So that's the level that you need to make sure is running smoothly or else the rest of it doesn't even matter. PACT hits the bios level.
A couple I finished working with not too long ago proved by "bios" theory beautifully. They came in one day and said "we've been thinking it might be time to stop seeing you regularly". They went on to say that they both looked at the lists that they had made before seeking me out. These lists were the things that they both wanted to see change in the relationship. The amazing thing to me was that now they said "we looked at the lists and realized that all of those things are either fixed or no longer important to us but we don't remember discussing them in here with you!". Ah, bios. See, we fixed the deeper problems that were quietly running their relationship amok but that they did not know were there. They were so stuck on fixing the "I hate it when you don't do your share of housework" programs/patterns that they did not realize that there was a deeper level that was driving the rest of the mess. When we worked on that everything else miraculously (or really not so miraculously!) shifted. The rest of the stuff either got fixed without my help or they no longer cared about it because they were so thrilled about the rest of the relationship that those things seemed trivial now. To me, that's the elegance of PACT. It gets right to the underlying issues without getting stuck in the daily "who left the cap off the dang toothpaste" stuff. It's surgical. Which makes is not only more effective but so much faster than other theories I have been exposed to. And as much as I love doing therapy, no one wants to be in therapy forever. So there you go. Buy it. Listen to it. If you are a therapist it will improve your work. If you are in a couple it will improve your relationship. If you aren't currently in a couple it will give you some great stuff to think about before you get into the next relationship. The whole download takes about 5 hours, which sounds like a lot but I found that if I just played it while I was driving back and forth to work each day that I had listened to the whole thing in less than a week. So don't let the length intimidate you. Also don't let the idea that it has some neuroscience intimidate you. As much as I love the brain that was NOT my best class in graduate school. Dr. Tatkin is gifted at making difficult stuff easy to understand so that even those of us who could not currently pass a high school chemistry class can still understand his work. I hope you give it a try. Cheers, Dr. Jordan  First let me say that this blog topic has been on my "to do" list for months. I keep putting it off, frankly, because it's complicated. Psychotherapy has been around formally for about 200 years. However scientific studies explaining exactly how therapy causes change have only been around for about 50 of those. Studies that are able to look inside the brain and show brain changes associated with psychotherapy have been around even less.
Furthermore there are a lot of really good articles on whether or not therapy works. See for instance Jonathan Shedler's article from the University of Colorado Denver School of Medicine entitled "The Efficacy of Psychodynamic Psychotherapy" published in the American Psychologist (2010, 65(2), 98–109). Schedler makes an impressive case for the fact that psychodynamic psychotherapies are very effective and that their effects persist for years after finishing treatment. However, his article, and many others that I have read do not explain HOW psychotherapy works. While I am prone to want to explain as much as possible through the physical sciences there are a number of theories that are worth exploring as well. So I will put off the neuroanatomy and biochemistry piece until the end of the blog. We'll get there but let's first look at some of the theories that make a lot of sense even without the functional MRI's to back them up. If you start with Freud you would find that surprisingly some of his ideas still make sense in terms of how therapy works. Freud believed that we repressed things that were too painful or triggering to manage on a conscious level. These could be aggressive feelings, love feelings, sexual feelings or any manner of things. He felt that urges were going to seek expression one way or another and that it was up to the person to try to find a socially and morally acceptable way to express these baser "drives". So for example a person with a high aggressive drive could become a professional football player (an acceptable "sublimation" of the drive) or could become a thug who goes around beating up people. Some people, for various reasons usually stemming from their early childhood experiences, may have trouble finding acceptable expressions for their not-so-nice drives. Those people might, in Freud's opinion, develop symptoms like panic attacks, bouts of depression, or even more bizarre neurological problems like sudden blindness. He felt that by helping the patient to reconnect to those baser drives and accept their existence, and then find a more appropriate form of expression, patients could be freed from their neurotic suffering. While a lot of what Freud believed now feels outdated and archaic, I agree with his central idea that when we cannot accept parts of ourselves and instead shove those into the unconscious realm we may develop painful symptoms that then lead us to therapy. Many of the different styles of therapy that came after Freud actually took pieces of his theory and modified them, indicating that at least some of what he postulated continues to be useful. One group of clinicians that I think do a good job of explaining how therapy works is the "(intensive) short-term dynamic psychotherapy" group, also called STDP or ISTDP. Authors in this area include Habib Davenloo (it's originator), David Malan, Robert Neborsky and Marian Solomon. This camp of therapists believe that therapy works in a very predictable (and thankfully replicable) way. First, they conceptualize emotional problems as stemming from fear of experiencing certain painful emotions. These tend to be anxiety, shame, guilt, pain, contempt and disgust. Due to our inability to tolerate these intensely negative feelings we respond in maladaptive ways. For example due to intense shame a person may hide aspects of themselves which leads to feelings of loneliness, disconnection and an intensifying of the shame. From the ISTDP perspective therapy works by helping the client to 1) recognize that they have defensive habits (such as attacking the self), 2) be motivated to change this defensive habit, 3) identify the feelings that are being avoided, 4) allow themselves to experience the avoided feelings within the therapy session (where it can be supported), 5) learn to express those feelings in more adaptive ways outside of the therapy sessions and 6) recognizing that by acting differently with others you have created a new identify for yourself that has replaced the defensive pattern with a more adaptive one. According to research in the Harvard Review of Psychiatry in 2012, is a highly effective type of therapy. For those of us who use psychodynamic theory in our practices ISTDP has many elements that are common to psychodynamic therapy in general. Indeed other studies have shown that psychodynamic psychotherapy is also a very effective form of treatment. Another theory about how psychotherapy works was highlighted in an article on time.com recently. The article discussed the idea of "narrative". Each of us has a story that we tell ourselves (and others) about our lives. When this story is incomplete or flawed in major ways it can interfere with our happiness. For example if our "narrative" is that we were lazy and never tried hard and that's why we quit college and have never achieved much that story could easily lead us to feel depressed and self-loathing. What if the real narrative was more like we had an undiagnosed learning disability, making it hard for us to learn in a traditional environment, causing us to fall behind due to lack of educational success? That narrative leaves much more room for healthy self-esteem and hope for the future. Some therapists believe that helping patients "rewrite" their narrative or life story in a way that is more balanced can lead to letting go of old pains, shame, guilt and negativity. I do think that this is often a component of successful psychotherapy and have seen this alone change people's lives in dramatic ways. OK now that we have considered some theories and research on technique we can move on to my beloved psychoneurobiology explanation. In an article published in 2011 in Psychiatric Times numerous brain changes were identified as related to psychotherapy. Some of those were similar to the effects of antidepressants but some were distinctly different. Some of the effects reported included changes in activity/metabolism in various areas of the brain (such as the medial frontal cortex or the hippocampus) while others showed changes in the chemical serotonin and it's transport within the brain. Finally more recent studies have looked at structural changes in individual neurons that are thought to be produced by learning. So while the results of various studies differ in terms of how or where the brain changes are taking place, the overall conclusion is that psychotherapy DOES change the brain chemically and anatomically, and that those changes are related to a reduction of symptoms in the therapy graduates. While there are other explanations of how therapy works I hope that these at least give you an overview of some of the more well-researched ones. As new research emerges I am sure I will be making updates to this particular blog for those of you who are interested in the underlying curative factors of this strange and powerful endeavor we call psychotherapy. Best wishes, Dr. Jordan  Shame, embarrassment and self-interest are powerful motivators. They can keep us from letting others truly know us. We tell ourselves that "what they don't know won't hurt them" or "it's not relevant" or "they wouldn't understand". But if you truly examine why you don't tell those close to you these difficult truths it usually comes down to the trifecta of secrecy: shame, embarrassment and self-interest. Why share? How harmful are these undisclosed bits of ourself? Isn't everyone entitled to their own private lives? In a recent post on the blog "Mirror of Intimacy", Alexandra Katehakis and Tom Bliss wrote of disclosure that "Keeping secrets from, or telling lies to, your partner can be an enormous burden that will ultimately get in the way of your sexual intimacy. A guilty conscience is not sexy, but making yourself vulnerable is". They went on to say that "Exposing your true self means facing your shortcomings and any accompanying shame you feel about your actions. Speaking the truth about things that make you feel bad about yourself can be scary or painful, but is essential if you want to build your relationship on honesty. Living a life of secrets and lies doesn't allow love and sexuality to flourish but, instead, suffocates them." Katehakis and Bliss recommend that we "Take time today to think about what an act of courage it would be for you to disclose any secrets and lies you're holding that separate you from your partner. Are you ready to face yourself and stand up as an adult? Keep current with your partner by banishing secrets and lies from your relationship, and experience what it's like to live in honesty every day." That's a tall order for many of us. Especially if you grew up in a dysfunctional family where secrets and lies were the norm. Many of us were taught that being vulnerable would be met with blame, punishment, shaming, teasing or attack. Certainly this would train us to keep anything difficult or potentially self-incriminating to ourselves. And to those of us who grew up in dysfunctional homes not only does this secrecy seem normal, it seem smart! Why make ourselves open to the slings and arrows of those around us? Haven't we suffered enough? If only that strategy worked. I often tell those who work with me that I am a huge pragmatist. I really am. I aspire to do what works because in the end I just want the desired result. If lying or keeping secrets or sequestering parts of ourselves away from our loved ones worked I would have no issue with it. If it did not ultimately cost us, if it did not ultimately lead to loneliness and damaged relationships, I would encourage it. Whatever road leads to health and happiness I am fully prepared to not only walk myself but lead others on. Unfortunately keeping secrets, lying (by omission or otherwise) and partitioning off parts of ourself so that no one knows the true us really doesn't work. It may serve to keep us safe in the moment, but ultimately it keeps us apart from those we yearn to be close to. It leaves us feeling that existential angst of "born alone, live alone, die alone". Which I firmly believe is NOT true! In fact, of all living organisms, humans are born to need others MORE, not less. We are inherently pack animals, desperately in need of connection to maintain our own mental and physical health. When I work with people on trying to deepen connection to others I am fond of explaining the concept of "laddering intimacy". Relationships deepen when each person reveals something to the other that represents an emotional risk. This prompts the other person to respond with their own escalating level of emotional risk. The process builds on itself, giving each person the feeling that they are being trusted with important information. This bonds people together. When we fail to disclose risky material to our partners or loved ones our relationships wither and become flat. We drift apart. We no longer have that feeling of being tightly bound together. What we do to protect ourselves ultimately cuts us off from the very relationships that we need to survive emotionally. I encourage you to take stock of your intimate relationships. How vulnerable have you made yourself? Are there parts of yourself that you keep hidden? Do you lie by omission? Keep secrets? Revise the truth? If so, what toll do you think it has taken on your relationships? Are you truly close? And what are you really afraid of? Many years ago while still in training a wise supervisor (Dr. Marc Rathbun) told me "marriage isn't about having fun, it's about growing up". I think those words are true for any deep relationship, not only marriage. I think that being close to someone is about growing up and realizing that we cannot continue to protect ourselves while expecting others to be vulnerable. We cannot be halfway invested and yet reap the full benefit of intimacy. Part of being an adult is moving past one's fear, past one's selfish desire to protect oneself at the expense of another. Withholding, lying and secrecy leaves the relationship inequitable. We hold cards the other doesn't. This is the currency of childhood, of a time when centeredness is the natural phase of our development. But it holds no place in adulthood and cannot lead to truly deep bonds with others. And circling back to my pragmatism, the good news is, if you practice disclosure and put all of your cards on the table, you will be rewarded with the same. In this way you create the intimacy we all need. The price, I would argue, is worth the benefit. Wishing you health, happiness and closeness with those you love, Dr. Jordan  You hear a lot of talk about boundaries. These mysterious dividing lines between ourselves and others that somehow, if properly maintained, keep us and our relationships healthy. But what are boundaries really? And how can one measure them? How do you know when they are "right"?
There is a great little book that a former supervisor introduced me to many years ago as a young clinician. It's How to Be and Adult by David Richo. This slim volume, only 122 pages, tells the straight story of what interferes with our ability to mature into well-grounded and autonomous humans. The chapter on boundaries is particularly useful. Richo says "Your personal boundaries protect the inner core of your identity and your right to choices". In other words, when you are not maintaining appropriate boundaries you start to lose who you truly are and your ability to feel that you have choices. This does not enhance relationships but instead breeds resentment as we feel ourselves losing ourselves and losing the sense of having options. We begin to feel manipulated by people and situations and naturally respond on some level, conscious or unconscious, with anger or despair. It brings to mind the old adage "good fences make good neighbors". Any of you who have read my blogs or worked with me knows that I am passionate about connection. I am not the sort of person who feels that we need to learn to be alone. I truly believe that humans are designed to be interconnected. But that does not mean a lack of boundaries. In fact, not having good boundaries is putting your relationships at risk. Conversely people who have good boundaries have a sense of mutuality that comes from appreciating that both people in the relationship have needs and that truly loving someone is honoring what is best from them while not sacrificing what is also best for yourself. As Richo says, they are able to "be in-touch and intact". When this process runs afoul you often see people trying to control or manipulate each other, or feeling that they must subjugate themselves to the needs of the other despite feeling over-run. When you "don't let go of what doesn't work" and it feels like "[you] can't let go of what could work" your boundaries are out of balance. "Co-dependency is unconditional love for someone else that has turned against the self". (Richo) Rico's book contains a clever list of symptoms of good versus not-so-good boundaries. I am not going to quote all of them here but have selected a few that I think are especially salient: Not Enough Boundaries Healthy Boundaries You feel unclear about your preferences You feel clear on preferences and act on that You are so focused on surviving that you You recognize when you are happy/unhappy often don't know how you are feeling You do more and more for less and less You do more when/if that gets you more You are satisfied if you are coping/surviving You are only satisfied if you are thriving You let other people's minimal improvement You are encouraged by sincere and ongoing improvement maintain your stalemate You act out of compliance and compromise You act out of agreement and negotiation You are enmeshed in a drama and it feels like You are always aware of your choices and feel free to act you have no control over how it unfolds based on them Healthy boundaries, like most relationship skills, are passed down from parents to their children. Many of us did not get blessed with the lessons of good boundaries. We either over-restrict and fail to allow others into our inner lives, fearing their influence and potential loss of autonomy, or we have permeable boundaries that fail to keep our authentic self safe and are too yielding to the needs of others. Therapy is a great way to work on boundaries and, like most skills in life (driving a car, baking a cake, etc.) they can be learned. If you notice that your boundaries could use some help I hope you consider therapy. I have seen it help many people lead happier, more comfortable and more fulfilled lives. Warm wishes, Dr. Jordan  We've all been there. Someone cuts you off in traffic, or your spouse pushes a particular button, or your child whines for just a few minutes too long and...wham! You have devolved into a stress-ball and can no longer stay calm and act rationally. You yell, or snipe, or attack, or shut down. In short, you have "flipped your lid". The "smart parts" of your brain have been hijacked by the emotional center and you now cannot access the higher areas of your brain that normally allow us to be rational and reasonable people.
As the "hand model" of the brain to the left illustrates, our brain is made up of lots of different parts. If your hand is clenched in a fist the fingers that are visible will represent your higher cortical areas such as the frontal lobe. This is, as I like to refer to it, the "Spock center". It's the part of the brain that can help us not intentionally ram the car in front of us when they cut us off in traffic. It helps us to inhibit responses and respond rationally and calmly. Sadly that part of the brain gets disconnected under high levels of stress. Yes, folks, just when we need it most our higher cortical areas literally go "off-line". So who is running the show at that point? You guessed it, our emotional center. The limbic system, represented in our hand model by the thumb, is now in charge. Which is why when we are highly triggered we tend to say and do things we regret later, when our higher cortical areas come back online and assess the damage. Under normal circumstance when we are not too stressed out our limbic system is still active and reacting but the cerebral cortex is "wrapped" around it (as in the illustration of the fist) so that it "hugs" the emotional center and keeps it relatively quiet. There are literally bundles of nerves that carry information from our frontal lobe to our limbic systems when things are running smoothly. This keeps us from killing people whenever we get slightly stressed out. Normally this system works well enough to keep most of us out of trouble most of the time. However, when the stress gets too high, those fibers stop carrying information from the cortex (as in the illustration with the hand extended upwards) and the limbic system has free reign. It's like letting your 3 year old drive the car on the freeway. Not such a good idea and we should not be surprised when there is a multi-car pile-up! So, what can one do in this situation? Well, here is what most of us try, which incidentally doesn't work: we try to talk rationally to the other person. We try to explain or rationalize or educate them out of their feelings. The problem here is that we are talking from our cerebral cortex and their cerebral cortex is not operational. So it can't hear us. And the limbic system doesn't speak that language. In fact it doesn't really understand language. It's much more influenced by things like tone and volume of voice, gestures and facial expressions. So if you can see that someone has flipped their lid, the best thing you can do is to show that person that you understand how they feel. This is creating a connection between your limbic system/emotional center and theirs. So if my friend is frustrated with me and I show her that I understand that feeling through my facial expressions, voice and gestures our brains are now connected. At that point I have the opportunity to influence her brain because we have an "open channel" between the two systems. So I can now start to offer calming words, sounds and gestures (such as smiling, gentle touching, quiet and low tones of voice) that will start to calm down her nervous system. As her limbic system begins to get more calm her cerebral cortex will come back on-line and now I can communicate with her logical brain from my logical brain. Notice that this strategy is about how to manage another person when they come unglued. That's because the fastest and most efficient way for a human brain to get calm is to use another human brain. If we have to calm ourselves it takes more oxygen and glucose (the power sources for our brains) so it's more resource-intense. We can, of course, calm ourselves if we have to. Other people are not always available. But the optimal way to handle a flipped lid is to have another person who can connect to our brains and calm us down. Humans are, after all, pack animals and we derive numerous benefits from living in groups. So next time you flip your lid, or observe one of your pack flip theirs, remember to get the emotional connection established FIRST and then, only after the emotional intensity has dissipated, try to connect to the logical parts. For more information on interpersonal neurobiology and the science of our connection to others see the work of Dan Siegel, MD, and Stan Tatkin, PsyD. Or stay tuned for more blog posts on this website. Warm wishes, Dr. Jordan |
Krista Jordan, Ph.D.Dr. Jordan has been in private practice for 20 years in Texas. She is passionate about helping people to overcome hurts and obstacles from their past to find more happiness and health in their current lives. Archives
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