Being your own therapist or coach
Fire me (Or partner with me)
: Build your own mental wellbeing
(Author's note: 1. This is not intended as psychological consultation or a replacement for therapy. 2. This particular blog post is a work in progress. I will be back with more links and resources, but wanted to make the content available in its current form in the interest of time. 3. If you feel like you are having a psych emergency -- particularly if you are having thoughts of harming yourself or someone else, call 911 or go to the nearest hospital emergency room)
The crisis state of mental health has led to a national shortage of access to psychotherapy. Those who have the financial means and flexibility of schedule are able to access therapy, but many are left unhelped, struggling with their distress and impairment of functioning, which in turn makes it harder to keep up the momentum of pursuing mental wellbeing for themselves and their families.
Even before the current crisis, a market has began to emerge for brief therapies, a raft of cell phone apps, self help and support groups, and the like. There’s nothing wrong with that, if it works for you. And if you are in therapy, doing part of the work yourself helps you live better, sooner – and that is important. The more of life you live at improved functioning levels and with less distress is related to how you care for your mental wellbeing.
Whether you want to go it on your own, or move your work with a therapist ahead more quickly or deeply, you are in charge of yourself. And there are some specific things you can do to take charge effectively.
A big part of that pursuit of living well – whether in your individual quest, or with a therapist is engaging distortions in thoughts, and ineffective or destructive behavior which stems from distorted beliefs and negative habits of thought and being, and overwhelming feelings which we believe ourselves to be at the mercy of.
A recipe for my model of self assessment, which is one path to mental wellbeing, is at the bottom of this blog post, but you’ll need some background first. First, we have to have an agreed definition of the purposes of therapy and self-analysis. For our purposes, we will say that therapy has the goals of
Reducing distress,
Improving functioning – removing impairments and/or realizing potential, and
Living authentically in self-acceptance and self-awareness Background
By using therapeutic tools to develop our own capacities and skills for observing ourselves neutrally and accurately in situations, and evaluating how we want to respond that is in our best self-interest, we improve our lives, relationships, and outcomes.
Let’s take a slightly deeper dive on each of these aspects of self assessment.
Thought Distortions: Thought distortions are mistaken beliefs or ideas which become an integral part of our way of understanding ourselves, the world, relationships, and feelings. All of us have some thought distortions, most of which come from a primitive part of the brain called the amygdala. There are particular categories of thought distortions including catastrophizing (imagining it to be worse than it is), generalizing (assuming that one bad thing means that everything is bad), and personalization ( “It’s about me.. Or this is happening because I’m unlucky or because ‘they’ don’t like me.”)
You aren’t alone. Our habits of thought and underlying beliefs are part of the uniqueness that makes us who we are.
One thought distortion is that we are ‘smaller”, less capable than we actually are. Another is general negativityˆbias, which makes us less optimistic than is realistic or helpful. These two biases have the impact of making us less likely to take positive, calculated risks and less able to enjoy positive results when we achieve them because we chalk it up to not being an actual victory, but an anomaly which will soon correct itself via some negative consequences.
A patient reported to me that she felt devastated because a coworker had publicly, sarcastically suggested that she has a pervasive habit of pointing out what people are doing wrong. She worried that the relationship with this coworker, and other coworkers was poisoned by this perception – that they must not like her, and that she’d be best-off looking for another job where she could start with a clean slate. She might have done that, and who knows with what results.
Instead she brought the concern into therapy, and was very upset about it, short of breath and tearful. Some of the underlying assumptions she was making included:
That the statement was both true of her (she felt bad about it), and that other people shared disdain of her as a result.
That the person who said that intended it to hurt her and push her away
That it is imperative that (all) coworkers like her
That If people don’t like one thing about you, they don’t like you in general
That one example of a behavior causes all people to come to a pervasive negative conclusion that overall.you are a certain kind of person
When the patient evaluated the first belief – that it’s true that she often tells people they are doing something wrong, she was able to identify many examples where that was true. She related that her social media posts were often about what people were doing wrong politically, how they had the “wrong” attitudes, and were being reckless and selfish about responding to COVID. Interestingly, acknowledging that the belief was true made her feel better because she could look at it with neutral, benign curiosity instead of judging herself negatively about it. Upon reflection, she decided that this pattern of behavior generally made her feel worse, and that it was something she wanted to, and could change – not for anyone else’s benefit, but rather because it wasn’t producing the results she wanted. Her critique wasn’t changing anyone else’s beliefs or behavior, and was alienating people, and possibly galvanizing those beliefs and behaviors she felt were wrong. She realized that it wasn’t in her long term self interest to be so critical of others, even if it felt satisfying sometimes in the moment.
The patient looked at the second belief – that her coworker made the observation to be hurtful. She concluded based on the evidence that she and the coworker had enjoyed a long friendship, and that the coworker has a tendency toward friendly joshing in a sarcastic manner, that he may not have meant it to hurt her, but ultimately decided that his motivation of the moment needn’t be so important to her – it was just a few words which came out at a particular moment, and didn’t merit much of her energy and attention. She also decided that the evidence of her many friends and good relationships negated the idea that people don’t like her, and that even if people don’t like everything about her, they can still find enough to like about her that relationships stay intact. She reflected on some relationships she maintains where a friend has a characteristic she doesn’t care for, but that she still likes them overall. On further reflection, she evaluated that it is unlikely and also unnecessary to be liked by everyone.
She felt much calmer and behaviorally, eased back into normal friendly relationships at work, and didn’t feel any further need to leave. She would leave only if/when it suited her desire for career and personal growth.
Ineffective behavior: Emotional intelligence in large measure is the ability to perceive, manage, and evaluate situations and emotions, and make strategic decisions about how to behave (that is, choose behaviors that lead to the results we want, rather than responding impulsively). This method of self assessment teaches us to use emotions for our own benefit, taking the information they convey, using it to make decisions and motivating us to take effective actions.
If you’ve heard people say, “I felt so _________ that I had no choice but to _______,” they are recounting an example of ineffective behavior where, because of beliefs, skills, habits, and pain tolerance, they behaved in a way that either avoided short term pain or provided short term satisfaction, and sacrificed long term wellbeing. Examples of this include impulsively breaking off a generally good long term relationship because of an interpersonal disappointment which resonated symbolically with an earlier painful experience or frustrating dynamic, or not trying things that there is a reasonable chance of achieving, and which would be of benefit, for fear of being humiliated by not succeeding
Overwhelming feelings: in brief, emotions are made up of two components: A thought (or cognition) in psychological terms, and a physical feeling or sensation in the body that can be characterized by its intensity, duration, quality, location, and size. A habitual fear of the physical experience of pain or agitation leads us to avoid or escape those feelings in ways that are unnecessarily self-limiting, undermining, harmful, or hurtful to others, and/or wasteful of time, energy, and resources:
One obvious example of a maladaptive response to overwhelming physical feelings is substance abuse, but other examples include avoiding social situations to avoid the discomfort of agitation, or acting hostile toward others when feeling vulnerable.
Do these aspects of growth and change seem to overlap? That’s because they correspond to what I like to call the three pillars of psychological growth and change: New insight, new behavior, and new experience. Like a three legged stool needs all three legs in order to be stable and useful, psychological growth and change requires all three of these. The order in which they arise isn’t important – new experience can lead to new insight and/or new behavior, for example, just as new insight can encourage curiosity about trying new behavior and being open to new experience.
To Self Assess (Here is the recipe)
First, cultivate the habit and skill of observing yourself accurately and compassionately in situations. This capacity is arguably the most important foundational element for ongoing psychological growth and development, and ability to reduce neurosis, barriers to functioning, and distress. This is validated in Neff’s Self Compassion and other work, as well as Goleman’s Emotional Intelligence.
How do we get this capacity for high quality self-observation? Its foundations are in very early childhood development as the nascent brain receives empathy from caregivers. Even before an infant begins to perceive itself as a separate entity from its caregivers, it begins to get a sense of who it is and what is happening when, ideally, caregivers provide first experiences of empathy reflected in parents’ adoring and fascinated gaze when holding the infant, which says, “Unconditionally, You are the most wonderful and fascinating thing in the world.” When the baby cries, and the caregiver, again ideally, makes sympathetic/empathetic and soothing noises in response to the baby’s distress, the baby begins to recognize that it is having an experience which can be observed with compassion and understanding, and that it’s possible to internalize that care as internal self-soothing.
Throughout development, children get messages about their own inherent, versus conditional goodness, which become internalized. Consider the difference in what a child learns about itself when they hear, “You are such a star on the soccer team and I was so proud when you scored two goals!,” versus, “I love watching you play!” The former, less compassionate, and more conditional conveys esteem in response to an achievement or production, the latter conveys genuine fascination with the child’s experience and development without regard for what the child produces.
Such empathy can’t be perfect, and nobody comes of age without a few psychological bumps, scrapes, and bruises, but if they did, when faced with most emotional experiences, they would perceive it with the posture of compassionate, benevolent interest, rather than becoming overly emotional or needing any means of escaping their own feelings. But the good news is that we don’t just get empathy needs fulfilled from parents and caregivers – we can cultivate mature relationships where we receive and give empathy, and we can fill our own empathy needs through practicing benevolent fascination with ourselves.
Benevolent fascination
It’s my clinical observation that it is possible to enhance this capacity by practicing noticing our agitated states and the situations that precipitate them, responding to them with the practiced self talk, “Isn’t that interesting about me?” with a self-talk tone of compassion and earnest curiosity and interest, similar to a reassuring, benevolent caregiver’s stance.
Just from practicing this simple self-talk approach, in my observation with many patients, has the effect of redirecting away from unproductive and undermining self-criticism, seizing upon behavioral and relational learning opportunities, and .making room for strategic response to situations which might otherwise cause distress and damage. Applying the technique is simultaneously disarmingly simple, and challenging.
Deepening the inquiry:
New Insight: Once the therapeutic “team” of the patient and therapist – or the patient on his or her own – develop the stance and habit of benevolent fascination with everything about the patient, there are some refinements which can deepen the inquiry. The first is asking a followup question to identify patterns, traits, habits of thought, and temperament which are descriptive of who the patient is, phenomenologically. (That is, who is this person who is having these thoughts and feelings and manifesting this behavior?) That question is, “What are you saying about yourself?”
At this point in self assessment, it is useful for the patient to start journaling about what he/she is learning about him/herself.
Wrapping up a discussion about conflict in her relationship, a patient said to me in passing, “Relationships are all about a contest for dominance, followed by a pattern of one partner controlling, and the other submitting, don’t you think?” I was a bit surprised and resisted my impulse to “correct” her, which would have been less effective, and instead said, “I think it’s more important in our work to look at what you think than what I think, but I do think it’s notable that you have that idea.” Prompting her, I said, “Isn’t that interesting….”
She said she’d never questioned that as a premise, and had always considered it to be empirical truth, but that she supposed that it wasn’t necessarily a foregone conclusion about all relationships. I then gave her the next prompt, “By stating this belief, what are you telling us about yourself?” Her expression clouded a bit, and she began to say some negative things about herself, such as, “I guess I must not be very pleasant to be in a relationship with,” and “You must think I’m a pain in the…”
I encouraged her to stay in benevolent curiosity about herself rather than making negative assumptions about how other people felt or criticizing herself. More objectively, she was able to say that she does struggle with control in relationships, in that she wonders whether people who are important to her genuinely like her, and that her overall relationships tend to be more tense and high conflict than she would like. She noted that she spends a lot of time thinking about what she “should have said” to stand up for herself in situations where she felt like someone insulted her, took advantage of her, or took her for granted, and that this pattern of thinking makes it hard for her to relax and have fun. I asked her to think outside our session what she might do to use the energy that she saved by not thinking and struggling this way.
Additional useful open-ended probing questions include, “Is there evidence to support the underlying assumption I’m making here?” and “What about evidence to support a different (perhaps more positive) thought?”
Event or situation which troubles you___________________
Your thoughts, feelings, and actions in response___________________
Stance: Isn’t that interesting?!
What are my assumptions/beliefs about that?_____________________
What evidence supports my belief?__________________
What evidence would support a different, more positive belief?__________
What does my pattern of belief about this say about me?______________
How does this pattern of belief both benefit and harm me?__________________
How would I, my life, the situation be different if I had a different belief?____________
Where did these ideas come from?___________
Is that a source I believe?_________________-
Does this habit of thought show up in other settings? ____________
Summarizing the responses to the above provides one component of healthy psychological growth: Insight or New Understanding. For that to be useful in our goals of improving functioning and reducing distress, insight must be accompanied by new behavior and new insight.
New Behavior: Unfortunately, it’s usually not as simple as saying, “Okay – now I understand it differently, so I’m going to act accordingly.” Whatever was the troubling situation that got us started on our assessment is probably anxiety laden, and intimidating to change. So we look for ways of changing behavior in a way that is more primed for success. This starts with the analysis question, “Where else does this pattern show up?
One approach we can try to jump-start behavior change is to peruse the list of where the pattern shows up, and pick one that has less emotional charge, and try the behavioral change there, while keeping alert for what we changed, what our concerns were, and what about the results was different.
Mariana, a 40-ish female patient I worked with in therapy around her feelings about her weight was criticized and berated by her father about her size, among other things, and it led to her being unhappy in a range of ways including feeling insecure about her attractiveness and generally unconfident, in spite of being a lovely and accomplished woman with a good marriage and three beautiful children. Her father had divorced her mother in a very humiliating and dismissive way, and was a bully in general in his relationships. As the patient talked about how she was impaired in her ability to enjoy aspects of her life and feel good about herself, and recounted instances of her father undermining her or being cruel to her, I found myself getting angry on her behalf, but she wasn’t angry at all. I inquired, “How come I’m angry about this and you’re not?” She said she believed there was nothing to be angry about. She could call her father’s behavior, “mean,” and had no illusions the way he treated her was loving or well-intended. She could even say that he was manipulating by putting people down– including her – as a way of maintaining a dynamic where he was top dog. But no: No anger.
When we dissected the connection between messages she received about herself from her father, and the disconnect about her lack of feelings of anger about the lifetime impact of those, she decided it was important to take steps to stop subjecting herself to those messages. But there was no way she was going to start with a full-on confrontation with her father. She was afraid of him, although there was really nothing he could do to her and she wasn’t dependent on him in any material way, and she also believed she couldn’t “win” – that an attempt to confront him would end up in humiliation and tears (as it had during her youth), and also jeopardize all the relationships in the family, which she thought would be selfish.
Mariana started to imagine little, oblique confrontations with her mother over her treatment of her mother, and her undermining her authority with her daughters. Even these, where she felt like she was confident of her clear “moral ground” felt too dangerous in that she still worried about having the whole family turn against her, or that her mother would humiliate her and reduce her to tears, leaving her feeling crushed.
At a family Thanksgiving dinner, Mariana's sister Margo, who had lost quite a bit of weight (all the women in the family struggled with weight, understandably given the context) by using a combination of drastic and unhealthy methods made a display of giving away her now-unneeded larger-size clothes to Lily. (“Here, hon– Mama’s little girl (Margo) won’t be needing these anymore, but they’ll look so pretty on you.”) Mariana's mother beamed approval at Margo.
Fighting back tears, Mariana excused herself to the kitchen and waited there for one of her sisters to come looking for her. It was Margo who came, and Mariana , in a calm voice said to her, “You know that was hurtful. You knew it before you did it, and you made a choice to do it anyway. It was hostile, and you were deliberately hitting me in what you know is a weak spot, and you did it for the sake of winning Mama’s approval over your sisters.” Margo couldn’t deny it. Everything Mariana said was true, and he tearfully admitted as much.
Mariana didn’t understand at first why she felt so much better, but when we debriefed it in therapy (“Where else does this dynamic show up?”), she was immediately able to say that what her sister did to her completely replicated the dynamic with her Mother: Humiliating her, pretending to do something kind and generous, and manipulating for power within the family. And Mariana had successfully confronted her!
Mariana planned to confront her mother, and we rehearsed what she might say over the course of a couple sessions in preparation for an impending visit by her mother to her home. When they were alone, Mariana asked her mother to sit down to talk about something that had been on her mind. Her mother said she had something to discuss too – and asked to go first. She told Mariana she’d been diagnosed with a serious, possibly life threatening illness, and said she hadn’t told anyone else in the family – only Mariana, and asked her to keep it a strict secret. She felt she couldn’t confront her mother then– she’d been thrown a curve she wasn’t ready for, which played into the family belief that it would be petty and selfish to bring up such a thing when something much more serious had been shared with her.
Over the coming weeks, there was no talk of the illness, and her mother played tennis, worked, and lived her life as usual. She showed no sign of being sick or weakened in any way.
I thought Mariana might have felt defeated again, but when I asked, she laughed a more mirthful and open laugh than I'd seen from her to date, and said, “Hell no!’ (This was a shock because she had a personal prohibition against profanity.) I said, “Well – isn’t that interesting?” Mariana explained, “Yes it is. It certainly is. I don’t think she’s actually sick. I think she knew what I was going to say, and thought she’d prevent me from confronting her, as she’s skillfully done so many times. But actually, I WON! Now she can’t say anything about my weight, can’t put me down because she painted herself into a corner with this little trick. And she hasn’t. Not a peep. I didn’t actually have to confront her – just had to be willing to. She did the job for me.”
She added, "I actually feel okay about my weight. I'm not skinny, but I'm healthy, strong, and my husband loves me this way. I'd been trying to talk myself into thinking this way, but suddenly, It's not just talk. I actually feel it."
So the new behavior was practicing on an easier scenario – confronting her sister, and being willing to stand up for herself with her Mother. This was a level of challenge she was ready for, and she gained the new experience of being in charge of herself and not subject to being undermined by other people. It was the beginning of a bolder, better habit of thought and behavior for her.
Another lens: One thing a therapist offers is multiple models or lenses through which to understand us, our thoughts and feelings, our behaviors, and our patterns. Another tool you can use – not like a therapist, but you can use it is based on a therapeutic assessment technique that comes from Object Relations (https://www.simplypsychology.org/Melanie-Klein.html) theory and practice, and has been boiled down to a simpler way of looking at yourself in relationship to others. A product of the assessment is identification of a cyclical maladaptive pattern, which when identified and made conscious provides a foundation for insight, and motivation to try different behavioral approaches.
In Hannah Levenson’s Psychotherapy in a new key: Time Limited Dynamic Psychotherapy, and also in Strupp and Binder’s research, the assessment focuses on understanding of patterns of relationship between the patient and others
Acts of the self toward others
Acts of the self toward self
Acts of others toward self
Expectations of acts toward self
To benefit from this model, one thing you can do is to simply live your life asking yourself the questions,
What did I do toward another person or people? (Broadly, for example, did I Cooperate? Compete? Assert? Submit? Resist? Shut down? etc.)
How did I treat myself? (Broadly, what status did I take? Was I cautious or risk-taking? DId I value myself? Did I undermine myself or my communication, etc?)
What is my narrative about how others treated me? (For example, did they include me? Help me? Act aggressively toward me? Act seductive? Manipulate?)
How did I expect others to treat me? (Such as, did I expect them to be kind? Friendly? Inclusive?)
You can deepen your use of this lens by journaling a paragraph or two, briefly telling a story of something upsetting from the day, perhaps a situation you would like to change or handle differently, then translate your story into these categories. Then when you’ve accumulated a few examples, see what categories emerge.
Here is an example and format:
Narrative: Mama was visiting, and seated around the dinner table, we had just finished saying Grace. It was a nice moment, and I felt proud and happy about having my family together. I was feeling especially proud of my daughters, the older of whom had been accepted at her first, second, and third choices of universities for next year. I was also feeling grateful and happy for our home and proud of my own recent academic achievements. As we started serving our plates, my eldest daughter asked Mama to pass the mashed potatoes. I winced, anticipating how he would respond, and predictably, instead of just passing them, he asked her, “Do you really think you should be eating these empty calories? You know that your genetics are working against you, and really I don’t know why these are even on the table.” I was furious, and thoughts flooded my brain: How dare he usurp me as the authority of what my kids can eat? He probably thinks he should speak up because he doesn’t respect my judgment. How is she going to feel about her body (which is strong and healthy) if he is fat-shaming her at this stage? I should stand up for her, and I’m letting her down by sitting silently. I felt tears forming behind my eyes, and felt disgusted with myself for feeling so frozen. Why isn’t my husband saying anything? Boy do I feel like just telling Mama to get out! What must he think of me – my daughter isn’t the least bit overweight. I was looking forward to having some potatoes, but guess I won’t. Mama goes to bed early – I’ll leave the dessert in the kitchen until he’s asleep and then bring out plates for myself and the girls and my husband and he’ll never know. The tension was broken for a moment when my husband reached across the table and handed the potatoes to my daughter, who thanked him, avoiding eye contact with her grandmothr. But I knew somehow the other shoe would drop, and Mama would end up victorious, and I would be defeated again. |
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Acts of Self Toward others | Acts of Self toward Self | Acts of others toward self | Expectations of acts toward self |
Prepared a nice dinner for them. Passively accepted aggression and lower status Hid dessert plans | Allowed my joy to be essentially stolen
Fought back tears
Censored myself | Theme of domination and subordination Invasiveness in relationship between me and daughters, undermining my role | Expectation of continued pattern of bullying Expectation that nobody will help. -- "I'm on my own in this" |
New Experience: Getting better results because of differently understanding ourselves, our thoughts and feelings, our relationships, and the situations we are in, motivates us to keep learning more, confirms positive and accurate new cognitions and beliefs, and habituates more functional behavior, creating a virtuous self-reinforcing cycle of improvement. And -- it is fun and exciting!
Caveats: 1. There is nothing wrong with asking for help. In fact, asking for help and not expecting that you can do everything on your own is an act of courage and strength. 2. Another person, especially if trained, may see distortions you don’t. In the same way that fish can’t describe water because it surrounds the fish and is part of context the fish lives in from birth, it can be harder for us to notice what is unique about situations and our responses to them, and easier for someone who doesn’t live in that context with us; 3. Self-discovery should be at least partly fun and exciting. Content can be painful and intimidating, though it probably won't ALL be; and 4. It takes discipline to keep going, and can help to have support and accountability. 5. Therapists go through years of training and supervision, and most view psychology as a lifelong study – always learning new techniques and models, and continuously improving. They have quick access to lots of resources that you’d have to go looking for by trial and error. 6. A skilled therapist can also use the relationship between the two of you to identify patterns, thoughts, and behaviors in vivo, which can be a very powerful learning tool. 7. Simply, it can be fun and gratifying to share the victories, growth, and learnings with someone who has been with you for the whole journey.