“You’re already living your life. You may as well be here.” (unknown source)

16 Nov


Lately I’ve been thinking and talking a lot about what it means to be present and mindful. Mindfulness practices can be extremely helpful at reducing distress and improving impulse control. People tend to believe everything they think without realizing that thoughts are not the truth and aren’t permanent. With awareness, we can increase control over our thoughts and decide what stories we want to follow and when. For example, as a human race we are more prone to notice the negative and therefore may not recognize the absence of distress. Will Kabat Zinn said, “Patterns of thought can feel like a prison. With awareness, it’s a hologram. You can walk right through. Thoughts have no substance. When you’re not entangled in thoughts, they don’t have power. They are still there, but without suffering.” If you don’t know that you are having thoughts, you cannot decide how to interact with them. For example, if you are feeling depressed or anxious, it may be due to self-critical thoughts that are engaging in a running commentary in your head. Once you begin to notice these thoughts, you can start having a conversation with them and decide how to proceed.
Awareness can also help us to act more carefully and therefore may result in the reduction of negative situations. Learning to be aware of thoughts can allow us time to decide how we want to respond. I once heard a meditation teacher say that we are often “reaction slaves”, but that we can gain mastery over our reactions. Just because we have an itch, doesn’t mean we have to scratch it. If we don’t know what’s happening in our minds, we are a slave to both our thoughts and behaviors.
Being present is not only helpful at reducing negative thoughts and increasing stress tolerance, but it also improves enjoyment. When you are present while doing something enjoyable, you will get much more satisfaction out of the activity if you are paying attention. Being present may also improve neutral experiences because you are more aware of details that otherwise might have gone unnoticed. Think of it like traveling in a new country. I know that when I travel, I am generally very excited, curious and super aware of everything happening around me. This is similar to young children who are experiencing everything for the first time and are therefore extremely present. While traveling I have had some of the most fulfilling times in my life, but I don’t think it has to be limited to going to new places. If we stopped taking things for granted and paid more attention to each moment of our lives, enjoyment would skyrocket. But don’t take my word for it. Next time you eat something pleasant, really take your time to enjoy every flavor, texture, sound and detail of the experience as if it were the first time you were seeing/eating this object. Instead of engaging in many activities at once or listening to a story in your mind, just focus on eating and see if this is more satisfying.
Despite my encouragement to be more present, it is also important not to attach to these enjoyable experiences and to recognize that everything is temporary. In Buddhist psychology, it is explained that people have a tendency to grasp onto good feelings, ignore the neutral and resist the negative. Although understandable, these behaviors lead to increased suffering. Of course the good times must end, so attempting to hold onto them will only lead to frustration, disappointment and many other negative feelings. If we ignore the neutral, we miss out since so much of life takes place in this category. Constantly seeking out the extremely pleasant leads to inevitable disappointment. Often people are so averse to the possibility that something might go wrong, that they avoid taking risks. People may even cling to the negative because they have gained comfort with the known, or lack hope that it will ever end and don’t want to be disappointed if they try to escape and don’t succeed. This aversion or clinging comes from a lack of acceptance and awareness that every experience is temporary. At a meditation retreat I went to, one of the teachers said “we are held captive by our preferences”. We cannot control many things in life, and so learning to tolerate and accept this lack of control is extremely valuable. This doesn’t mean that we shouldn’t have preferences, but when stressful situations arise, we will suffer much less if we’ve learned to tolerate what is out of our power and recognize that it won’t last.


(Update) and Anxiety: Friend or Foe?

23 Sep

Update: Hello again. I’m back! I apologize for the long lapse in entries, and I welcome my new followers. I have been working on getting a full-time private practice established. I am thrilled to say that I now see clients four days a week in my Oakland office. I have also begun to supervise other therapists which is an exciting addition and complement to my direct- practice work. I hope to be writing entries more often, and will be sharing quotes and articles that I find interesting. I hope you enjoy what’s to come!

Anxiety: Friend or Foe?

Lately I’ve been noticing a theme in which many people suffering from anxiety do not really want to let it go. You may ask why anyone would want to continue dealing with the litany of distressing thoughts and panic-like sensations in their bodies for a moment longer than necessary. Well the truth is that sometimes worry convinces people that it is helpful. To understand why anxiety is so challenging to let go, it may be useful to explore possible causes of it’s existence.

Anxiety often develops based on distress.  For example, experiencing a car accident or a break-in likely will cause someone to fear recurrence. Someone who was in an abusive relationship might worry about being attacked again. This is our way of being emotionally prepared to handle what we might not have been previously. Anxiety can also be passed down from generations. Having an anxious parent predisposes you to develop this issue. Additionally, we all have a “negativity bias” as a means of protection and survival. When our brains were being formed back in the beginnings of human evolution, they developed in such a way as to be cued into possible risks. We needed to be prepared and possibly hypervigilant about any dangers in our way. Our current biology still works this way, although we are unlikely to find a tiger waiting to pounce on us or any of the other dangers from primitive times. Of course, we still deal with dangerous situations frequently (some more than others). Yet it is likely that our ways of worrying won’t prevent bad things from happening.

Anxiety is a completely natural response to suffering (especially due to our brain chemistry), and it can seem very useful. Anxiety may cause us to think we’re prepared to handle stressful situations. We may feel more at-ease by constant alertness. In some case, being on guard is necessary for survival. For example, a woman in a violent relationship may need to be alert to any signs of potential violence from her partner. Anxiety may help people to avoid other emotions. To be anxious takes an extremely high amount of energy. Without expending that energy and attention on fears, other feelings may arise. So for some people, anxiety helps with emotional survival when dealing with other feelings would be more challenging or unsafe. Worry can become part of our identities and imagining ourselves without it can be uncomfortable and confusing. It may help guide our decisions and expectations, and many other aspects of life.

Yet generally, worry does not help in the long-term and in most situations it is unnecessary. I don’t have to tell you that worry is unpleasant and makes life more challenging. That being said, it is a difficult and gradual process to reduce anxiety. Beating yourself up about your worry is never helpful! Most people have worried about something at some point in their lives. And as I said earlier, in certain situations being on-guard may have been necessary. So my first suggestion is to honor yourself for figuring out how to get through the tough situations you’ve had to deal with in the past. Notice any benefits to your worry and thank it for the ways in which it has been useful.

Next, imagine what your life would be like without your anxiety. That may be a completely scary thought, and if so, you are not alone. It might not be the time to let it go. If you are not sure about your readiness to let it go, try thinking about the ways in which anxiety is bringing you down. Imagine how you might feel if anxiety were replaced with taking precautions to keep yourself safe. Taking precautions in case of dangers like car accidents and break-ins can be very useful. Being aware of possible signs of unhealthy relationships can help you to make better decisions for yourself. But constantly worrying about these types of issues can cause you to make poor choices like avoiding situations all-together. Anxiety can severely limit one’s life, whereas reflecting and taking precautions will likely get more useful results. Chances are that even if you decide you’re ready to work on letting go of anxiety, it may try to fight for it’s presence in all sorts of ways. Therefore, finding a therapist and/or other supportive people, and engaging in anxiety-reducing techniques makes the challenge more possible. There are many ways to reduce anxiety, but first you need to be willing to say goodbye to an old frenemy.

No right way to grieve

10 Jun

grieving_processDeath and its impact on survivors has been very present in my work lately. It has left me feeling humbled, and slightly incompetent. As someone who is lucky enough to not yet have lost someone close to me, I feel that I am unable to truly relate to those grieving the death of a loved one. Although as a therapist I cannot have experienced everything my clients have, this issue seems like something one has to go through in order to really comprehend what it’s like. Fellow therapists, maybe you have some thoughts on this subject. Despite my limitations, I respond compassionately and I try my best to help people process their loss in whatever way works for them.

I will share some of the responses I’ve witnessed in the hope that those who are grieving may feel less alone, and those who wish to help may have an increased understanding of how to do so. Keep in mind that death not only affects people who knew the deceased, but may impact others who hear about a death. I have noticed that this type of reaction may actually offend people who were close to the deceased, as their reactions may be considered an insincere way to get attention or to feel connected to others. Although this is a possibility, vicarious trauma is a very real experience. Vicarious trauma can occur when you witness others who are suffering. It frequently occurs when people see images or hear vivid reports of death and dying on the news. When the deceased is only one person removed, vicarious trauma may be even stronger. In fact, my recent reaction to a colleague’s sudden loss surprised me. Although I did not know the person who died, I became very emotional and preoccupied upon hearing the news. I am still trying to make sense of this reaction.

Responses to death and dying often differ based on the circumstances. Although we have no control over whether someone dies quickly or not, it seems like people often have an opinion as to which type of death would be easier to handle. Some people wish that their loved one wouldn’t have died so suddenly, and others wish that the death of their friend or family member would’ve been less gradual. Initial reactions to sudden death are often shock and denial. People may feel a sense of being out of control when they suddenly realize how quickly life can be taken away from them while engaging in everyday routines. People may search for someone or something to blame so as to feel more in control over their own mortality. Losing someone quickly seems to evoke feelings of regret at not saying something or of having said or done something hurtful. Denial and disbelief are often present as our minds try to comprehend how someone could no longer exist when just moments before they were very much alive. With gradual death, the anticipation can be the most difficult piece. Some people feel a sense of guilt due to wishing the death would just happen already so that they can move on and return to a sense of normalcy. Since there is more time to interact with the person who is dying, there is sometimes pressure to say or do something extraordinary.

People have varying ways of grieving. Some have reported a strong desire to be alone, and others only want to be around those who knew the deceased. It may be helpful to reminisce about the positive experiences one had with the deceased. People may find it useful to process the details surrounding the death by replaying it over and over until it begins to make sense. Others need to distract themselves and then gradually explore their feelings when they begin to feel less overwhelmed. Some people are less distressed than they would have expected, and may feel a sense of guilt that they are not more impacted. Grief may cause a variety of behaviors and feelings including but not limited to anger, sadness, nightmares, insomnia, eating disturbances, isolation, substance abuse, and self-harm.

Regardless of the circumstances surrounding the death or the reactions people experience, it’s important to be patient and gentle with yourself and others who are grieving. I’ve learned that since everyone handles grief differently, it is helpful to ask how you can be supportive without assuming you know the right thing to say. I’ve heard that some people cannot stand when others say, “I’m sorry”. This statement may be interpreted as fake or may cause the griever to feel obligated to say, “It’s okay”,when it’s not. Across the board, I’ve heard that it is unhelpful to say “It will be okay” to someone experiencing a loss. Generally these statements are well-meaning, but they end up meeting the speaker’s needs more than the griever’s. It’s hard to know what to say and many people feel extremely uncomfortable dealing with the subject of death. So if you truly care about being helpful, let the griever know that you care about them and will try your best to support them in whatever way they need. Refer them to a professional if they are at risk for hurting themselves or others. Also, be aware that there is no right way of grieving and no appropriate time limit. I believe that it’s harmful to pathologize bereavement and/or try to create a formula for understanding grief. We are all different and loss is a very personal experience that doesn’t need to be labeled and/or judged.

I will not “should” on myself today

5 Apr

I should be over him already!  I should sbuddhatop worrying about my weight.  I shouldn’t be so upset about that disagreement with my mom.  How often do you tell yourself you should act or feel differently than you do?  Judgement is a powerful force and seems to creep its way into the minds of successful and caring people by telling them there is one right way of dealing with things.  Both at work and within my social circles, I hear people criticize themselves because of the emotional space they’re in. Why are people so hard on themselves?

At the school where I work, I constantly hear teenagers say that they don’t talk to their friends or family about their problems because they don’t want to feel like a burden or be pitied.  They say that they don’t like to cry or that they should stay busy and not think about their difficulties.  I don’t blame them because at times these same people have sought out the support of a friend or a caregiver and been told either directly or indirectly that they should get over it.  Teachers often tell kids they have no excuse for missing homework assignments before hearing the student’s story.  Of course sometimes their stories are fabricated as an easy way out of their responsibilities, but what about the kid who was awake all night listening to her father beat up her mother in the next room?  If the teacher never listens, isn’t that the same as telling the child their feelings don’t matter?  I’ve heard stories of parents laughing at their children for crying.  That may seem extreme (and it is), but what about parents who never cry or express any emotional pain in front of their children?  Or what about parents who never ask their child how he/she is feeling?  These actions may have the same impact.

It seems like our culture doesn’t allow a space for emotional pain.  We seem to receive the message that emotions are a sign of weakness.  This idea is especially significant for men and boys.  Sure, we are given a few weeks or a month to grieve the death of a family member or the loss of a relationship.  But after that, people are expected to return to life as it was or at least stop “whining” about it.  After all, we slap on a disorder label if bereavement goes beyond the “normal” time limit.   Is this the result of a culture which emphasizes individuality over social support?  How do statements like “suck it up” and  “pick yourself up from your boot straps” impact peoples’ ability to manage emotions in their own ways?  Is the desire for immediate gratification reducing Americans‘ ability to slow down and accept their process?  When so much of American culture is focused on making money and gaining power, is there any room for feelings?

I don’t have the answers to those questions, but I’ll propose another question in response.  Does it work to tell ourselves or others to get over it?  If not, why do we continuously expect that result?  What is the impact of judgement on our well-being?  Judging can make the pain continue much longer than if there had been space to express feelings in the first place.  Avoiding feelings does not make them disappear, and it often increases suffering.  Telling someone that he shouldn’t feel something does not stop him from having that feeling.  It will most likely create distance in the relationship, and he’ll be less likely to go to you for support in the future.  Not allowing healing to occur on its own time can lead to an unending slew of consequences including but not limited to depression, anxiety, self-medicating, violence, and suicide.

There’s a Buddhist story that explains how life hits you with arrows, but some people are hit with additional arrows because of their responses.  Accepting the pain, attending to physical and emotional needs, and recognizing that everything is temporary can reduce suffering.  Ignoring or judging can increase pain, while showing compassion and acceptance will most likely help the healing process.  Thoughts and feelings pass like everything else, and kindness (even toward yourself) goes a long way.  Letting go of the should’s and giving yourself and others permission to cope as needed is the way to increase happiness, improve relationships, and accomplish your goals.

Mothers of teen girls: Well-meaning but destructive

23 Feb

Body Image

Although the problem of poor body image for teenage girls is not a new one, it saddens me to see that it’s not improving.  When I hear a beautiful, intelligent girl say that she cuts her stomach fat because she hates her belly, I feel outraged with our culture.  When a teenager tells me that no boys will like her if she doesn’t look exactly like the skinny girls in her school, I want to shake some sense into her.  There are so many messages from not only the media, but well-meaning moms who are trying to help their daughters “fit in” and “feel good about themselves.”  Many of these women do not even realize how destructive their comments are when they tell their daughters to eat less or to “just lose a little weight so you can be on the volleyball team”.  They are giving their daughters the message that the societal ideal for female bodies is the correct one.  They are causing their daughters to believe that their own mothers’ acceptance of them is based on their appearance.  These comments do not generally improve their child’s physical health, and certainly are detrimental to their mental health.

So what can mothers do to help create a society in which girls are healthier in body and mind?  To start with, mothers can ask their daughters about the messages they receive regarding the female body.  They can share their own challenges with comparing themselves to societal ideals.  They can explore their values and those of their daughters’ regarding not only appearance, but the importance of standing up for what they believe.  So if these mothers want their daughters to believe in their own abilities, they may stress the importance of fighting back against a society that seeks to weaken their resolve.  They may ask, do you believe that women should be judged based on their appearance?  Do you think women are only beautiful if they are a size zero and have long blond hair?  Is it okay with you that these messages you receive are causing you to feel bad about yourself?  Well if not, then how can you stand up to these forces that threaten you and your confidence?

In addition to fighting back against societal forces, mothers can help their daughters by focusing on their child’s strengths and accomplishments.  It seems to me that people tend to feel more motivated when they believe in the possibility for success and recognize their own abilities.  They also tend to enjoy those relationships in which they are recognized for their efforts more than those in which they are constantly put down.  In general, I have not noticed that long-term success is created by making decisions out of fear.  So all those parents who threaten to take away the phone or the computer if their child’s grades don’t improve may be helping create temporary change, but a belief in oneself will continue to promote success throughout a lifetime.  The same goes for helping a child improve his or her physical health.  So moms that focus on what their daughters have accomplished will help them to feel more confident in making decisions that align with their values.  A focus on successes will help them to feel more empowered to set their own goals and follow through with them regardless of whether they are to lose weight, get better grades, or ask someone out on a date.

So if we ever want to create a society in which women of all sizes and races are valued, and girls feel good about themselves regardless of whether they look like models, mothers need to start interacting with their daughters in a different way.  Media cannot be blamed for all of our poor body image issues if we continue to perpetuate its messages in our homes.

Kick that problem to the curb

23 Feb

Tawny Eagle (Aquila rapax)

Do you ever notice how people tend to focus on the negative aspects of their lives?  For example, if a teenage recently received an A on a test, she might say, “yes, but my other grades are bad.”  Or if a businessman had a positive conversation with his boss, he might say  “that’s great, but my colleague is continuing to get on my nerves”.  Time and time again, I hear my clients stress their discomfort with praising themselves.  People have somehow gotten the message that to feel good about themselves means they are conceited.  Sometimes it’s easier to praise someone else, but it is often the case that the negative is still emphasized when related to loved one’s.  I find it difficult in my work with families to get people to acknowledge what they appreciate about their child or parent.  Our society is so problem focused that we often don’t even realize there are other ways of seeing things.

So how are the “yes, but’s” impacting the quality of our lives.  Do they influence how we feel in any given moment?  Do they impact our relationships?  Our identity?  How does the negative focus influence how therapists work with clients?  What happens to the level of hope and optimism?

In my opinion, this focus on the problem is sabotaging our ability to enjoy our lives.  As a therapist, it has caused me to lose hope and feel burned out.  When all you can see is a depressed person with several years of dysfunctional relationships, low self-esteem, and a pessimistic attitude about his/her future, it is almost near impossible to maintain hope.

So I’ve decided to start focusing on the positives!  I strongly believe that people are not their problems.  A person can be taken over by depression, but she is not a depressed person at her core.  A child may be controlled by temper tantrums, but he is not an aggressive child.  A woman may be tortured by anorexia, but she is not just an anorexic.  These people and all of us have alternative storylines.  The woman suffering from depression has exhibited several incidents in which she stood up to depression.  For one, she sought out therapy in order to feel better.  She also went to work every day even when depression attempted to keep her in bed.  The child with temper tantrums came from an abusive home in which he was left alone for days at a time.  The temper tantrums allowed him to be seen and heard as a human being with needs.  The woman who had been consumed by anorexia was originally intending to gain control over her body after being sexually abused.

There is always a more positive way of seeing a situation.  With every person I’ve worked with, there have been countless examples of rebellion against the problem.  There have been many experiences in which the problems were forced into the corner or out of the room completely.  These are the stories I seek to find in everyone.  It never ceases to amaze me when I see someone so distraught over a long-standing problem with depression who smiles when she realizes that there have been times without the depression’s influence.  When she recognizes that those times have all occurred based on her strength and determination, a sense of lightness and excitement can be seen in her eyes.  Focusing on the positive may be all it takes to create a sense of hope and belief in oneself, and therefore the power to kick that problem to the curb.

An introduction to Natasha Shapiro, psychotherapist

23 Feb

 Licensed Clinical Social WorkerThank you for your interest in my blog.  You may be wondering who I am and why you should keep reading, so I will share a little about myself personally and professionally.  I am a Bay Area transplant from upstate New York.  I have lived in several states, cities, and countries, but now consider myself settled in The Bay.  In my free time I enjoy practicing yoga, hiking, traveling, and going out to eat with friends.  I have always had a passion for learning about other people and offering support when needed.  I believe that everyone deserves to enjoy their lives, and that obstacles within the social, physical, and internal environments can sometimes threaten this enjoyment.

I decided to become a therapist so that I could help others navigate through these obstacles and accomplish whatever goals they have for their lives.  As someone who has been in therapy, I recognize the positive impact it can have on anyone with an open mind.  Unfortunately psychotherapy is often stigmatized  and thought of as a place for the weak or crazy.  I believe it is a safe space in which one can really be heard, a place to learn about yourself, an environment in which to share feelings with family members, and a place to gain power over problems and obstacles.

I have worked in a variety of settings including schools, clinics, private offices, homes, and I have even conducted therapy sessions in restaurants.  The people who I have had the privilege of working with cross all economic, racial, and cultural lines.  I have seen children who were abused and placed in the foster care system.  I have worked with adults struggling with painful relationships, and families who are feeling unable to manage a child with ongoing temper-tantrums.  Throughout these years, I have learned an incredible amount about others’ suffering.  At times the pain I have seen has threatened to overwhelm me, and I have left sessions crying and feeling hopeless.  But then I remember that strength and hope can always be found if you know where to look.  I refer back to the many joyous moments I have experienced in which relationships improve, families reunite, people gain control over their problems, and life fulfillment increases.  I feel incredibly lucky to have witnessed some of the most powerful moments in people’s lives.

This blog is my way of sharing the experiences and insights I have gained through my interactions with people of various ages and backgrounds.  In addition to all I have learned from my clients, I have been lucky to have had some fantastic supervisors and colleagues over the years who have helped me navigate this challenging profession.  Through this blog, I seek to inspire other clinicians to continue their search for hope and life satisfaction with their own clients.  I wish to share some of what I have learned about the way humans interact with themselves and others.  My goal is also to continue maintaining a dialogue about mental health so as to stay open to various perspectives, and continue being helpful to my future clients.  I recognize my knowledge as limited and know that everyone is the expert of their own lives.  I encourage you to provide as much honest feedback as you’d like, and hope that this can be an open forum for sharing experiences and perspectives.