Therapeutic Change: It’s not in the doing. It’s in the being.

Therapeutic Change: It’s not in the doing. It’s in the being.

I am constantly asked by patients, and now by readers, “Ok. But now what?” The insinuation being, “yes I’ve enjoyed the insight, but what can I do?” As a species we do not embrace idle time, maybe because it really is the devil’s play thing. Most of us are uncomfortable with just being in the process; we like to make sure we have a modicum of influence on how the process unfolds, how fast it goes, and what destination we end up at.

This kind of goal directed focus is not a bad thing per se’. In fact, it is part of why we rose above instinct and utilized the substantial brain functioning we have available to us as humans. One of the underlying principles of the work I do is to create a space where an emphasis on the process can unfold in ways that “ordinary” life does not always allow for. Usually when a patient asks me some version of the aforementioned question, I reply, “It’s not in the doing. It’s in the being.” Most of what occurs in the therapeutic relationship is a result of the being, not the doing. That being said, this blog is my best attempt to outline some of the strategies I encourage my patients to “do” to help increase their tolerance for the process of “being.” 

Observe Your Mind.

The development of the capacity to observe how our mind and brain works from a space of true observation is a skill that lends tremendous insight in the process of change and growth. Psychologists call the ability to achieve this state of mind the “observing ego.” In this state we have no horse in the race, so to speak. We just observe our thoughts, feelings and experiences from a place that is conflict-free.

In the beginning, I suggest my patients say things to themselves like “oh there I am doing “that” thing that I do” and then shepherd the mind away from fixating on even that process. Just simply move on. This helps people to begin the process of interrupting the never-ending internal dialogue that most of us have, as we critique our thoughts and feelings on a spectrum of good or bad, right or wrong, comfortable or uncomfortable. But mostly the emphasis is on observation. Just being present in watching how your mind and brain operate.

The great part about starting with this observational mind technique is that you can “do it” anywhere because it is only happening in the quiet (or not so quiet) of your mind. This is different than mindfulness or meditation, which requires a different type of commitment. We will discuss later about the formal practice of mindfulness. This observational practice involves observing your thoughts, feelings and sensations as they are happening while you go about your daily life. Observational practice is what I ask my patients to start from the very first session. We just carve out space to observe how your mind works and experience your feelings and thoughts without any conflict, judgment(s) or any other critique that serves merely as a hindrance at this point in your journey.

Our mind, the way it metabolizes information, fuels our feelings, and organizes our thoughts is the ground upon which progress, change, and evolution occur. The power to develop a strong capacity to observe your mind, without enabling it (I feel anxious, therefore I will avoid that feeling or stimuli), or masochistically abusing yourself (I am such an idiot. What is wrong with me!), or any version of self-dialogue that centers on harsh critiquing is the central groundwork to quieting our central nervous system. For many of us, prior to the development of this ability our reactions to our experiences are hardwired and lack any true sense of free will, as we simply play out patterns of the past in an unconscious and unobserved manner. (Please refer to my last blog post about how the unconscious rules the roost 

Neutralize Intensity.

Remind yourself frequently that all you are experiencing are feelings. Some of them will be intense. Some will be mild. Feelings have a beginning, middle, and an end. Nothing lasts forever and nor will your internal state of discomfort. Likewise, the good feelings will fluctuate and crest and then recede and crest again. Our interior architecture requires dexterity and sway in order to thrive, just as trees and buildings do. The structures that really stand the test of time are able to bend and sway with the ever-changing demands of its environment. So too is our interior world. The more flexible and tolerant of changes and shifts in our thoughts and feelings we are, the better able we are to withstand all the inevitable undulations inherent in being human.

When patients are deeply overwhelmed by anxiety (usually close to panic) I often reflect to them something along these lines:

You are really uncomfortable and you wish you didn’t feel this way. But it is just a feeling. It will pass. Try to find space and fluidity in the pain to simply tolerate it. Tolerance is all we are aiming for here. No one expects you to be graceful under these conditions. Eventually, usually in a few minutes, it will crest and then recede.

In time, this process of neutralizing the intensity of our feelings allows for a deepening of the ability to simply observe your experiences. And with enough practice, eventually you can begin to actually “listen” to the feeling(s) in a way that was previously inaccessible because of the noise of critique and anxiety around the intensity of the experience. Something along the lines of, “I can’t stand feeling this way. What the hell is wrong with me that I feel this way? I don’t want to feel this way. What if this never stops!” All the while your heart rate is increasing and your thoughts start to try and keep pace with the 160 beats per minute and you are, from a central nervous system standpoint, well on your way to a panic attack.

Does any of this ring true?

Fret not, the battle with anxiety is won and lost with the regulation of the central nervous system. It’s biologically impossible to experience profound anxiety if you learn how to regulate the central nervous system through observation, breath, and mindfulness. You will feel anxiety in life. There is no way to completely avoid or eliminate that emotional experience. That is not the goal of therapy. But by observing your mind and neutralizing your reaction you will reduce your propensity towards the more severe expressions of anxiety (panic attacks, chronic worry and anxiety, hypochondriasis, etc).  

Neutralizing our feelings also allows us to gain access to the deeper and more unconsciously held belief patterns that are operating outside of our awareness, but with considerable influence. When we begin the process of observing the first layer of our feelings (in this case anxiety) we will find emotional layers of much more complexity, texture and history that have been protected and hidden by the low hanging fruit of our emotional world. Our goal is to help you rework your internal response to your thoughts and feelings. Neutralizing the intensity of your feelings is one step in that goal towards quieting the central nervous system. Like all the strategies put forth here, consistent practice is the only ingredient necessary for success.

Mindfulness.

When it comes to mindfulness I endorse the style endorsed by Jon Kabat-Zinn called MBSR (Mindfulness Based Stress Reduction). This is the process where we learn to just sit and be present with our thoughts and feelings, observing the content, sensations, etc but without any effort to clear your mind or even influence the content of your thoughts (you are not making any effort to “think positively” or clear your thoughts).

MBSR is a specific practice of mindfulness that asks patients to carve out 45 minutes per day of seated mindful observation. I start out by asking my patient’s to commit twenty minutes per day, broken up into two ten-minute intervals. I suggest doing it first thing in the morning and last thing in the evening. Sit in a comfortable position or lie down flat (before you get out of bed in the morning) and just observe your mind, body and brain. Observe your thoughts, feelings, and sensations. That is all. It is that straight forward. This is a process of addressing long-held central nervous system patterns that lie deep in the parasympathetic nervous system. Maintain the practice daily, even when you feel “better.”   Again, this style of practice yields the best results when it is implemented daily.

The 300 Rule.

I remember when I started to really pay attention to baseball and started to notice what a civilized game it is. Like golf, there are a lot of good life metaphors in the game of baseball. The 300 rule is one of those metaphors. As any good baseball fan already knows, a top hitter in baseball makes contact with the ball .300 times up at bat or 30% of the time. And, by the way, those are the top hitters. The same can be said of parenting and attachment. If you can meet your child(ren)’s needs 30% of the time you are well within the “good enough” parenting bell curve. The other 70% of the time we are merely repairing the inevitable parental strikes or misses.

I encourage my patient’s to view life this way and more specifically therapeutic change. When you first start out with these types of techniques, which are by design subtle, you cannot expect yourself to be a top hitter. These are not grand gestures of change or upheaval; they are subtle shifts in your interior state of being with yourself. In other words, go easy on yourself. Just start swinging the bat, observe your mind, suspend critique, and hope you get a base hit every once in a while. If you expect more from yourself in such a short amount of time, observe that. And just remember, we have the rest of the 70% of the time to make up for all our strikes.


About the Author: Dr Sarah Sarkis
Dr Sarah SarkisSarah is a licensed psychologist living in Honolulu, Hawaii. Originally hailing from Boston Mass, she has a private practice where she works with adults in long-term insight oriented therapy. She works from an existential psychology vantage point where she encourages her patients to “stay present even in the storm.”  She believes herself to be an explorer of the psyche and she will encourage you to be curious about the journey rather than the destination.  She emphasizes collaboration, partnership, and personal empowerment.

She approaches psychological wellness from a holistic and integrative perspective. Her therapeutic style is based on an integrative approach to wellness, where she blends her strong psychodynamic and insight oriented training with more traditionally behavioral and/or mind/body techniques to help clients foster insight, change and growth. She has studied extensively the use of mindfulness, functional medicine, hormones, and how food, medicine and mood are interconnected.  Her influences include Dr.’s Hyman, Benson, Kabat-Zinn and Gordon, as well as Tara Brach, Brene’ Brown, Irvin Yalom and Bruce Springsteen to name only a few.

Please visit her website at DrSarahSarkis.com and check out her blog, The Padded Room

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3 Comments

Peter

Hi I’m confused with the observe your thoughts situation .my mind just chatters away about things, and I don’t really know it’s happing. Then when you realise , and think stop this , it’s to late it’s happened . So how can you observe your thoughts, it has already happened . I don’t think you can observe and think at the same time. Or do you just observe what you have already just thought. After you realise
Thank you for any comments.

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Karen - Hey Sigmund

When you realise your thoughts are taking you away, come back to your present experience – what can you feel, see, hear, taste, smell? Then, try stepping back and imagining your thoughts as clouds. This is a form of mindfulness and is a way to still your mind and pull back from the mental chatter. Here is an article that will help with other strategies https://www.heysigmund.com/different-ways-to-practice-mindfulness/. Hope that helps to make sense of things.

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Margaret O'Quigley Psychotherapist

I totally agree with your suggestion of just being with your feelings as they arise not trying to fight back at them. In the case of anxiety I have found it helpful to write down reassuring words as when one is in such a heightened state it can be hard to remember what to say. Words like this to will pass can be helpful. Many thanks

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Growth doesn’t always announce itself in ways that feel safe or invited. Often, it can leave us exhausted and confused and with dirt in our pores from the fury of the battle. It is this way for all of us, our children too. 

The truth of it all is that we are all born with a profound and immense capacity to rise through challenges, changes and heartache. There is something else we are born with too, and it is the capacity to add softness, strength, and safety for each other when the movement towards growth feels too big. Not always by finding the answer, but by being it - just by being - safe, warm, vulnerable, real. As it turns out, sometimes, this is the richest source of growth for all of us.
When the world feel sunsettled, the ripple can reach the hearts, minds and spirits of kids and teens whether or not they are directly affected. As the important adult in the life of any child or teen, you have a profound capacity to give them what they need to steady their world again.

When their fears are really big, such as the death of a parent, being alone in the world, being separated from people they love, children might put this into something else. 

This can also happen because they can’t always articulate the fear. Emotional ‘experiences’ don’t lay in the brain as words, they lay down as images and sensory experiences. This is why smells and sounds can trigger anxiety, even if they aren’t connected to a scary experience. The ‘experiences’ also don’t need to be theirs. Hearing ‘about’ is enough.

The content of the fear might seem irrational but the feeling will be valid. Think of it as the feeling being the part that needs you. Their anxiety, sadness, anger (which happens to hold down other more vulnerable emotions) needs to be seen, held, contained and soothed, so they can feel safe again - and you have so much power to make that happen. 

‘I can see how worried you are. There are some big things happening in the world at the moment, but my darling, you are safe. I promise. You are so safe.’ 

If they have been through something big, the truth is that they have been through something frightening AND they are safe, ‘We’re going through some big things and it can be confusing and scary. We’ll get through this. It’s okay to feel scared or sad or angry. Whatever you feel is okay, and I’m here and I love you and we are safe. We can get through anything together.’
I love being a parent. I love it with every part of my being and more than I ever thought I could love anything. Honestly though, nothing has brought out my insecurities or vulnerabilities as much. This is so normal. Confusing, and normal. 

However many children we have, and whatever age they are, each child and each new stage will bring something new for us to learn. It will always be this way. Our children will each do life differently, and along the way we will need to adapt and bend ourselves around their path to light their way as best we can. But we won't do this perfectly, because we can't always know what mountains they'll need to climb, or what dragons they'll need to slay. We won't always know what they’ll need, and we won't always be able to give it. We don't need to. But we'll want to. Sometimes we’ll ache because of this and we’ll blame ourselves for not being ‘enough’. Sometimes we won't. This is the vulnerability that comes with parenting. 

We love them so much, and that never changes, but the way we feel about parenting might change a thousand times before breakfast. Parenting is tough. It's worth every second - every second - but it's tough. Great parents can feel everything, and sometimes it can turn from moment to moment - loving, furious, resentful, compassionate, gentle, tough, joyful, selfish, confused and wise - all of it. Great parents can feel all of it.

Because parenting is pure joy, but not always. We are strong, nurturing, selfless, loving, but not always. Parents aren't perfect. Love isn't perfect. And it was meant to be. We’re raising humans - real ones, with feelings, who don't need to be perfect, and wont  need others to be perfect. Humans who can be kind to others, and to themselves first. But they will learn this from us. Parenting is the role which needs us to be our most human, beautifully imperfect, flawed, vulnerable selves. Let's not judge ourselves for our shortcomings and the imperfections, and the necessary human-ness of us.❤️
The behaviour that comes with separation anxiety is the symptom not the problem. To strengthen children against separation anxiety, we have to respond at the source – the felt sense of separation from you.

Whenever there is separation from an attachment person, there will be always be anxiety unless there is at least one of 2 things: attachment with another trusted, adult; or a felt sense of you holding on to them, even when you aren’t beside them. 

If separation is the problem, connection has to be the solution. The connection can be with any loving adult, but it needs more than an adult being present. Just because there is another adult in the room, doesn’t mean your child will experience a deep sense of safety with that adult. This doesn’t mean the adult isn’t safe - it’s about what the brain perceives, and that brain is looking for a deep, felt sense of safety. This will come from the presence of an adult who, through their strong, loving presence, shows the child their abundant intention to care for them, and their joy in doing so. The joy in caretaking is important. It lets the child rest from seeking the adult’s care because there will be a sense that the adult wants it enough for both.

This can be helped along by showing your young one that you trust the adult to love and care for your child and keep him or her safe in your absence: ‘I know [important adult] loves you and is going to take such good care of you.’ This doesn’t mean children will instantly feel the attachment, but the path towards that will be more illuminated.

To help them feel you holding on even when you aren’t with them, let them know you’ll be thinking of them and can’t wait to be with them again. I used to tell my daughter that every 15 seconds, my mind makes sure it knows where she is. Think of this as ‘taking over’ their worry. ‘You don’t have to worry about you or me because I’m taking care of both of us – every 15 seconds.’ This might also look like giving them something of yours to hold on to while you’re gone – a scarf, a note. You will always be their favourite way to safety, but you can’t be everywhere. Another loving adult or the felt presence of you will help them rest.
Sometimes it can be hard to know what to say or whether to say anything at all. It doesn’t matter if the ‘right’ words aren’t there, because often there no right words. There are also no wrong ones. Often it’s not even about the words. Your presence, your attention, the sound of your voice - they all help to soften the hard edges of the world. Humans have been talking for as long as we’ve had heartbeats and there’s a reason for this. Talking heals. 

It helps to connect the emotional right brain with the logical left. This gives context and shape to feelings and helps them feel contained, which lets those feelings soften. 

You don’t need to fix anything and you don’t need to have all the answers. Even if the words land differently to the way you expected, you can clean it up once it’s out there. What’s important is opening the space for conversation, which opens the way to you. Try, ‘I’m wondering how you’re doing with everything. Would you like to talk?’ 

And let them take the lead. Some days they’ll want to talk about ‘it’ and some days they’ll want to talk about anything but. Whether it’s to distract from the mess of it all or to go deeper into it so they can carve their way through the feeling to the calm on the other side, healing will come. So ask, ‘Do you want to talk about ‘it’ or do you want to talk about something else? Because I’m here for both.’ ♥️
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