Wednesday, March 12, 2014

Improve your mental health: Move your body.

Get some Exercise. Your brain will thank you.

Physical exercise is probably the single best thing you can do for your mental health—and it's the thing that people often have the hardest time beginning and sticking with. I frequently advise clients to make exercise a regular part of their mental health. Once, this recommendation made me unusual among therapists. Today, more therapists are coming on board with the whole"exercise as treatment" approach

Here's a quick rundown of how exercise helps with mental health, and how you can get through some of the most common barriers to establishing a regular physical activity.

How does exercise help the brain?

1. Exercises reduces depression. In fact, exercising can be just as effective as antidepressant medications in the treatment of depression.

2. It will make you feel better about yourself. Exercise has been shown to improve self-esteem in some studies.   This is not because of changes to the body, but just due to the effect of regular physical activity. Further, exercising outdoors seems to increase the boost to self-esteem

3. Exercise reduces anxiety. Regular physical activity helps settle the mind and reduces anxious feelings. Research shows that exercise can be an important part of anxiety-management

4. It boosts brainpower. It's time to kill the stereotype of the dumb jock. As it turns out, exercise helps learning in adults and helps the brain develop in children.

Here's a quiz: Which activity most reduces age-related cognitive decline, daily crossword puzzles or daily exercise? Turns out, exercise is more important than brain games

So I know that exercise is good for me. What stands in the way? And how do I get through that?

Merely knowing that something is good for us does not improve the chances that we will do that thing. Behavioral change requires actual change, not just insight. Here are some of the answers to common resistances to physical exercise that I hear in my practice. 

1. I don't like exercise.

I think the word "exercise" turns people off. It isn't necessary to spend hours in the gym, or to run a 5K. Think about ways you can incorporate some physical activity in your day. Can you ride your bike to the store, or to work? (As a bonus, the Earth will thank you, and so will your wallet.) Can you take the stairs instead of the elevator? Can you take a walk around your office on your lunch hour? (Related: One powerful way to manage workplace stress is to take a 30 minute walk outside every day as part of a lunch break.) Can you take a walk after dinner, or when you come home from work? (If you want to improve your relationship, take a 20-30 minute walk every day with your partner.) So remember that you don't have to think about exercise in terms of target-heart-rates and feeling-the-burn. Just get up and move more than you have been.

2. I don't have the time.

Maybe you don't have the time to train for a marathon or powerlift. But in terms of adding some exercise to your life, you most likely do have the time. Like I just wrote above, think of ways you can fit physical activity into your daily routine. And every beyond that, think about how much TV you watch, or how much time you spend on the internet. You could be watching TV while on a treadmill, or reading on an exercise bike. You could even be surfing the internet--or working--on a treadmill desk.

And, we're talking about something like 15 minutes a day, or 30 minutes a few times a week. If you really don't have the time for that, then I would suggest that may be a symptom of skewed work-life balance. 

3. I'm too tired.

You're tired, but not too tired. That's a big difference.

Occasionally, you will be too tired. Sometimes you may find that you had an exhausting day, or you are sick with a cold or something, and on those days you go home and go to bed early. But mostly likely, you are just tired. If you get up and go get some exercise, you'll probably feel better.

Here's a trick I've used in my life: When I'm thinking, "I'm too tired," I tell myself that I'm just going to change into my workout clothing. If I'm still too tired, I can take them off and go back to the couch. But first I have to get up and change clothes. My experience is that merely changing outfits triggers something in my brain, and I find the energy.

4. I'm self-conscious/embarrassed.

Lots of people are worried about how they are perceived at the gym, or when they are jogging, or at the yoga studio, or whatever. But it's really unlikely that anyone else is watching you. Honestly, other people are most likely so deep in their own experience they don't even notice you. And, even if they do notice you, and even if you do something embarrassing, so what? That can be an opportunity to practice your ability to cope with difficult feelings.

5. I'm overweight.

First, let me be clear that my intention is not that you lose a bunch of weight. I am interested in mental health, not BMI. I fully believe in the health at every size movement and that includes mental health at every size. I am not telling you to exercise yourself into a new body; I am encouraging you to enjoy the body you have, and see how moving it can make you happier/smarter/more creative and generally improve your life.

With that said, there can be some challenges for people of size. Some exercise options are going to be hard on joints, and mobility for some people of size becomes an issue. Again, this isn't about doing 30 minutes of intense aerobics every day. Just start where you are. If you can swim, do it. If you can walk around your yard, do that. If you like yoga, do yoga. Take some time during your day to get some activity, and move around a bit. See how it impacts your mood after a couple of weeks. Here is a nice resource that addresses the concerns around bodies of size and mobility.

Another challenge for people of size can be feelings of embarrassment or shame. I've heard people say they "don't feel like they belong in a gym," or that "everyone is watching me as I jog, thinking 'Oh, that poor thing'." This is a very real concern and should be addressed internally. Consider if you would feel that way if you saw yourself, or someone who looks like you. If you think you might have the same judgement about someone else in your situation, then I'd suggest you think about what those kinds of judgement do for your own self-esteem. Maybe you want to think about changing some of those thoughts. You deserve to like yourself for who you are, not based on a societal norm of beauty.

Remember that there is a whole community of people out there who face this issue on a daily basis. I cannot speak as a member of that community, so let me point to some people who are more qualified and more eloquent than I am.

Necessary Disclaimer:
Talk to your physician if you have concerns about physical exercise. Don't overdo it—make sure you take care of yourself. Think of this as something you enjoy, not something you have to do.

Friday, February 14, 2014

Ten Healthy Love Songs

I wrote a popular post a few months ago about the Ten Great Love Songs with Terrible Messages. So today, Valentine's Day, I thought I'd follow up with the Top Ten Healthy Love Songs. To make the list, the songs have to have to have a healthy message about love and be good musically.

So I present, in no particular order, my Top Ten Healthy Love Songs.

1. “When I'm 64,” The Beatles

First of all, this song is just fun to sing. As for the healthy message, the song focuses on the small things that we do for our partners that let them know we love them. That kind of connection builds love and affection between people over a lifetime. 

2. “Tell Him,” Barbra Streisand and Celine Dion.

Usually when two women are singing a love song as a duet, it is about competing for the same man. In this case, one woman is supporting the other as she tries to get the courage to be vulnerable and be honest about her love. It has two of the greatest voices of our time, and a fantastic line about love and self-actualization: “Love will be the gift you give yourself.”

3. “True Colors,” Cyndi Lauper

I have to confess that I'm a fan of Cyndi Lauper. (The song “Sally's Pigeons” makes me tear up, and I'm not afraid to admit it.) In “True Colors” she describes a love in which she can can see her partner for who they are:

And I see your true colors
shining through
I see your true colors
and that's why I love you...

True love recognizes exactly who the other person is, in shadow and in light. Just like in the song.

4. “You Can't Hurry Love,” The Supremes

Who doesn't love Motown and The Supremes?  Not only is the song a great example of the Motown sound, it is a rare love song for the single person. The vocals sung by Diana Ross describe wanting to be in a relationship to feel complete, and then remembering her mother's advice: “You can't hurry love... It's a game of give and take.” As the singer struggles with wanting to be in a relationship just for the sake of being in a relationship, and uses her mother's advice to find the emotional strength to wait for healthy love. 

5. “Our Song,” Taylor Swift

This song is so Bubble-Gum Pop that you can taste it. But it's so much fun, and the lyrics talk about celebrating the early moments in relationships. When couples remember what it is that they have in common (something relationship expert John Gottman calls “creating shared meaning”) they strengthen their relationship. Way to go, Taylor.

BONUS: This male cover of “Our Song” performed by Tyler Ward is worth a listen, too. I do not know if Tyler Ward intended this song to be same-gender loving or not, but a male voice singing these lyrics gives the song a different perspective.

6. “Like a Prayer,” Madonna

Life is a mystery;
Everyone must stand alone.
I hear you call my name
And it feels like home.

That lyric all by itself is enough to have this song make the list. It is rare to find an accurate and poetic description of the state of being alone existentially, and yet finding comfort in a loving relationship. Madonna doesn't always strike the right tone for mental health ("Borderline", anyone?) but this song could be used as a healing affirmation for healthy boundaries in relationships.

As for this video... well, we could write a whole book about the portrayal of race in Madonna videos. Maybe that will be another entry in this blog someday. 

7. “A Whole New World,” Alan Menken and Tim Rice.

Yes, the song from the movie Aladdin. There is plenty to say about the movie—It's been rightly criticized for showing that the best way to win someone's heart is to pretend to be someone you are not. And let's not even get started on the images of Arabic people.

This song, though, describes healthy love. Yes, it is incredibly cheesy, but that kind of adds to its appeal. The lyrics speak of wanting to experience new things with a partner, and that is a great way to build a relationship.

8. “Greatest Love of All," Whitney Houston

Oh, you knew this would be on the list somewhere, right? It's a fantastic song--perfect for belting out in the shower or the car.Whitney Houston had a voice for the ages, and she was at the height of her talent in 1985.  And lyrics don't get any more emotionally healthy than "Learning to love yourself is the greatest love of all." 

Bonus! Did you know that this song is actually a remake? The original version was recorded in 1977 by George Benson for a biopic of Muhammad Ali called The Greatest.

9. “Hallelujah,” Leonard Cohen

I tried my best but it wasn't much.
I couldn't feel, so I tried to touch.
But I never lied, I didn't come here to fool you.
And even if it all goes wrong
I'll stand before the Lord of Song
with nothing on my tongue but Hallalujah.

This song has beautiful lyrics that describe the ups and down of a relationship accurately without sacrificing the poetry. It's been covered by just about everyone, but my favorites are k.d. lang and Rufus Wainwright. I loves me some Leonard Cohen, and I highly recommend seeing him live in concert if you can, but I've chosen k.d. lang's version to embed here. If you want to hear Leonard Cohen's original, it is here

10. “”I Just Called to Say I Love You,” Stevie Wonder

This is how you keep love alive and relationships healthy—reach out to your partner, say you love them. Surprise them during the day with a call (or a text message) that says how you feel, for no other reason other than you're thinking of them.

For a special treat, here is the version done on The Cosby Show, in which Stevie sings with Phylicia Rashad (whom we have seem on this blog before!)  and the rest of the cast. As if the song wasn't 80s enough!

11. Honorable mention:

“The Sweater” Meryn Cadell

So the reason this is an honorable mention is that it is not technically a love song, and it describes unhealthy patterns. But this song makes the honorable mention list because it describes the vulnerabilities and mistakes that we make when learning how to be in a relationship. It's perhaps the best song about an adolescent crush ever written. Plus, it's got a killer beat and it's crazy fun.

Thursday, January 30, 2014

The "Friend Zone" in Therapy

A young man sat in my office and related how he had recently attempted to initiate a romantic relationship with a woman friend. He told me they had seen a play together, and then gone to dinner. At dinner, he asked her if she would be interested in making “more” of their friendship.

“Do you know what she said? She said, 'I'm really not looking for a relationship right now. I'm more than happy to be your friend, though.' What am I supposed to do with that?”

I had a feeling that he actually wanted me to answer that question. But I didn't take the bait: “You tell me: What do you do with what?” I said, reflecting the question back to him.

“I don't know. I mean, it happened again! I got friend-zoned!” he said.

And there it is: The dreaded “Friend-Zone.” For those who do not know, the “friend-zone” is supposedly this place where men go when they are told by the object of their romantic fancy that there is no chance of a romantic relationship, just a friendship. (Although, this is somewhat of an unfair definition: I've heard women complain about being in the “friend-zone” more times than I can count. But that's a topic for another day.)

I replied: “So let me get this clear: You have a friendship with Sara [not her real name, obviously], and you would like a romantic relationship to develop. She is not interested. Do I have that right?”

“Yes,” he replied. “This happens to me all the time, though. I try to be a nice guy, and then I end up with a lot of women friends, but not a girlfriend.”

As a therapist who is also a feminist, I have so many responses to this. For example: “If you're just trying to be a nice guy to get a girlfriend, then you're not really a nice guy at all.” Or: “What makes you think that 'being a nice guy' is sufficient to generate romantic interest in anyone? 'Being a nice guy' is a default setting, dude.”

However, one of the realities of the therapy office is that I have to be present and aware for all my clients, even the ones who may not necessarily act in alignment with my politics.

I have noticed over the years that indignation—like most forms of anger—often hides emotional pain. So what I said was, “It sounds like you've been rejected more than a few times. Can you tell me what that feels like?”

His response was one of confusion. I think he was warming himself up to go on a “all women are terrible” rant, and I cut him off and asked him to explore his hurt. I could actually see the emotions on his face as he struggled—on the one hand, he really wanted to vent his rage. On the other, he really was in pain, and I had hit something real.

Eventually, pain won out: “It really does hurt. I mean, I know it hurts, but I never think about it. I really like Sara. I mean, I think we'd be great together. I want to make her as happy as she makes me, you know? I don't know... I just feel sad now.”

“Brian [again, not a real name, obviously], your pain is real. You stepped into vulnerability—you took a risk, and showed your true self. And, you got rejected. That hurts. What would happen if you just let yourself be hurt, instead of covering it with anger?”

He sat quietly for a few moments, and then said, “I just want someone to love me.”

Sometimes, it is better if the therapist doesn't say a word. I suspected that this was one of those times. It seemed like hours, but in reality it was only a couple of minutes. And then he spoke again: “I don't know if I can still be friends with her.”

“Tell me more about that,” I said.

“When I see her, it hurts, because it reminds me of what I don't have. And, if I stay friends with her, I'll always be thinking about dating her. And what's that going to be like when she does start dating someone? It's not fair to her or to me.” He was quiet for a minute. “Would it be terrible if I stopped being her friend?”

“I guess that depends on what you mean by terrible,” I said. “It would probably be painful, because you have feelings for her. But you are not obligated to maintain a friendship with anyone. So if it has to be that you cannot be friends anymore, then maybe that's what you have to do.”

“But...” he protested, “that's not what I want.”

“No,” I said as gently as I possibly could. “What you want is a romantic relationship. That's off the table. Now, you have to decide what you can live with.”

Our session continued. This client and I revisited this topic for several weeks. Eventually, he did end the friendship with Sara. To his credit, he did not pressure her for a romantic relationship. He did not try to "win her over." He was mature and respected what she said. And, he tried to remain friends, but found that too difficult and painful. 


Why did I write this post? Because I have seen the “friend-zone” stuff coming up again and again, and I wanted to give my opinion. (What else are blogs for?) Also, because I wanted to write a post that was more personal then my usual “5 Ways to Improve your Relationship” kind of thing.

And also, because I wanted to make a point about the "friend zone" being anger that masks feelings of hurt and rejection. I wanted to offer an alternative to engaging hurt and rejection besides falling into blaming another person (or an entire gender). So here is the summary of what I think may be helpful in this kind of situation. 

1. If someone tells you they are not interested in a romantic relationship, then you have to respect that. You do not get to pressure them to change their mind. You are not “entitled to an explanation,” so don't ask why they're not interested. And ultimately, knowing the reason you have been rejected won't make you feel better anyway.

2. That pain you feel when someone says they're not interested? That's real. It may be rejection, or sadness, or disappointment, or any number of things. Acknowledge that you have pain and work through it. If you have been turned down multiple times, it may be a significant amount of work. That's OK. In fact, it's better to work through the pain than to ignore it, or to blame someone else for it. And it is possible to work through emotional pain, trust me. And though it should go without saying, I'll say it anyway: Do not expect to resolve that pain by getting the romantic relationship you were just turned down for.

3. If you cannot stay friends, then you don't have to. There is absolutely no obligation to be friends with anyone. If it is too painful, you may have to end the friendship. (Notice that I'm talking about a friendship being “too painful.” If, on the other hand, you feel that you cannot stay friends because you no longer have common interests, then perhaps you weren't really friends to begin with.)

4. Finally, if you are respectful and direct with your communications, you do not need to feel shame around wanting to have a romantic or sexual relationship with a friend. There is no shame in wanting a romantic or sexual relationship with another adult. Taking a risk and being vulnerable is something to celebrate, not something to punish.

Wednesday, January 8, 2014

Dysfunctional Family Roles (Illustrated!)

Ideally, a family unit is a strongly connected group of individuals who provide mutual support, encouragement and feedback. Ideally, a family is a safe environment in which children (and adults) can have their needs met regularly and predictably. In order for a family to fulfill these kinds of functions, the individual members—and particularly the adults in the family—must be fairly stable and able to meet their own emotional needs.

But some families do not have this kind of stability. Some families are organized around conflict, mental illness, or addictions. We often call these kinds of families “dysfunctional.” Children will often seek stability and safety, and when children are raised in dysfunctional families, they begin to seek ways to normalize their experience. The may start to act in ways that bring structure, consistency and safety into an otherwise chaotic environment. Many of these roles are predictable, and were first identified by Virginia Satir.

Understanding what kinds of roles we play in our families is important in our understanding of ourselves. The roles we play in our families set up our behavior for our adulthood. Of course the way that these roles manifest in a real family will be complex, but for the sake of this article, I have briefly described five common dysfunctional family roles. I have also illustrated them with an example from popular television, just because. 

Family Hero
The One We're Proud Of.

“If I don't do it, no one will.”
“If I don't continue to achieve, bad things will happen.”

Lisa Simpson, the Hero of the Simpsons.
Her achievements distract from the
reality of the family dysfunction.   
The family hero is the one who strives for perfection. This person gets attention through accomplishments and achievements, whether they are academic, social, athletic or in some other area. The narrative that drives this role is “Our family can't be so bad if we produced this star athlete/talented musician/straight-A student.” The Hero will usually make the case that s/he is merely driven, and seeks accomplishments and achievements for their own sake. Ultimately, the Hero knows that s/he enjoys the attention and power that come from this role.

The family's definition of functionality depends on this person's achievement, and this is a very difficult burden to shoulder. Heroes are often workaholics, perfectionists and controlling. They may have difficulty with relationships with others. Heroes almost always have extreme difficulty tolerating failure. They avoid shame and other negative emotions at all costs.

The Troubled One.

“You have to take what you want in life. No one will give you anything.”
“This family is messed up, and I'm the only one who admits it.”
Tyrion Lannister, who is blamed
for much of the family dysfunction,
is the Scapegoat of his family. He also
shows that "Scapegoat" is not
the same thing as "underachiever."  

The Scapegoat is the inverse of the Hero in some ways. Instead of seeking attention through positive accomplishments, the Scapegoat gets attention through negative actions. The Scapegoat may feel that s/he “never fit in” to the family. The Scapegoat brings the family together by being a “problem,” and needing attention and intervention.

The Scapegoat's behavior can become a habit, figuratively or literally. Frequently, Scapegoats have problem with addictions, get into trouble with the law, or have difficulty holding down a job. Internally, Scapegoats can begin to feel hurt, rejection or shame. The Scapegoat may begin to believe that s/he is “bad,” and this can become a self-fulfilling prophecy.

It is important to note that the Scapegoat's behavior does not have to be illegal to be considered "troubled" in the family. The Scapegoat acts outsides of the family norms and rules, even if the behavior itself is not condemned by society at large. 

The One We Turn To.

“People will like me if I'm nice.”
“I'll take care of you—and then you won't leave me.”
Michael, from Arrested Development,
is the one his family turns to when
things need fixing. 

The Pleaser is the member of the family who picks up the pieces after a catastrophe. This person is usually caring and empathetic, and s/he usually gives good advice. After something goes wrong, the family can and does turn to the Pleaser to “make it better.”

The Pleaser often gets validation from being needed, but often does not learn to take care of her/himself. S/he may also develop a high tolerance for inappropriate behaviors, and may have difficulty setting boundaries with others. In adult relationships, s/he may confuse love for pity, and fall in love with people s/he can rescue and fix. The Pleaser is often anxious, and may have feelings of guilt that are not centered in a specific situation.

Lost Child
The One We Don't Think About

“If I don't get involved, I won't get hurt.”
“It's best not to draw attention to yourself.”
Jan Brady was the Lost Child in her
family. But unlike most lost children,
she expresses her feelings of
being overlooked. 

The Lost Child disappears from the family chaos—physically, emotionally, or both. The Lost Child might become lost in books, video games or other distractions. Or, s/he might literally leave the family by becoming involved in activities away from home. Sometimes, the Lost Child runs away from home.

The Lost Child may find that s/he has difficulty being in touch with emotions, and may not know how to begin to express them to others. S/he may feel powerless in relationships. S/he may feel lonely, ignored, or unimportant. The Lost Child may have difficulty feeling loved and needed in relationships.

The Clown

“You can't laugh and be in pain at the same time.”
“If you just smile, everything will be fine.”

Roseanne meets every situation, no matter
how challenging, with a joke. Her character
showed that humor is both a source of strength
and a way to avoid dealing with difficult situations. 
The Mascot copes with the family chaos by bringing laughter to the family. This distracts the family, and helps the family avoid resolving the underlying difficulties. The Mascot usually enjoys being funny, and enjoys being able to “cheer people up.”

The Mascot may not learn coping mechanisms other than humor. S/he may hide real feelings with humor and jokes; s/he may feel inadequate and frightened in the face of difficult or painful emotions. The Mascot may struggle with achieving maturity in life, career, and relationships because the family is dependent on the Mascot never to grow up.