Paths to Change

woman on phone, hopeful

When you start therapy, you are looking for some form of change in your life. Maybe you are wanting to treat a mental health disorder. Perhaps you seek to make choices about your life's path. You may desire the change of being heard and understood instead of ignored, minimized, or not able to speak. These are all valid reasons to enter the therapy process.

As you may be considering meeting with me for therapy, I wanted to offer a few ways that I conceptualize and talk about change processes.

Lowering Your Distress

One way that I think about change comes from the Yerkes-Dobbs model for stress. Picture a typical bell curve. On the y axis, you have the measure for performance, and on the x axis, you have amount of stress (I often sub in anxiety for stress, but other emotions could fit, too). When you start off at 0 units of stress about a situation like a presentation for work, you will get 0 on performance because you don't do things like prepare and create the presentation. As the stress you feel increases, you respond to the stress by performing in ways such as: asking questions, gathering information, brainstorming, working with team members, designing the presentation, and practicing it. These are appropriate reactions to stress that are likely to result in higher performance. Yerkes and Dobbs talk about this level of stress as being optimal for performance. 

As you keep increasing stress from this optimal level, however, your performance may go back down. For instance, if you become so stressed by the idea of the presentation that you lose your appetite, have difficulty sleeping, and are paralyzed and distracted by fear, then you will do less well on the presentation. Your performance will go down, and can go all the way back down to 0, if you cannot work on the presentation because your stress is in the way. This is when stress is a problem.

The Yerkes-Dobbs curve informs one way that I talk about change. I believe that we are not meant to get rid of all stress and anxiety. We cannot expect life to stay the same and not make demands of us. However, we can learn skills and develop attitudes to notice our stress levels and work to lower them back into the more moderate range where we can also be more productive. For a simpler example, I might work with a client to recognize when her anxiety is getting too high. She might note feeling "like a deer in headlights," unable to approach her problems because she is too worried, and she might feel tension in her body and experience shallow breathing. If we rate her stress from 0 (feeling neutral) to 10 (high distress), she might say that she is at an 8. Our goal is to introduce approaches that lower her stress and anxiety by a few levels so that she can be more productive and effective. We would look at breathing exercises, grounding, chunking the problem, encouraging self-talk, and so forth until she is able to lower it to a 3 or 4. From this lowered stress level, she can move forward and accomplish what she wants to do.

Changing Negative Core Beliefs

I also see the Adaptive Information Processing model (AIP) as another way that change can occur during treatment. AIP posits that we are constantly integrating and assimilating new material into existing neural networks. For example, a young child may first be exposed to pet dogs at a neighbor's house. The neighbor's dog might be very friendly, and lick the child and allow the child to pet him. The child holds positive associations with dogs. When the child goes out into public and sees dogs, she waves at them and tries to pet them. Her parents tell her to ask permission first because some dogs aren't as friendly as the neighbor's dog. The child takes in this new information and adds it to what she knows about being around dogs. She may notice that some dogs run away from her, seem indifferent, or even growl at her, but she still holds the belief that she basically likes dogs. She has learned that dogs will react differently to her and that she should ask before approaching a new dog so that she is safe.

A trauma can occur when an event gets stuck and is not assimilated into the child's knowledge about dogs. Suppose instead that the child who likes the neighbor's dog sees a different dog at a park, and she runs to greet it. Her parents are not able to stop her in time, and the dog barks and jumps, knocking the child to the ground. The child feels overwhelmed and worried that she will get trampled as the dog continues to jump. After the dog is pulled off of her, both her parents and the dog's owner are angry with each other, and the child does not get much comforting. In this case, the experience with the dog in the park is new and frightening and leads the child to experience a state of fear, frozen in her body. She notices the new belief, "I am not safe," that comes up around dogs. If this belief stays in place over time, then she will start to avoid dogs or become fearful whenever she hears one behind a fence or sees one far away. This traumatic material is stuck, and it is paired with the intense sensations, emotions, and cognitions that occurred at the time of the incident in the park, even though she is safe in the present day.

The AIP model is foundational for Eye Movement Desensitization and Reprocessing therapy (EMDR), a therapy developed by Dr. Francine Shapiro. In EMDR, the person is in contact enough with the traumatic material that she can allow her brain to do the work of processing through it and assimilating the bad event into the story of this person's life. At the same time, the distress about the event abates, and the negative world view changes from "I am not safe" to "I am safe now." In this type of change, there can be a letting go and an enduring change in the negative belief and distress.

Traveling Around the Mountain

For this model of change, picture the following: There is a mountain, roughly cone-shaped, with a road going to the top. Because the mountain is steep, the road starts at very bottom and the car drives around the lower base of the mountain, slowly making its way to the top of the mountain as it climbs higher and higher with each rotation around the mountain. Also, picture that one side of the mountain faces a beautiful scene, and the sun shines brightly on this side, making this the "light" side. On the other side, the mountain is in "darkness" as the sun cannot reach it, and the road is rocky and even treacherous in places. 

I use this imagery to discuss the way we can make changes and take a journey toward healing during our lives. We start on our healing path at the bottom of the mountain, on the dark side. As we drive, we eventually find ourselves on the light side, with all of the love, wellness, and success that this entails. However, as we continue on, we will come back to the dark side again. While we may feel familiar feelings or see similar sights, we are no longer in the same place on the mountain that we were when we began. We are, in fact, one rotation above where we started, and one rotation closer to the top of the mountain. We have access to new tools and experiences that are helping us continue to go on, even in the darkness. Likewise, as we keep driving and go back to the light side of the mountain, we are not at the same point of abundance that we were on the first rotation; we have gained new skills, experiences, perspectives, and relationships.

In this model of change, there is an awareness of change occurring over time and a message to hold onto hope in the dark times of the journey. This model encourages people to complete stages of work, as they are able to do so, and accounts for how we may feel like we have gone back at points. For instance, I have seen clients with childhood trauma begin to address it in early adulthood, but then do more detailed work when they enter a first serious relationship or have a child, because their new life stages bring up another element of the journey.

Your therapy may focus on a single one of these paths, or could include a combination of some or all of them. No matter what your destination, we can work together to discover the most effective journey for you.

More Ideas for Self-Care

One of the challenges of adding in self-care when you are having a rough time is generating the ideas. When we are low or overwhelmed, it is more challenging to be creative or nurturing. This is why I recommend making lists of activities to soothe, ground, and calm ourselves. 

I am attaching one article that can help jump start your self-care, and it happens to be one for which I was interviewed. Enjoy!

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