Thursday, February 2, 2017


One of my patients gave me a copy of "The Book of Joy". It describes a series of conversations between two of the most respected contemporary psychospiritual teachers - the Dalai Lama and Desmond Tutu. Thee two men - now both in their 80's - share their thoughts about how to experience joy amidst all the pain and suffering and conflict in the world.
Among the myriad insights of the book one notion presented by the Dalai Lama inspired me to write this blog. He raised the question: since we emphasize the importance of having a strong physical immune system why don't we also encourage people to develop a strong mental immune system? "Of course" I thought,"that makes sense. As psychotherapists and counsellors we can help our clients to do that." Some of what follows flows out of their discussions and some emanates from my own work with patients.
The central concept is that by developing our psychological immune system we are taking a proactive preventative approach. As with physical illness is it not wiser to try to prevent problems rather than wait until an illness occurs? When we have a strong psychological immune system negative emotions(fear/anxiety, powerlessness/helplessness etc.) usually arrive in an attenuated form and are not overwhelming. Also when a large stressor does occur we have more internal resources to deal with the situation.
All of what follows will involve active work by our clients between their sessions with us. Or as some of my patients describe it - homework. The active work is necessary because so many of our usual psychological patterns are deeply engrained and have been reinforced repeatedly over our lifetimes. And - it is important to remember - are physiologically wired through brain patterning. A plethora of brain research in the last decade confirms this neurological patterning - including the important insight that our brains are "wired for negativity." The concurrent hopeful news is that the research results are also reporting that it is possible to change these patterns through active effort.
I teach all of my patients a simple breathing technique as a tool for dealing with anxiety and for releasing negative thought patterns. I say to them,"Physiologically with your in-breath your body takes in what it needs (oxygen) and with your out-breath it gets rid of what is not good for it(noxious gases). Let us now imagine that with your in-breath you are taking in what you need psychologically(peacefulness, relaxation,positive thoughts/energy etc.) and with your out-breath you are releasing what is not good for you(anxiety/fear, helplessness/powerlessness, self-criticism etc.)" We practice this in the office for ten minutes. The enables my clients to experience the process, give feedback and to receive from me individualized tweaking of the technique. Then I encourage them to do this for ten minutes each day until our next session. At the next visit, and periodically in the following months, I inquire about their efforts. We discuss difficulties in the mechanics of the technique and any psychological/practical resistances to incorporating this tool into their lives.
I also recommend that during their everyday life whenever they are feeling anxious or being overly self-critical to take a few minutes to do the breathing technique. Each time that they do that they are strengthening a new psychological and brain pattern.
Of course there are a number of my clients who already have some form of a meditational practice that involves breathing(e.g. mindfulness) or an active practice(yoga,tai chi etc.) that incorporates breathing. For these folks I encourage them to bring these practices more into their daily life utilizing mini meditational moments throughout each day to release noxious emotions. I also now say,"The more you do this practice the stronger your psychological immune system becomes."

Both the Dalai Lama and Desmond Tutu place a strong emphasis on cultivating compassion. Since the need for connection with others is a fundamental part of our humanity they emphasize that it is essential that we develop a greater sense of concern for the well-being of others. Interestingly evolutionary scientists see cooperation(including empathy,compassion and generosity) as fundamental to our species survival. There is additional research that indicates that the reward centers of the brain are activated when we feel compassion and do something for others. Psychologically each time we do something for someone who is suffering we expand our heart's capacity for compassion.
Often when our patients are describing their own pain they will also report that they are aware that there are people in the world who are suffering more than they are. Not infrequently this makes them feel less entitled to their own pain. My response is"I have a different perspective. Whether your pain is greater or lesser than others is not the issue. It is not a competition. Our common pain is one of the things that connect us to others. Imagine that your current pain is part of the universal pain and that our hearts go out to each other." Another common comment by my clients when they are reporting the losses or big life trauma of someone else,"I cannot imagine what it would be like to lose your...or to have that kind of trauma." My usual response is,"I have a different perspective. Even though to do so is hard I think that it is important to take the time to try to imagine what it would be like to be them experiencing that pain. It will increase your compassion for them. Both of you will benefit. You will feel closer to them and they will feel the energy of your compassion. They will feel less alone."
Whenever my patients are overly critical of themselves I say to them,"It is important to be compassionate towards yourself." After they have heard this phrase from me a number of times they gradually internalize it and begin to say it to themselves. Developing self-compassion significantly increases our resiliency to stress because we are no longer attacking ourselves.
Many of my clients have difficulty taking in praise from others and in genuinely feeling good about their own accomplishments. Some of this difficulty is personal and related to their life narrative.(Please refer to the chapter entitled "Love Blocks" in my book "Working From the Heart" or an earlier blog also entitled Love Blocks" for an in-depth discussion of this issue). Some of this difficulty is cultural in that there is an overemphasis in our society on constantly striving and being productive. For many people this contributes to self-criticalness and unrealistic self-expectations. The resultant diminished self-esteem is not good for our psychological immune system. It leaves us with a sense of less inner strength to deal with life's stressors. I try to counteract this personal and cultural pattern whenever possible. When one of my patients reports some moment of psychological growth I stop the flow of the session to acknowledge the accomplishment. Then I encourage him or her at that moment to use their in-breath to take in more deeply the sense of accomplishment and with the out-breath to release some of the inner feelings of low self-worth. For some bigger moments I extend a "high-five"; for even bigger moments I will give a "double high-five" or a hug at the end of the session. These moments during the session are also a modeling. I encourage my clients as "homework" to take a few moments during their everyday life to use the breathing technique to acknowledge, celebrate and take in more deeply their daily accomplishments.

One of the areas that Desmond Tutu and the Dalai Lama emphasize in order to experience more joy is to encourage us to cultivate gratefulness. They discussed how our competitive culture focuses on the accumulation of things, success/failure and external measurements of status. I also witness how often my patients focus on what is missing or insufficient in their lives. As a Buddhist the Dalai Lama has practiced for over seventy years non-attachment to externals and cultivating gratitude for life. He expressed his delight about the research that grateful people report more positive emotions, better physical health,vitality and life satisfaction combined with lower levels of depression and stress.
Introducing a more grateful attitude into our life does not mean we deny or minimize our pain and struggle. What it means is that we are acknowledging that coexisting with our current suffering are things and people in our life for whom we are grateful. To help cultivate gratefulness I teach my patients to use the word "and". For example,,"I am really struggling right now and I am grateful for friends who really care about me." I also think that ritual can be helpful in cultivating gratefulness. For example, at the end of my meditation I always spend several minutes thinking about the people now and in the past who have contributed to my growth including those who have caused me problems and forced me to grow. Several years ago I also started another ritual. After I have seen my last patient for the day I kneel down in my office and give thanks for the patients who came to me that day who by opening themselves to me sustain my work and my life. I am also grateful for all the sources,known and unknown, who have provided guidance that day so that I could help my patients. As these practices have evolved my life has felt increasingly rich and full.
In conclusion I would like to reiterate that all of these ways of developing and strengthening our psychological immune system inquire conscious effort and hard work. We are often going against the patterns of a lifetime that are psychologically engrained and neurologically wired. The results,however,are worth the work.