Therapy contains paradoxes; the one I most often marvel at is the universality of human suffering that sidles the individuality of each person’s journey. In my experience, a majority of emotional suffering sources itself from just a few wellsprings: relationships (the dance for love, attachment and belonging), trauma (experiences our minds can neither assimilate or accommodate), being human (getting sick, losing people, getting older, dying) and the need for meaning (sometimes appearing as work and life dissatisfaction suffering). Ultimately, none of these are inherent causes of emotional suffering in everyone all the time; I have come to believe that all of our (optional or extra) suffering relates with how we relate to our thoughts and feelings.
Each of you, dear patients, has your own wisdom by virtue of who you are or what you have learned; during our sessions together, some of those wisdoms have hit me like lightning bolts. It’s also true that some of you come to the therapeutic endeavor with a lot more, or a lot less, understanding about mental health, therapy and the human mind. Illuminating these blind spots is an important part of therapy, but I can’t help but wish this knowledge and education was taught or offered just at baseline: healing would catalyze.
A few provisos before I share my thoughts: I feel confident in saying that each seasoned therapist would have different lists. This includes the future me! Also, knowing something can change and accrete throughout therapy - I’ve often had people tell me “I got that, but now I really get it.” Lastly, these are not rules or even truths in the ‘100% sense / all of the time’ sense of the word. My biggest proviso: take everything I say lightly and trust your own experience above any of this:
A lot of mental health is basic. It’s about addition: adding what works. We have mountains of evidence showing us that - perhaps the majority - of mental health for most people has to do with what we are in relationship with on a daily basis: sleeping enough and regularly, cultivating and maintaining healthy relationships, eating in a way that works for your body (subjectively & objectively), reducing or eliminating unhelpful substance use, connecting with things that make you lose or right-size your ‘self’ (awe, nature, flow experiences, meaning) and making sure that you move often. How wonderful that these are also some of the best predictors of healthy and long lives!
I know, I know! But my problems couldn’t be explained or solved by just doing these things! You’re probably right, but I would suggest that dialing all of this in - to the extent you are currently able - could make a surprising difference. We tend to see our problems as more complicated and fascinating than they are, and our moment-to-moment lived experience as far less complicated and fascinating than it is.
The rest - the more complicated stuff of mental health - is about subtraction: removing obstacles. I wholeheartedly believe that we are generous, wise, compassionate, ethical and easeful … underneath all the built-up plaque obscuring that inner, core place. Nearly all of therapy, at least the kind I do, about the activity of removing obstacles, clearly seeing what’s there and living from that place.
Being a human involves suffering. I’ve had thousands of conversations that involve me identifying and trying to correct the belief that you (dear patient) are somehow special, different, unique, or even like the other humans because of the way you think or feel. It takes little time to logically dispel the idea that you are somehow different - and the only one who is! - than the rest of humanity. It’s not egotistical (though deeply egoic) to believe this - it’s better thought of as a deep fear of separateness, rejection or of not belonging. What’s more human than that?
I’m unique! Of course, but still human. Being human comes with the pain of life (heartbreak, loss, aging, dying, illness) and then the innumerable sufferings (typically our resistance to said pain, or mental habits / processes we have learned). By definition, everything you experience is human.
The natural and healthy state of mental health is change. Having a wide variety of thoughts and feelings is just what it’s like to have a healthy human mind. On the other hand, having repetitive thoughts and repetitive feelings that are stuck - a neurological constipation of sorts - is what characterizes the insensitively named category of ‘mental disorders.’ In many critical human systems, variety is a signal of health.
Every form of mental suffering is caused by underlying processes. These could be biological, but most commonly they are psychological: rumination, emotional suppression or avoidance, emotional or somatic illiteracy / disconnection or the many tricks of the mind (comparison, over-generalizing, personalizing, etc.). These are more practical than diagnoses: when you identify what processes your mind seems to like - your mental habits - you’re close to unlocking intransigent patterns of suffering.
Calming the body calms the mind. The brain is constantly storytelling to make sense of what is happening in the body. These neural summaries of the state of the body are expressed as emotions and thoughts. When you deeply calm your body, your brain naturally tells a more helpful somatic story while also helping you detach from distressing mental and emotional narratives.
Happiness shouldn’t be the point. It’s too fickle to be useful. I respect Dr. David Burns, but I don’t see “Feeling Good” as the point. Try meaning, try contentment, even flow. I also personally resonate with “engagement” or “fullness.” Or perhaps your point is about being ethical: kindness, compassion, generosity. Any desire that is based on acquisition is unlikely to be ultimately fulfilling. Pursuits, like those mentioned above, that rightsize the self - typically (but not in every case) a reduction - lead to mentally healthier humans.
Emotions have evolved as messengers. Emotions are meant to guide us. Can you imagine if you didn’t have something that gave you that ‘red flag’ feeling or not grieving for someone you love who passes? Would you even want that?
Many people ignore the messages within emotions, instead seeing them as inconvenient, pesky or loathsome. Emotions are to be mindfully felt without the fetters of judgment or filtration. This is what I would call deeply listening to feelings. This can be confused with acting out of the emotions. I’m talking about feeling feelings as a way to incorporate that data stream to more fully inform our lives.
Compassion is skillful responding to suffering. We ignore, judge, criticize or avoid emotions at our own peril. Thoughts also respond poorly to harshness. Compassion - as I define it - is seeing something clearly and then responding in a way to reduce suffering. Ah, I can see that sadness is coming up in my body, and I can feel it in my chest - just right here - in fact, I can feel it changing as I see it clearly. I can see there are thoughts related to it, but those are just judgments or reactions to the emotion. It’s a hard thing to feel sad, but I know I’m not alone in that, I know it’s just a human experience. Those who respond to suffering without compassion will get stuck in suffering.
Compassion helps with behavior change. Changing behaviors can be very easy or very tough. Because my body has a talent for creating cholesterol, I have worked to reduce heartland favorites like cheese and BBQ. Here’s what hasn’t worked for me: I know I need to not eat this … but it’s so good!! Here’s what has: seeing my food choices as direct acts of compassion towards the lining of my blood vessels (which is just as much me as my desire to have something tasty).
Thinking is a tool that should only be used when it’s needed. I try not to actively think about something unless I need to or I want to. Of course, discursive thoughts and streams of thinking occur, but many people give carte blanche to their minds 24/7. This conditions a very busy mind.
Your ‘self’ is probably being defined in a too-limited way. We tend to think that it’s me, up in the tower, directing all the flights, calling all the shots, with all my important concerns - all of them words and thoughts. If this is what or who you think you are, you’ll think that you’ve chosen your thoughts and feelings which will lead you to personalize your thoughts and feelings: I can’t believe I feel this way, how could I have that thought?! This is a sure-fire path to stuckness and suffering. We are so much more than this: we are the trillions of alien life forms living in our guts, we are our mitochondria, we are the parts of the brain we don’t have conscious access to - and so much more than we can possibly know.
A regular meditation practice is likely to speed the recovery process and reduce the chance of relapse. At least in my practice, meditation (one’s personal psychological laboratory) alongside psychotherapy has a powerful synergistic effect. Certainly, meditation is my personal, primary form of (non-basic) mental health support. Also, when my patients have a thriving meditation practice, I have many more colors to paint with as a therapist.
To quote meditation teacher Joseph Goldstein: “don’t waste suffering.” I want anyone working with me to become expert composters. To take what you see as garbage and skillfully convert it into the raw material that allows for growth that would have been impossible without it. Every time you have suffering you have an opportunity to learn: what underlies the suffering, how you can skillfully respond. When I am at my best, my suffering constitutes the direct pain of the experience and also excitement and joy that comes from seeing an opportunity to uproot a mental habit that causes suffering.