What I Learned On Summer Vacation, Part 2: Novelty!

View from the Colorado River

In part 1 one of my series on life lessons gleaned from my recent family vacation I focused on the importance of boundaries. By taking care of my own needs first – with flexibility, acceptance, and humor – I was better able to show up for my family. I also learned how important it is simply to have fun and step outside of my own comfort zone, which brings me to the topic of novelty.

My Name is Robert and I’m a Scaredy-Cat

By novelty, I mean anything (idea, object, interaction, adventure, etc.) that’s new, anything that one wouldn’t normally experience or commit to in one’s workaday routine. As one ages there can be an assumption that there’s nothing new under the sun, which can contribute to a narrowing of experience. This sometimes has been my reality in times past. Thankfully, I have a habit of regularly choosing to shake things up and yet as far as I can remember it’s never been a conscious decision to seek novelty. It typically has occurred as an often organic transition in my life: perhaps a nonconscious novelty-seeking urge!

On the whole, I am, for lack of a better term, a scaredy-cat when it comes to what I perceive as high-risk activities. In fact, I tend toward anxiety in the face of any new experience, but when it comes to high adventure, thrill-seeking does not thrill me at all! Sure, I engaged in some reckless behavior as a younger man, but I rarely sought out purely visceral experiences. I was happy camping, backpacking, or pursuing purely intellectual adventure. In most ways, this path has served me well and yet I’m now beginning to fully metabolize the importance of “the new” as it pertains specifically to my own life.  

Given my druthers, I still prefer slowing down when I break away from my normal routines. I will stop and smell the roses, but my focus when relaxing generally is not to push myself. However, I’m beginning to whistle a new tune these days. I still enjoy lazing, but I’m discovering that seeking out new and challenging adventures is rejuvenating and essential to my mental health.

The Adventures of Dopamine and Plasticity

If we start with the simple premise that the human brain craves novelty, it’s worth asking why. In a nutshell: new experiences – and these could be intellectually or viscerally rewarding experiences – flood our brains with dopamine and dopamine makes us feel not simply rewarded, but motivated to learn and experience more. It’s a self-reinforcing system that if unwisely indulged can lead to addiction, but if neglected can lead to stagnation. Our task as humans is to find the golden dopamine mean that physiologically prepares and rewards us to push beyond our comfort zone in order to quite literally change our brains.  

The saying, “neurons that fire together, wire together,” is a simple summary of the concept known as brain plasticity. With new experiences, we create new neural connections. The assumption for many years was that new connections in our brain ceased at some point in time, but the relatively recent discovery of brain plasticity drives home one of the enduring tenets of psychotherapy: change IS possible.

I may be locked into some realities of birth, but I am not a prisoner. I can choose how I respond to my circumstances. In choosing and experiencing new ways of being or thinking, my brain has the capacity for growth. The notion of brain plasticity reveals that the childlike, or more accurately, the adolescent desire to throw caution to the wind and push against our boundaries is something that can exist positively throughout our lives. The notion of brain plasticity encourages us not to forget that the adventure does not and should not end with the onset of adulthood.

When experiencing “the new” we are reminded affirmatively of our own limitations. To immerse oneself in newness is to admit, “Wow, I never did that before!,” or “Cool, I didn’t know that!” My take on witnessing my own limitations this summer is that it has allowed me to confront my own vulnerability. In the final analysis, I will have known and experienced very little that this great big world has to offer me. Therefore, it is imperative that I engage with the unknown, the new, while I have my chance. I realize the circularity of the following statement, but I’ll say it anyway: I am most human when I am risking something in order to more fully experience my own humanness.

I’m not suggesting that we obsessively look for the next thrill in order to avoid self-reflection  only that we remain willing to take risks occasionally in whatever way best suits us in our current circumstances. We do not have to resign ourselves to becoming just another Man in a Gray Flannel Suit or to becoming just another Peter Pan. Instead, we can choose to remain curious and willing to be willing to look, feel, or sound silly, scared or imperfect; that is, to be vulnerable.

Ecce Homo, Behold the Man

When I recently found myself suspended a mile above the Grand Canyon in an EcoTour helicopter I discovered within my ear-to-ear grin a joyful co-occurring giddiness and terror. I had approached and zoomed past my comfort zone. My mind was blown (and transformed)!

Floating down the Colorado River and witnessing first-hand the forces of wind, water, and time I felt awesomely miniscule. Beaching the raft and feeling what 46°F water feels like (brrr!) and then beholding petroglyphs left by Ancestral Puebloan peoples in the Navajo sandstone, I felt like an adventurer!

Bouncing around the Arizona desert in a hot pink jeep I felt like, well, I felt like a tourist and I was OK with that! How else would have I seen John Wayne’s initials carved into a boulder or tasted manzanita berries for the first time?

I sought out these experiences, consciously and willfully and made a decision to stretch myself simply by having fun. Luckily, such experiences also help my brain grow. Novel experiences lead to new connections ready for learning, excitement, and more connection with my innate humanness. Who knew that a family vacation could do so much?

More to come: next, I’ll be sharing with you the value of not accepting the first option offered.

What I Learned on Summer Vacation, Part 1

Have Family, Will Travel

Bryce Canyon

This year I headed west with most of my family. We were off to see some of the natural wonders of these United States: Grand Canyon, Monument Valley, Lake Powell, Bryce Canyon, and Zion National Park, among other idyllic spots. Traveling with one’s family of origin as an adult is a mixed bag, equal parts excitement and anxiety, but I knew in my bones that the trip would be memorable: fun and silly, yes, and also potentially tense and frustrating. In other words, a family vacation!

Having now had some time to digest the experience, I’ve come away with a clearer understanding of how to thrive in the midst of potential family drama. Over the next few weeks I will touch on each of the lessons I took away from the experience. Up first: boundaries.

Boundaries? I Don’t Need No Stinkin’ Boundaries

Mental health professionals are fond of talking about boundaries. Why, you ask? Because they are a vital part of healthy human relationships and they’re tricky as hell to maintain. Boundaries are one of those things that most of us assume we have plenty of, thank you very much, until we find ourselves acting out of character. If not discussed or reflected on, boundaries can get blurry and confusing.

Case in point: when I was a younger man and living many states away from my family, I would visit and sometimes find myself at the end of the trip exhausted, frustrated, and vowing to not repeat the experience. Of course, I found it difficult to put a finger on what to change in order to improve my visits and by the time my next one rolled around I’d forget the promise I made to myself!

In hindsight, of course, the one obvious mistake I made was choosing to value other’s needs or wants above my own. I chose to spend as much time as possible with members of my family without setting aside any for myself and my sanity. I didn’t realize this at the time because I didn’t know I had a choice. I had no boundaries!  

Saying No

It can feel mean-spirited or even disloyal to say no to family members. The pressure to squeeze as much nostalgic joy as possible out of time with family is, I’ve found, both external – “Why won’t you come to the pool with us?” – and internal – “I’m a bad son if I don’t go to the pool with them.”

The illusory goal of Rockwellian tranquility, unfortunately, quickly morphs into short tempers and exasperation when on the horns of a false dilemma: I can either be a good son or a bad son. Thankfully, there is always another option.  

Those of us who are able to have healthy relationships with our families – and it’s important to note that not all of us should maintain relationships with our families of origin – can fall into the trap of wanting and wishing for a storybook family. Sure, we can admit our families drive us crazy, but it wasn’t that bad was it?

Maybe not, but we’re not kids anymore. It’s necessary to individuate ourselves. Ignoring this need can lead to repeating the same mistakes over and over again, always looking for a different outcome. The intention “to family,” if I may coin a new verb, is noble, but the impact can be painful without acknowledging our own limitations and preparing accordingly. Learning to say no is necessary for everyone’s good mental health.

Good Fences Make Good Neighbors

I must admit that prior to this family trip I remained firmly and blissfully in denial. On a number of occasions my wife would ask for some small detail about the trip and I found myself dumbfounded. What trip? What are you talking about?

In those moments when I could not bring to mind our plans, I realized that my fear and worry were having their way with me. Unknowingly, I was forcing the trip into some deep nearly inaccessible region of my non-conscious mind. After more than a few humorous discussions about this denial, my wife and I came up with a plan.

We admitted our concerns to one another and planned not simply to have mental, emotional, and physical boundaries, but to utilize them. We made the advanced decision to detach consciously in order to have more fun. We discussed how we were going to survive and thrive in the midst of this summer vacation.

Family relations might still and forevermore create stress, but I have a choice in how I respond to that stress.  

Flexible Boundaries

The simple solution: we intentionally planned time away from the family in order to maintain our sanity and better our odds of having fun.

We walked into the vacation fully expecting feelings of overwhelm and planned accordingly. We identified excursions just for us and invested in our own experience. We detached with love from the larger group and created our own adventures. By taking care of ourselves first we were better able to be present for everyone and everything else.

Boundaries, of course, must be firm, and it also helps if they sometimes are flexible. If you are not capable of bending, if you remain rigid, you will break. Historically, steel supplanted iron because of its hardness, yes, but only in combination with its flexibility. Firm and flexible is another way of defining strength. When in doubt, remain firm and bend like steel rather than break like iron.

In the context of this vacation, when our plans didn’t pan out the way we had envisioned, my wife and I rolled with it. Sure, we grumbled about actually having to exercise our flexibility, but we kept in mind the reality that we were going to be just fine. Internally, I steeled myself for unknown, but expected bumps in the road.

My past experiences of overdoing family have somehow allowed for a wee bit of wisdom to creep into my life. Premeditated and boundaried love allowed me to experience the fullness of this family vacation no matter what. When things went according to plan, I flourished. When those plans went awry, I admitted my frustration and moved on as best I could. A trip detour, after all, is simply another route to adventure.

Next up: the power of novelty!

A Reflection on Anxiety

A recent incident reminded me of the power of anxiety. The partner of a family acquaintance was seeking confirmation of a suspicion he held about a loved one. (This individual, whom I have never met, was neither a client nor a potential client.) He contacted me in a moment of panic hoping to gain certainty around a fear only he himself believed was true. The fear itself was not irrational and if true would have impacted me. For the individual, this fear was unbearable. The anxiety was palpable.  Afterward, I found myself continuing to ruminate on the experience. What exactly was this person looking for?

I am not in a position to make a diagnostic assessment of this individual, nor do I think one is necessary; rather, what follows is a brief exploration of this situation in order to reflect on the idea that anxiety is indicative of a discomfort with and a rejection of uncertainty.

What is Anxiety?

Clinical anxiety disorders affect a large number of people in the U.S. The typical estimate is that about 40 million of us, nearly 20% of the population, live with it. Anxiety differs for everyone, but there are some common manifestations: worry, avoidance, fear or panic, disappointment or sadness, and physical reactions like muscle tension, breathing difficulties, nausea, or increased heart rate. The causes of anxiety are multiple and difficult to pin down. Generally, anxiety is an individualized response to outside forces as varied as trauma, family of origin issues, natural disasters, personal genetics or biology, substance use, stress, or a combination of things. The personal impact of anxiety can range from occasional frustration or annoyance to lifelong, crippling fear and self-judgment.

Meaning-making is critical to human survival and if we bracket the symptoms and causes of anxiety it seems to me that anxiety itself is a symptom of a search for certainty. We make sense of the world in any way we can and yet sometimes we are faced with meaninglessness. Anxiety’s emergence is in a sense a rational response adopted in order to survive senselessness. The chaos that characterizes meaninglessness allows us nowhere to focus our emotional response, usually fear, and anxiety emerges, perhaps out of necessity.

Anxiety and Freedom

One philosophical understanding of anxiety emerged in the 19th century with the rise of existential thought. The Danish philosopher Soren Kierkegaard referred to the possibility of taking action, even a potentially dangerous or deadly action, as the “dizziness of freedom.” French philosopher Jean Paul Sartre convincingly used the term nausea to describe this state of human being.

Many of us, myself included, sometimes spend inordinate amounts of time and energy seeking to avoid anxiety and attain certainty. In order to avoid meaninglessness, or the realization that we each have the freedom to make any choice we want, I will experience anxiety and search desperately for some kind of certainty. In this telling, anxiety is a frenzied flailing for some type of life boat. For existentialists, uncertainty is a defining condition of the freedom we all possess to create meaning. Anxiety presupposes the possibility of creation, an act requiring reflection on what has existed, what exists now, and what could exist in the future. Choices are not infinite, they usually are quite limited, but the quest for certainty can send us either ping-ponging back and forth within our freedom or it can freeze us in our tracks. Who wouldn’t want help in this scenario? Thankfully, it is possible and healthy to assume another stance: curiosity. 

A Chaotic Quest for Certainty

Returning to the story I began with, the individual in question had reflected on his situation and chosen to pursue certainty (i.e., the elimination of possibility) via distorted reasoning: I fear X, X appears to be more powerful and convincing than any other option, therefore I will believe X if only to experience the brief tranquility of certainty that my fear is reality, and my assumptions about the world are correct.  This need not have been the case, however. He could have elected to remain free within his anxiety through the creation of a new understanding about himself and his situation. This would have entailed a change in his relationship to another person, to the relationship itself, and to his own self-understanding. The moment was overwhelming for him and he reached out to me, I think, for confirmation of his deepest fears, but without acknowledging the possibility that he could be wrong. He reached towards the choice to believe, which did not yet exclude the choice to not believe, and sought my counsel to confirm and soothe his dizziness, to relieve his anxiety.

In his effort to attain certainty, even if only certainty of his negative interpretation of events, a choice was made by this individual thus, creating a situation in which everyone’s role was predetermined: in choosing to believe, he required confirmation in order to calm his nerves, if only for a moment of satisfaction in being “right,” being certain. Upon reflection I realized there were two choices for me at that moment in time: I could choose to engage and accept his choice – even if I disagreed with his choice, engagement would have validated his belief – or I could choose not to engage and allow this individual, and myself, the opportunity to remain in freedom; that is, in anxiety. My collusion with his version of reality would have granted him certainty, even if only briefly, whereas exiting myself from his predicament would keep him in uncertainty; that is, freedom.  I chose not to participate. 

Anxiety and Psychotherapy

Anxiety is debilitating. There is no doubt about its potential to damage individual lives and relationships. However, choosing to accept the open-endedness and unknowability of life on life’s terms and to examine how one makes sense of this predicament has the potential to create even more possibility, including the possibility of increased anxiety. A primary habit associated with anxious people is the avoidance of anxiety provoking situations, itself a grasping for certainty. Unfortunately, conscious avoidance of anxiety as a style of being ultimately leads to increased and deepened anxiety. (Generalized anxiety disorder, for example, is sometimes the endgame scenario of a lifetime of avoidance, which might be a rational response if one is never allowed the chance to build a collaborative relationship in which to examine and fully experience one’s emotional responses.) The straightforward yet tricky route through anxiety is accepting the sickening reality of it and acting anyway. Avoiding stimuli creates the certainty of avoiding discomfort and also decreases one’s freedom whereas seeking stimuli, an act of curiosity, exercises one’s freedom and increases possibility.

Naming anxiety, exploring its reason for being, and owning one’s primary emotional state when faced with it is difficult. What many of us want is simply to avoid what we perceive as pain. It is today an almost national obsession. We pursue relief through varied means: medication, meditation, exercise, therapy. However, anxiety in my understanding is the human condition. Adverse experiences, individual biology, and working models of self and other prepare the ground for greater or lesser anxiety, but humans are condemned to freedom; that is, no matter how much effort we invest in seeking certainty and security there always exists the option of choosing another path, of experiencing uncertainty. This potentially is debilitating, whether because of panic or guilt, for example, but in the final analysis it opens up the reality of living creatively. We can choose to accept or deny our ability to create, we even can choose both/and. To be fully human is to accept our own responsibility, however limited it is in some instances, and create our own lived meaning. To transcend anxiety is impossible, therefore. To embrace anxiety is difficult, but perhaps the only feasible way to be fully human.

My Role

What does this perspective mean for my clients? Am I asking them to endure suffering because, well, that’s just the way the world is? Emphatically and resoundingly, no! Working from the perspective that relationships or attachments are central to our humanity – they are the both the impediment and the pathway towards meaning and a life well lived – I believe that my role as a psychotherapist is to assist clients as they grapple with the risky proposition that meaning, happiness, fulfillment are not found, they are created in relation with others and with ourselves. Relationships are necessary for physical, emotional, and spiritual or psychological survival. They make life worth living.

As a psychotherapist, I know that attaining some modicum of safety, security, and stability is necessary for clients. After all, people come to therapy for relief. The alleviation of pain can and sometimes must be the focus of my work. The experience of depth psychotherapy requires full participation and only a safe, secure, and stable client can assent to this. However, to stop there is not fully accepting the human capacity for growth and change. Symptom relief is necessary, but not sufficient. Thankfully, because we are social creatures we have an inherent ability to grow within a variety of relationships over time. My role as therapist is to assist my clients in determining how, when, and with whom they wish to engage with life’s anxieties.

In the story above, I chose not to hold another’s anxiety, first, because I am a stranger to him. He was and is not invested in me or us. Perhaps just as significantly, I chose to allow this person the chance to experience his freedom, to actualize the possibility of possibility. This is a scary proposition when so much of our culture, especially masculine culture, embraces a skewed and damaging understanding of strength: act with certainty, deny emotional involvement, and damn the consequences. A more thoughtful approach is to consider the consequences, admit our emotional engagement, and move forward cautiously and humbly. In this way we might just evade the avoidance of anxiety and fully embrace our freedom to create meaning.

Learning to Pay Attention to Our Bodies

A client working on substance abuse issues once explained to me how it felt to know that his father was dying. He described a nauseous feeling in his stomach using his hands to mimic the roiling sensation inside of him. I wanted him to describe the phenomenon so that he could begin to understand the intimate and inextricable connection between his emotional and physical experiences. To practice coping strategies, after all, it is critical to know when to implement them. We have smart bodies that alert us to our feelings, but we too often unfortunately forget how to read physical symptoms as manifestations of emotional stress.

Tori Rodriquez’s recent article in Psychology Today (March/April 2015), “Inward Bound: The Mysterious Connection Between Emotion and Physical Sensation is Coming Into Ever-Sharper Focus,” briefly explores recent research on interoception, a “form of sensory perception…that involves the feelings that originate within the body.” Rodriquez posits that “if people can alter their sense of their body’s physiological condition…it can potentially shift their emotional state.” For my client, simply naming his physiological response to a stressor was a big first step. There was no need to alter his response. It was enough to just pay attention to it. With this intervention the client gained access to a practical tool for identifying potential use triggers.

If clients with substance abuse histories can quickly and consistently identify triggers to their use they are more able to utilize adaptive coping strategies rather than returning to their substance of choice to manage their feelings. Awareness of early physiological signs of stress is not just “nice to know.” The ability to name and thereby control negative emotions, by listening to our bodies, could be life-altering for most and lifesaving for many.

As infants, we lack the ability to verbalize our distress. We let the world know how we feel by crying, fidgeting, smiling, and cooing. We are not bashful. We let the world know that we need attention. As we develop verbal acuity, however, a strange thing happens; we separate the world, including ourselves, into discrete categories and become dependent on our ability to verbalize our thoughts. We relegate our emotions to a mysterious sometimes incomprehensible realm. The most common quick and dirty categorization system is the head and the heart. There is power in the head/heart metaphor – why else would so many people rely on it? – but what about the rest of our bodies? Could not our bellies, our backs, our knees also be barometers of change?

Returning to my client, that sickening agitation he described in the pit of his belly was not solely a byproduct of his grief. It was a signifier of his need: pay attention to me! In our session, he was able to articulate a desire to use, yes, but the first experience he described was his nausea, not the obsession to use. His body was the first alert. His nausea was the canary in the coalmine.  

Physical sensation itself could be the first indication that we need help and support in managing stress. By practicing and bettering our ability to “read” our body’s messages, like this client hopefully learned to do, many of us could improve our overall health. We are not just a collection of disparate parts connected by happenstance, but a finely tuned ecosystem. If we pay attention to our present embodied being, we might realize that we are built to feel. We have developed a cornucopia of maladaptive coping strategies (e.g., drugs, sex, food, media, etc.), I think, partly because we have forgotten that our bodies are not just vehicles for a disembodied spirit. Without our bodies, we do not exist. Without our bodies, we do not feel. Without our bodies, we are not human.

Perhaps it is time to pay closer attention to what our bodies are telling us.    

Holiday Expectations

Substance abuse is sometimes referred to as a threefold disease: mental, physical, and spiritual. Around November and December, however, those in recovery jokingly reinterpret the threefold disease concept as Thanksgiving, Christmas, and New Year’s. As corny and tired as the joke is, it rings true. The holidays can be, and often are, risky to well-being.

Unfortunately, just about anyone today can identify with the sentiment expressed by this threefold concept. The holidays are stressful! Many of us understand this, but why is this season of joy also a time of discomfort and pain? To paraphrase Tolstoy’s Anna Karenina, all individuals are unhappy in their own particular way, but I think there is a common thread knitting together much of the stress and unhappiness that presents itself during the holiday season: expectations.

The biggest expectation of all is that we should be happy. From Halloween until after the New Year, we are inundated with messages imploring us to be happy. The music, the movies, the advertisements, the parties, the greeting cards, the family: it’s overwhelming. Happy Holidays begins to sound less like an expression of cheer and more like a command! The impulse to make every holiday moment joyous and bright has the potential to backfire. Unremitting happiness is neither possible nor is it healthy. It’s normal and perfectly OK to be stressed or even blue when confronted with unsustainable expectations.

For those lucky enough to have fond holiday memories there can be an expectation that all holidays should match the magic and joy of our (hopefully!) halcyon youth. The nostalgic urge to recapture holidays past is reminiscent of an addict ceaselessly trying to recreate his first high; we almost, but never quite get there and we repeat the same mistakes over and over again always hoping for glorious results. Sounds like insanity to me! The only moment we have is now. The urge to recreate the past rips us from the present moment and makes it difficult to address our current realities, good or bad. Faced with the impossibility of turning back time, we can lash out in judgment, hurting others and ourselves. Fondly remember the past, but know that it is impossible to recreate. Besides, memory is unreliable and those fond remembrances likely exist that way only in our own minds.

There also is the insidious expectation that we should be able to meet and care for everyone’s needs during the holiday season. The simple fact is that I can give only what is truly mine. If I forget this, the season of giving can lead to emotional and financial bankruptcy. The intangible spirit guiding the urge to give – love – is a noble and powerful emotion and it might very well be an inexhaustible resource. However, the outward manifestations of love this time of year – overspending, overpromising, overextending – reflect a simple fact: humans possess finite power and when stressed beyond capacity, we will break. If I don’t have it (money, energy, emotion, enthusiasm, patience, etc.), then how can I give it?

Expectations are stressful and for many us, unhealthy. Thankfully, there are simple ways to manage holiday stress, anxiety, and depression. For a quick review of how to care for ourselves this time of year, I encourage you to review an article by Atlanta-area therapist, Alicia Simoni, “Helpful Tips for Dealing with Holiday Doldrums.”  

Where are you on the U-Curve?

Over time, life satisfaction changes.

Consider the midlife crisis; how many of us bring to mind a greying middle-aged man behind the wheel of a too expensive, bright red sports car, or something to that effect? Don’t be bashful. It’s a common stereotype. 

Interestingly, new research shows that the midlife crisis or midlife slump is perhaps not just a culturally bound phenomenon of privilege. It might be an inevitable, biologically determined journey in which we are given the opportunity to grapple with our own expectations and limitations in order (hopefully!) to cultivate a more generous and wise approach to determining what’s really important in life. (Hint: it’s not a bright red sports car!)  

Jonathan Rauch’s cover story in The Atlantic this month, "The Real Roots of Midlife Crisis," explores the so-called U-curve, a period in which life satisfaction or happiness begins to decrease in early adulthood until somewhere in one’s mid-50s when life satisfaction begins to increase again. In other words, “happiness may be affected by age, and the hard part in middle age, whether you call it a midlife crisis or something else, is for many people a transition to something much better—something, there is reason to hope, like wisdom.”

Where are you on the U-curve? And how are you dealing with it?  

The Stages of Change and the 12 Steps

I was introduced to the transtheoretical stages of change model during an intensive training in motivational interviewing (MI) in graduate school. In this model, change is a progressive and rational process dependent on hard work and sustained effort. It is not magic.

While reviewing the “stages” (precontemplation – contemplation – preparation – action – maintenance) I was struck by a similar structural feel between the stages of change and the 12 Steps introduced by Alcoholics Anonymous in 1939. A 2010 article, “Combining the Transtheoretical Stages of Change Model and the 12 Steps of Alcoholics Anonymous to Monitor Treatment Progression,” reached similar conclusions, specifically which Steps fit with each stage.

The 12 Step approach, especially participation in 12 Step groups, does not work for everyone. Thankfully, there are other approaches and strategies. I would like to reflect on a few broad structural similarities and differences between the stages of change and the 12 Steps. The stages of change might be more helpful for those not comfortable with the Steps’ orientation toward powerlessness and reliance on a Higher Power.

Similar in Structure

The most obvious similarity between the stages of change and the 12 Step approach is that both rely on a progressive “linear” approach. Change does not happen overnight nor does it happen miraculously. It moves directionally as a result of conscious, purposeful effort. Second, both approaches emphasize the importance of relationships. The 12 Step approach relies on sponsorship; the stages of change model functions within the therapeutic environment.

Third, both approaches are, if you will, guides or maps offering markers of progress. Above I used the word “linear” in quotes because while there is directional movement in both approaches, the 12 Steps and the stages of change assume the reality of relapse. So, while there is a focus on moving from Step 1 to Step 12 or from precontemplation to maintenance, relapse typically occurs more than once. Rather than an arrow-like unidirectional progression, recovery more often resembles a spiral as one falls back and moves forward again and again retracing ones’s path, hopefully wiser and more knowledgeable than before.

Finally, both Stepwork and therapeutic work effect internal change, but the work itself is self-consciously taking place outside of the individual; that is, there is an externalization that takes place. The “self” is examined, analyzed, and contemplated in conjunction with an Other in sessions, in meetings, or on paper. Distance is put between the recovering individual and his actions. Interestingly, as one goes “deeper,” further distance or space is emphasized by each marker (i.e., the designated stage or Step).

The disease model supporting the 12 Steps can be viewed as fostering internalized shame – “I am an alcoholic” – and yet in practice it functions as a convenient externalizing tool. For example, when a recovering addict says to her sponsor, “that’s my disease talking,” she is able to separate herself from her disease. A similar process occurs in session when a client and therapist explore and process specific experiences as merely one part of an individual’s lived experience.

Different in Use

There are differences, of course. To begin, the stages of change serve as markers enabling therapists or counselors to tailor their interventions, but within 12 Step work tracking one’s own progress is fundamental to recovery. The therapist as guide is marking a client’s journey, but the client does not need to track his progress for change to occur.

In other words, the stages of change are more important to the therapist than the client, but the 12 Steps are necessary accomplishments for the alcoholic or addict. They are crucial to building self-esteem and self-efficacy (i.e., recovery). Working through the stages of change with a therapist is labor intensive and yet self-consciously moving from one stage to another is not a requirement for recovery – a client can remain oblivious to his progression through the stages.

Second, the Steps are explicitly instructional while the stages are merely descriptive. I have heard the Big Book referred to as a textbook enabling alcoholics or addicts to manufacture a spiritual experience. Relatedly, the environment in which both approaches are utilized is unique and exclusive. The 12 Steps are used within specific didactic organizations like Alcoholics Anonymous or Narcotics Anonymous. The stages of change, however, can be utilized by any therapist, counselor, coach, or healer. The Steps are wedded to a specific program while the stages of change remain firmly nonsectarian.  

Next, it is important to remember that Step work must be guided by a sponsor who has completed the work herself. The stages of change do not require the guide’s direct experience. Many, perhaps most, therapists have experience with some type of personal recovery, but in order to move a client through successive stages of change it is not necessary for him to have lived a similar experience as his client. The success of the 12 Steps hinges on one alcoholic/addict helping another; moving through the stages of change only requires a therapist’s navigational skills.

Finally, within the stages of change model it is entirely possible for an individual to enter treatment at an advanced stage of change (e.g., preparation). This means that an individual can progress through some stages on his own. This is not possible within the 12 Step approach. The Steps demand that one begin at the beginning, the stages do not. The Big Book is organized sequentially for just that purpose.   

Conclusions

Here is a quick summary of the similarities and differences identified:

Similarities

• Both models offer a progressive “linear” approach.
• Relationships are critical to the success of both models.
• Both approaches offer guides or maps as markers of progress.
• In both, the work itself is externalized; that is, self-consciously taking place outside of the individual.

Differences

• The stages of change are more important to the therapist than the client, but the 12 Steps are necessary accomplishments for the alcoholic or addict to complete.
• The Steps are explicitly instructional while the stages are merely descriptive.
• The stages of change are nonsectarian, but the Steps are specific to organizations.
• The 12 Steps require one alcoholic/addict helping another: not true for the stages of change.
• The Steps demand that one begin at the beginning (i.e., Step 1), the stages do not.

In the final analysis, the similarities between the stages of change and the 12 Steps noted above are the most important takeaway. The differences, such as they are, are largely theoretical. They are the stuff of arcane nitpicking.

Successful navigation of either model does not require understanding or being aware of the other. And yet there is something moving about the realization that a group of recovering alcoholics discovered through trial and error what it took trained professionals years of practice and research to isolate and summarize.

Whether viewed as a spiritual awakening or simply as changing one’s lifestyle in order to feel better, change is a progressive and rational process requiring effort, self-reflection, and being in relation with others. It is not an isolated, miraculous, or pull yourself up by your bootstraps singularity.

7 Minute Workout

Not able to train today? Traveling and only have access to the hotel "gym"? Getting bored of your approach to exercise? Check out the 7 Minute Workout for a quick breath of fresh air.

Designed by trainer Mark Verstegen, the workout is a simple way to mix up your routine or a great way to begin moving your body. It offers a full-body, interval-style challenge that can be adjusted to fit anyone's fitness level. Verstegen's 2004 book, Core Performance, was pivotal for me and I respect his approach.

He noted in The New York Times, "The idea is to develop a relationship and routine with your body so that it feels strong and healthy and you feel energized and excited to be up and moving."

A healthy mind and body work together and we all can find 7 minutes for a little self-care. Check it out! 

Self-Talk and Emotional Regulation

A recent NPR story, "Why Saying is Believing - The Science of Self-Talk," introduced the notion that self-talk might be more than just a self-help cliche.

Recent research has found that addressing yourself in the second or third person (e.g, "you can do this" or "Robert can do this") is more helpful than using the first-person, "I." Participants in a study who used the pronoun "I" ended up doubting themselves and inducing stress whereas the use of "you" or their own names led to more positive support and advice.

The strategy, in essence, allows you to get distance from yourself and utilize more rational decision-making strategies. In other words, it helps regulate one's emotional response! This is an easy and helpful strategy for managing everyday stress. It also is a powerful way to address major life decisions. Pretty cool!

A Calming Presence

Effective therapy hinges on being willing and able to “stay calmly attuned and connected,” according to Martha Straus in, “Getting Unhooked: Connecting with Traumatized Kids Who Push Your Buttons,” from Psychotherapy Networker (September/October 2014).    

Straus writes about one of her adolescent clients, “My job is to feel calm with her. It’s not a matter of just teaching her isolated coping skills. If she can be mad at me, she can also come to feel, in real time, what it’s like to let go of smaller injustices.”

By simply being calm and present with our clients, no matter their age, we aid them as they learn to manage and understand their emotional lives.