Diagnosing Cats

I know it sounds weird, but I found all kinds of blogs about pets and they're chock full of stories. Mostly about cats. There are some about fish, surprisingly enough, and a few about dogs, but cats are huge.

The last post I read was about a cat who scratched and ruined whatever was handy to ruin in the house. Is this typical of cats? Why do I think it is?

Is it true that they have no consideration? I know they jump up onto counters and will gladly drink your milk, eat your goldfish, that sort of thing. Maybe dogs do, too, but I've yet to see one on a counter.

On the one hand I want to be charitable and say that cats who do as they please have an atypical psychotic disorder and are incapable of testing reality. They just don't know that their behavior is sociopathic. They feel they're doing the right thing. They behave as if we're a step beneath them on the evolutionary ladder. If we could, we'd jump on counters, too.

On the other I'd like to say they're personality disordered; they know but they don't care, can't help themselves.

I see no Axis I disorder, no eating disorder, no affective disorder, no anxiety disorder, no paraphia. They're not sick, right? They're just doing what cats do. But not ALL cats are destructive, right? Perhaps only cats who have seen some hard knocks, street cats who know from abuse and street crime are destructive.

The real question I have, and maybe one of you out there knows the answer to this one, Do pet psychologists diagnose pets in this way?

I had a great session on the phone with a patient who gave me the opportunity to play pet shrink. She's generally very anxious and when her cat was sick she was sick with anxiety and had to talk to me right away. As we were talking she noticed that the more anxious she felt, the sicker the cat behaved. The cat seemed really, really stressed.

"He's shaking," she told me.

Ah. So we worked on dialing her anxiety down and lo and behold, the cat chilled down, too.

Now I know that pets are very sensitive to our emotions and that dogs in particular will cozy up next to us when we're sad. So what this says to me is that if a cat is chewing up the furniture. . .

Nah, can't be. Makes no sense.

copyright 2007, therapydoc

Intimate Opportunities

No, not what you think.

I'm thinking about opportunities to connect and simply be with people, the ones that will make a difference years from now.

Here's a typical decision.

My d-i-l, an up and coming therapy doc, did something really wonderful. She's young and idealistic and she put herself on a registry that searches for people who agree to willingly go through dialysis to become stem cell donors. Plasma phoresis can be a brutal procedure. They stick a catheter in your vein for hours, perhaps in the neck. But there are types of leukemia that respond to healthy stem cells, and it's a rare opportunity to save a life. Her DNA made a match.

D-i-l went through dialysis for 6 hours, and days of hormonal preparation that made her sick and crazy (she felt a little off, she tells me). My son was with her the whole time.

It wasn't easy and it wasn't risk-free. Without the procedure, the person she matched (and she has no idea who this person is) had little to no chance of survival. We don't know if it worked, either.

So why do I mention this? Not to brag, although I'm incredibly proud of her and fall off my chair at the thought of these generous, wonderful, idealistic kids.

I mention it because healthy people her age (early 20's) are really independent. They'll tell you, I don't need you with me, and maybe they don't, but if you're not there when they need you, any procedure, even a minor procedure, can be a pretty lonely, empty, scary experience.

But the default for young people is often, "I don't need you, I'm cool." And sometimes they are, sometimes they're not.

If you offer therapy to a kid in college, it's likely the kid will say, "I don't need it." By the way, it's a GREAT time to get therapy, college, if you're lucky enough to have the opportunity to go to college.

It can be a real relief to parents when a kid says "I don't need it" when it comes to therapy And parents who are still on the fence about the actual benefits of therapy will say, "Okay, good."

You know what I say, right? Every one needs it, at least for a little while, at some point or perhaps several points in their lives, if only to deal with everyone else. So on that score, push the idea with your kid. Tell the kid to just go, try it.

Kids in their early twenties, even in their teens, maybe at any age, want to be independent and should be encouraged to be independent. But almost all of us have one foot in childhood, even if it's an unconscious foot.

That piece of us that's in childhood wants company. It's a healthy, social piece, assuming it's not a whiny, overly dependent personality disorder (we'll get to those another day).

I remember once telling my mother I'd stay overnight with her when she was in the hospital. She said, "No way, I don't need it," but she thanked me for it. I'm not patting myself on the back. I feel I'd have been a snail not to have stayed. It's not a question of being a good person. It's a question of quality time and being there for someone.

But back to young adults. When your kid is going through a medical procedure and tells you, "I can handle it alone; you don't have to be there with me," don't buy it. Be sure that SOMEONE in the family or perhaps a close friend is there. It doesn't have to be you, but someone.

If it is you, it's an opportunity. It's one of those snapshot memories you two won't ever forget. Remember the time. . .?

Delicious.

(As I was writing this I ditched the computer to get a cup of coffee and caught an NPR story on daughters pulling away from mothers during adolescence, and I thought how that ties into this, how it's not so easy to create these memories when your kid is itching for separation. So for sure, we'll have to talk more on that another time.)

But working people like me feel we've missed too many opportunities for intimacy with our kids. ANY opportunity you have to be alone with your kid that gets you out of the everyday hum drum is something to really consider seriously, if they'll let.

Sometimes you have to construct the opportunities, create them, take a kid on vacation overnight even, alone with you, perhaps. The time together doesn't have to be a medical procedure. Any time will do. Family vacations are fine, but they're also potentially really stressful.

Going fishing works, or to a spa maybe even. It can be hard to find a good hook.

In my family, going out and buying a new marine fish made for intimate snapshot memories. Picking it out, bringing it home. You bring fish home in plastic bags. Plastic bags can break.

These kinds of memories go in the What We Won't Ever Forget Book of Life.

You could be writing it right now maybe, at least working on the intro.

Copyright 2007, therapydoc

Oscar the Cat

I've been a little out of touch, as I've said.

So when a patient told me today that the biggest news story this past week (okay, these past two weeks) is about a cat named Oscar who can sense when nursing home residents are about to die, I perked up.

I've always thought that cats were intuitive, but basically selfish, and that dogs were there to serve. Now, apparently, scientists think that like both cats and dogs can be extremely empathetic.

Unwilling to go with second hand information, I Googled Oscar the cat. CNN informs us that Oscar lives in the Steere House Nursing and Rehabilitation Center in Providence Rhode Island. He knows the residents and sneaks in and curls up next to them in their final hours.

Apparently he's been right in 25 cases and staff now calls family members when Oscar gets comfortable. That usually means the resident he's chosen to snuggle with has under 4 hours of life as we know it left.

CNN quotes Dr. David Dosa who wrote up the phenomenon in the New England Journal of Medicine as saying that family members are happy that the cat is there to comfort their loved ones.

Oscar surprisingly doesn't especially take to people. He makes his own rounds in the center, just like doctors. According to Dosa, he sniffs and observes patients, then sits beside people who "wind up dying in a few hours." Sounds suspicious to me.

But there's more, and nothing malevolent about it. "Most families are grateful for the advance warning, although one wanted Oscar out of the room while a family member died. When Oscar is put outside, he paces and meows his displeasure."

Remarkable.

My take is about as unscientific as a take can be, and for sure the animal rights people will take issue. But some people will agree with me. Religious people.

My take is that the very purpose of some creatures, if not all of them, is to make humankind happy. They're here on earth for our benefit.

Sure we have to pay big time for shots and licenses, and they're a huge time investment. (Well maybe not cats as much). And they order us around, make us walk them when we're tired, take over our favorite chairs.

But we therapy docs have been recommending pets forever. We know they're psychologically good for people. They're comforting. We prescribe pets for psychological comfort.

CNN also links to another news story about 840 cats who were saved from becoming dinner. Would that have made them comfort food? Just wondering.

Meow.

therapydoc

Where'd That Therapist Go

Sorry, I know I've been out of touch. I'm getting email and comments: Are you okay?

The last time I ditched you (and my practice) to go on a real vacation (not a conference) a patient asked me, "Where are you going?"

I said, "I don't tell patients where I go, usually. Sometimes I make exceptions, but not this time."

She said, "Well, just don't go to Israel."

I didn't say anything.

I understand that real therapy docs in New York go away in August. They take the entire month of August and New Yorkers have to sink or swim and that's just the way it is. Unreal.

Anyway, I'm back again and have stuff to tell you, all kinds of good stuff, but no time today. Just wanted to say hi. And Yes, I'm okay. Thanks for asking.

therapydoc

Can You Cry Too Many Tears?

This will be a long one. Settle back and relax.

Today is the holiday that the Jewish people (those who observe it) dread for three weeks. Some people dread it all year long. FD says there should be a holiday that everyone dreads.

I'm not sure I follow his logic, but ours is certainly the religion for everything.

Tisha B'Av, the 9th day of the Hebrew month of Av, is a day that marks destruction. Like every holiday there are certain laws to observe. The law specifically associated with this holiday is about tears. Crying.

You're supposed to make yourself cry and get in touch with the loss of the Holy Temples of Jerusalem, built and destroyed by conquering nations. We lost the first in 586 BCE, two thousand, twelve hundred years ago, to the Babylonians who desecrated the holy walls and holy vessels; the second in 70 AD to the Romans who seconded the motion.

We grieve the martyrdom of people of other eras (think Spanish Inquisition, for one) who died rather than convert, and we remember every pogrom, especially the Holocaust.

Our history is full of tears.

On Tisha b'Av we get in touch with the loss of holy land and what are thought to be the dwelling places of the Old Mighty. (That's how my grandfather referred to Him. ) When we're in Israel we say that prayers are a local call. The Jews trace a relationship and ownership to the holy places of Israel to Biblical times, fifteen hundred to two thousand years B.C.E.

In any case, a huge mosque sits atop the spot that Jacob wrestled with an angel and won but walked away, limping.

This is also where his grandfather Abraham said to the Old Mighty, "Sure, you want my son, you can have my son, my only son from this particularly incredible mother, Sarah, my helper, my friend, my companion, the woman who has grown old with me. "

The midrash (an explanation, also a few thousand years old) tells us that Isaac was no baby at the time he was offered as a sacrifice per the Old Mighty's request. Sarah, when she heard about the possibility that Abraham would do this, had a heart attack, probably at the age of 103. We think Isaac was thirteen years old at the time.

Bound, his father readying himself with a knife for slaughter, Isaac looked up at the sky and the Old Mighty opened up the heavens so that His young servant alone could see beyond the stars. The tears of the on-looking angels fell into his eyes, which is the reason Isaac is said to have been near-sighted for the rest of his life. Most of his descendants are, too.

Anyway, the angels cried and the Old Mighty had mercy and crying is a theme in our culture.

I believe I told you that my mother said, "Cry, it feels good, it's good to get them out." I'm sure she said it in Yiddish, too, but I've forgotten the Yiddish.

And I've told you that there is not an infinite number of tears. Eventually you will stop. If you need to cry, cry. At least I don't think there's an infinite number of tears. I could be wrong. Has anyone done the research on this? I don't think so.

The rabbis say, Cry, for sobbing is all that the Old Mighty really does hear. In other words, He's sick of words. And who can blame Him? We are all talk, are we not?

Which is why talk therapies, especially rational therapies tend to work, but it's also why we need them to talk out our many obsessions.

But there IS such a thing as too many tears, if not for this holiday.

The story goes that a woman could not stop crying for the loss of her husband. She was irreconcilable. Her family brought her to the holiest rabbi in town who told her that she shouldn't be sad. Her tears went to good use. The Old Mighty gathered all of her tears in a cup, every one of them, and when a terrible calamity threatened destruction to the world, he used her tears to avert the tragedy. This calmed her down.

She could stop crying.

So sometimes it's good to cry, and sometimes it's best to stop. I used to tell my kids what my mother told me, advice I hope they will tell my grandchildren, that they should squirt out a few tears now and then, maybe every day.

I still tell my patients this. But this doesn't apply to people who can't stop crying, like the woman in the parable. So without a rabbi to tell you the importance of your tears, how do you stop?

Therapy's an interesting process.

Sometimes it helps to look over your life and find the things that you forgot to cry for or weren't mature enough to cry for or had been taught that you shouldn't cry for, but you should have cried for when they happened. You should have cried at the time but you didn't.


So for example, some little kids, upon the loss of a parent are told that it's okay, they'll be well cared for and they need not cry. They're told they should buck up at the funeral. Be a man, be adult. Be strong. Kids grow up thinking this is the way we're supposed to be all of the time. Strong.

Then they wonder why, having stored up so many tears, when they find themselves at a vulnerable place in life, that the floodgates let loose and they feel as if they're drowning in their own tears. I tell these patients they have to mourn those old losses.

They're not all deaths, either, these losses. You know how to list your losses. Loss of innocence, loss of love, loss of functioning, loss of health, loss, loss, loss. Talking about losses puts those tears into place.

Stoicism can be a problem. Stoicism helps when you get rejection letters, and it's never good to feel sorry for yourself, really, so stoicism has it's place. But holding back feelings as a general approach to life can definitely be a set up for problems.

Therefore it is nice to know that most cultures build in ways other than stoicism to handle Big Losses. (We'll talk about the smaller, annoying losses as they pop up in other posts. Let's talk about the big losses here).

The psych literature tells us that Jews handle death nicely, so it's convenient that I'm Jewish. Maybe there are some universal truths for everyone in our customs and laws.

Let's start with a funeral. I'll go back to Aunt C's funeral. You last read about her when I visited her in the hospital. It made me feel so good, connecting with Aunt C, even though I knew she was heading towards hospice. Anyway, she passed away soon after that post.

In our culture, at the funeral service people lclose to the person who passed away talk to an assembly of friends and relatives (like in most cultures I think). My aunt had eight eulogies, one more beautiful than the next. One of my aunt's children, cousin Bobbie, said to me, Mom would have loved the service. She would have loved what we said, and she would have loved that the day was sunny and everyone came out to say goodbye.

At the funeral everyone is supposed to ask forgiveness from the mais, the person who passed away. So that's therapeutic for the community of mourners, too.

Then there's the shiva. If you're a mourner, a first degree relative or spouse, you stay home from work for seven days so that people in the community can visit you and you can talk about the life that's lost. People cry, sure, but it's hard for them to cry non-stop when there are so many visitors.

It's not a law that a mourner has to cry. You can tell who's in mourning because the males don't shave that first week and everyone in mourning tears their shirt before the funeral and wears it all week long. Crying during shiva isn't a requirement. It doesn't have to be.

So when my cousin's mom passed away, her sister, my mom, sat shiva with her two only other living sibs and my cousin Bobbie and her two sibs.

I cooked. The community cooked. Jews are all about food, at the end of the day. Food is life.

My cousin Bobbie had an incredible relationship with my aunt. They really were best friends. Now that the formal ritual is over, the funeral, the seven days, the month, she's into the year of grieving for a parent. In that year you don't buy new clothes or go to movies or concerts. I am quite sure my cousin cries often for her mother, expecting, when she picks up a ringing phone to hear my aunt's voice.

It's very surreal, you know. One day you can talk on the phone to someone, and the next day you can't. I'm sure my cousin picks up the phone to call her mother, starts dialing, pauses and puts the receiver back into the cradle.

Now that we're a couple of months past the shiva, she's probably crying a lot. She's supposed to stop after the year is up.

Because there is this prescribed grieving, at the end of the year a person does feel that the job is done. They can stop crying. Not for good, of course not. But the person who has passed away has been accorded respect, and a mourner feels he or she has truly mourned.

Immediate losses are hard for most people, especially that first year, and tears come often if we let them, whereas once they're a thing of the past, it's harder to remember, harder to grieve.

Which is why this holiday, Tisha B'Av is so hard for most people to wrap their heads around. It requires reflection, memory, a very long memory. For Holocaust survivors the loss still feels immediate. For the rest of us, it's harder.

But what do we do about it when crying is getting old already? That's the problem for most people. People who come to see me usually don't have to make themselves cry. They can't stop crying. And, depending upon the person and the context, too much crying can make one sick, not better.

Which is why the docs are forever telling you, Take these medicines. Happy is better. (My motto, by the way). I can't say, Take these medicines because I'm not a medical doctor.

But for the record, if a medical doctor recommends medication, I'll support that decision. And legally, therapy docs have to tell you to get a med eval, a medical evaluation to see if you need medication if you can't stop crying.

So consider that. And sure, get therapy. Grieve the past losses. There is an endpoint to the grief and suffering in any one person's past. Clean out some of it with a caring professional.

There aren't enough rabbis in the world, certainly, to take care of all of those tears.

Copyright 2007, therapydoc

How to Talk to a Widower--Grieving and Drugging

Maybe it's not terribly intellectual and it reads like a comic book without the depth, but I loved a book I wasn't supposed to be reading.

It's not what you think.

I have a friend who reads advance copies professionally. Anyway, I happened to be hanging around her house and the book happened to be on her coffee table and she happened to be on the phone, and you know these books take about five minutes from cover to cover . . .

Actually, I took it home.

Have I blogged yet about grieving and drugging? No, I don't think so. I know I've talked quite a bit about grieving, facing end of life, that sort of thing, and I've surely talked about drugging and alcohol, America's favorite drug.

So put them together and you have the subject of Jonathan Tropper's upcoming book, How to Talk to a Widower. The sticker on the cover said it was due for release in July in hardcover (Delacorte Press).

If it's out, pick it up or get it at the library, because despite what I said about comic book depth, the stuff on how to talk to someone who has lost someone tragically is wonderful. I've never read anything close to it and if I weren't so against plagiarism I'd have copied those chapters just to keep them for myself. I'd make copies for patients.

You should just go ahead and buy the book if you want to improve your communication skills exponentially (most of us do). I haven't read Mr. Tropper's others but intend to.

How to Be a Widower is a laugh out loud fast read. It surpasses all the chick lit novels I've ever read. Seriously, that's an exaggeration, but I've read quite a few between the dry research intro books I'm making myself go over to be ready to teach in September (we'll talk about that another day).

This book is as dead-on as you'll ever get for depicting emotions following the loss of a spouse. Jonathan Safron Foer's Extremely Loud and Incredibly Close does that for kids who have lost parents. Foer's book is unbelievably, extremely, incredibly good, cover to cover. Nothing chicky or prurient, nothing shallow or silly about it.

Still. I could swear Mr. Tropper lost his wife having read this book. That or he's one of the cloth, a therapy doc who has talked to people who have lost their better half. Neither is true. He teaches writing at Manhattanville College.

His advice is great, but honestly, I feel I'd ruin the book if I told you more about it than that.

But I will tell you about the Jewish custom of sitting shiva, which is unbelievably sublime and therapeutic. People who visit mourners the first seven days following a funeral are supposed to behave in certain ways.

The mourner is sitting on a low chair and isn't supposed to fix meals or do any work. Visitors and friends take care of him. Briefly and most generally, it goes like this:

1. You're not supposed to speak to a mourner unless the mourner speaks first, addresses you specifically or looks your way with a certain acknowledgment of your presence.

2. You're not supposed to talk about yourself. At all.

3. If you do talk, it should be to ask the mourner about the person he or she lost--if anything. Even that can be very intrusive.

3. You can offer the mourner something to eat of drink.

4. Mainly, almost anything you say to someone who is mourning can and probably will be shallow and inappropriate, so try not to say much more than perhaps pass on a happy memory of the deceased. And even then, only if it seems the right time.

5. Never interrupt the mourner if he or she is speaking.

A very nice thing about Tropper's book is that he shows how a person who has lost someone can change dramatically within a year. It also shows how abusing alcohol can slow down the grieving process even though it feels really, really good at the time. The alcohol abuse makes the loss even worse.

So for me? Two thumbs up on this book. Thanks Mr. Tropper. Sure, I'll try another advance copy any day if you're offering.

Copyright 2007, therapydoc

The Cure for Self-Consciousness

Cham says, "Read this Mom," and tosses me the July copy of O, the Oprah Magazine.

"No time, Cham."

"But we'll be on an airplane forever. What are you talking about? You'll have plenty of time, Mom."

I've got nothing but time. She's marked the article, The Cure for Self-Consciousness. If Cham says Read it, of course I'm going to read it. She represents the younger smarter people out there. (Like you, right?)

Martha Beck starts us out at a cocktail party. (Already you like it, I know) She tells us to picture ourselves in a bad dress or something we think looks or fits badly.

So I'm supposed to think I look like a whale and I'm positive that everyone is staring and laughing at me at this party. And I'm embarrassed and ashamed. Not hard to do this visual exercise, is it?

But because we're logical thinkers and entertain a cognitive therapy, we know that the feeling of exposure is irrational and rooted in some kind of early childhood narcissistic injury.

Like maybe your mom said, You're not going to wear THAT are you?

And you say to yourself, It's not all about me. It's unlikely that most people are really looking at me or noticing me or even caring I exist.

But O is talking to readers who obsess anyway, who might know that but can't stop worrying about how they look and sound, or if they're dead silent in social situations, what people must think of that. And they have nightmares, like those we've discussed earlier in the fear of exposure post, dreams about being the only naked person in the room.

I'd say, by the way, that if you might be sensitive to a full page photo of a naked woman desperately trying to cover up, definitely don't buy the July issue of O. (Why is this necessary, someone tell me. Is it art?)

The problem here, according to Ms. Beck, who makes no claim to a relationship with the famous cognitive theraps, is that we're so worried about appearances and what other people think that we don't do the good things we want to do. We box ourselves into very boring lives.

She's right.

I remember my mom at that Gater Park in Florida just last winter. She didn't want to do the Everglade speed boats (there's a special name for them, I can't remember it) and her "better" judgment years ago would have held her back. But with only a little encouragement (she's with me, FD and my father, after all) she got on that boat. And her hair blew in the wind like crazy and none of us have ever, ever seen her laugh so much in our lives. It was wonderful.

Beck calls that fear of being judged negatively performance anxiety. I also see it associated with not so simple social phobias and anticipatory anxiety, worrying about worrying. Call it what you will, Ms. Beck brings up a study about the "spotlight effect."

I didn't see the study but I think that we can talk about the results anyway. Keep in mind that all we're doing here is passing on a few cognitive tools and the language we therapy docs tend to use at breakfast. (My kids tried to be polite about it unless I talked about sex and then it was, Shut up, Mom). Anyway, we haven't critically examined research on this blog and I don't intend to do that here. It's a blog.

So three psychologists, Glilovich, Medvec, and Savitsky coined the phrase Spotlight Effect and suggest that we must develop a "mental dimmer switch."

I love the metaphor, even if I doubt the outcome of their work. The study and supposedly other similar studies finds that the spotlight effect makes most of us think that we're getting twice the attention we actually get. We overestimate how much people are staring at us. If we realized nobody cared we'd worry less, but instead we magnify how much people care by two.

These social experiments bear repeating, as all experiments do. It's all about the way variables are measured and if the measures measure what they should. If I had to guess, I'd bet people quadruple the number of people they imagine are noticing that stain on the tie, that bad hair day. I'd even double quadruple it.

I suspect we only get a tenth of the spotlight we think we get, if that.

It really isn't about us. There's so much more for life to be about.

But many people have disabling anxiety and it's no laughing matter. Perfectly normal looking people come to therapy and say that they look in the mirror and see Frankenstein.

And I tell them: Even people with fairly good self-esteem see Frank in the mirror.

We're all a little paranoid is the truth, some of us much more so than others, and yes, social context makes all the difference. Why we are this way? I used to blame Madison Avenue. But I know it's probably a mix of genetics and the way we grow up. And Madison Avenue (environment).

Cognitively we can trace this anxiety to fear of exposure. Although the O article doesn't use this language, it's possible the therapy docs who did the research do.

The journalist is totally right when she tells us that reluctance to take risks socially limits what we do. We grow with new experiences. I'm pretty sure our brains get bigger as they forge new cellular pathways. It's mind-expanding, so to speak, when the roads not taken, those neural highways in the gray matter, are taken.

She's also right when she says that people who feel they're in the spotlight exaggerate their mistakes and under-emphasize their accomplishments. They also tend to under function: they don't shout out good ideas; they dress too conservatively; and they rarely sing or dance in public.

Don't tell me that can be a good thing sometimes. I personally like it when it's off-key but happy. (Remind me to tell you about that choir I was in 10 years ago.)

The docs who did the research also say that people regret it when they fail to try new things. We should go ahead and try things even when we doubt ourselves. We should take a risk or we'll regret not having worn that red dress, never having skied.

For sure on that dress.

And there's MORE! Remember, O has promised to pass on the CURE for this problem, so there has to be more, and it's all good, if not the cure for everyone. As I've indicated, if you've had a traumatic history advice won't make much difference. You need to be in a place to take advice. To make bread you don't just need yeast. To make a person rise, having advice is like having a little flour and water, a good start, but not enough to make bread happen any day soon.

The cure:

(1) We need to recognize that social fear is universal.

So I worry that I might be wearing two different socks, which can happen if you're me, but tell myself that everyone else is worried about how they look, too. If a patient isn't worried about socks, there's cellulite.

We should only care what the good guys say, by the way, and they won't care what we're wearing.

(2) We're supposed to double everything.

We docs are always going to tell you to exaggerate something, so doubling is a nice start. I prefer to think of it as over-shooting because you probably won't really over-shoot, so if you at least try to over-shoot you'll shoot. We learn this from the great 12th century Jewish thinker, by the way, the Rambam.

The research gurus are totally right. If we successfully rouse up the courage to put ourselves out there socially with gusto, then it is likely we'll be be appreciated for at least having some guts. Then there's always appreciation for providing comic relief and permission for others to chime in on a conversation, too.

(3) Think through your limits--not to them (I'd say, not about them).

A sensei taught Ms. Beck how to break a board with her hand. She had to pretend that the board didn't even exist and was told to aim ten inches behind it. Apparently you're not supposed to even be thinking about hitting the board itself. The focus is beyond the board, it's what's beyond the feared stimulus that matters.

Now this is great stuff. We see a situation as potentially very embarrassing so we're focused on the embarrassing moment, but we shouldn't. A person who is less anxiety-ridden still might see a possible negative experience, but keeps eyes on the prize, drives in the rain, so to speak, to get where he's going.

No pain no gain.

(3) Finally, there's the Universal Question, and Beck does a great job with this, by the way, her build up is really cute. The Universal Question is:

So?

I personally go with So what?

Beck: If I do that I'll look like a clutz. So?

Beck: I say that, people will disagree. So?

Therapydoc: They'll think I'm nuts. Yes! So What? Who doesn't need therapy?

CONCLUSION:

1. You want to worry? Worry about something that's already happening, not something that might happen. Like child abuse, for example, or the exploitation of women. Racism. Genocide. Then go to work on eliminating those things.

2. What we've talked about is all cognitive-behavioral therapy. Do you see how?

When you use your logic and imagination, it's cognitive. But the idea that you should make the spotlight less intense by subjecting yourself more to the source of anxiety is behavioral. It's an exposure therapy.

3. To make the spotlight feel less intense, you push yourself into it and find out what confident people already know:

The spotlight's not so bad, and someone else is going to take it from you anyway. In a nanosecond.

Copyright 2007, therapydoc