My patient, whom I’ll call Andrea, is a lovely woman in her 60s. She wakes at 4 am each night, stomach clenched with worry about her adult son, who just left his job without a clear plan for his next move and appears quite depressed. My patient leans her head against her hand, and through the video screen, I can see the worry lines tight across her face. She is terrified that he has made a terrible mistake in leaving his job, and she is fighting the urge to micromanage his every decision. “Feeling his pain is so much worse than feeling my own. I just want to make it stop,” she tells me. She and her husband have been at odds about the situation—he tells her she worries too much, and she thinks he isn’t worried enough. “I am all alone in this.”
We explore her good reasons for feeling anxious through a “Positive Reframe” exercise, which comes from TEAM therapy, developed by David Burns. In this exercise, we explore how painful negative symptoms can be useful and can reflect our most deeply held values. “It shows I’m paying attention, it keeps me vigilant about the situation,” she reflects. Indeed, she has been very proactive about helping her son find a good therapist and has been brainstorming with him about leads for a new job. She identifies the values that underlie her worry—“Seeing his pain hurts so much because I care so much about him. But I know my reaction pressures him, and that’s not helpful. I just want him to be happy!”
Most recently, Andrea and I discussed the Buddhist concept of the Four Bramaviharas or the “divine abodes.” They are 1) Metta—loving-kindness or goodwill, 2) Karuna—compassion, the awareness of the suffering of others and the desire for it to stop, 3) Mudita—sympathetic joy in the happiness of others, and 4) Upekkha—equanimity.
When she examines her underlying motivations, it is clear that Andrea is manifesting Metta for her son. She wants him to be happy. She is also demonstrating Karuna, compassionate awareness of his suffering and desire for it to stop. And by coming to see me, she demonstrates both Metta and Karuna for herself: she recognizes a need to bring things into balance and bring down the level of her suffering, which she can see does not help either of them.
She finds this part of our conversation helpful: “It’s a good reminder that I don't need to believe all the things my mind tells me, like that I’m not a good mom. I’m feeling pain because I care about him, not because I’m doing something wrong.”
“And what about the thought, ‘I’m all alone?’” I ask her. “Could there be a kinder way to speak to yourself?”
“What do you mean?”
“Well, what if instead of saying ‘I’m all alone,’ you said, ‘I’m with myself’?” Changing the words we use is an example of one of Burns’ cognitive methods, the “Semantic Technique.”
She looks up thoughtfully as she tries that on. “My first response is that I don’t really want to be with myself. No wonder I feel lonely! It’s interesting to imagine being ‘with’ myself.”
“Are you willing to try that right now?”
She nods.
“Go ahead and turn your attention inward. When you think about your son’s suffering, what comes up for you?”
Her face tightens into a grimace. “I feel a strong tightness in my chest—right here,” she gasps. I feel a swell of admiration for her as she stays with the difficult sensations.
“That’s great, keep going. What else do you notice?”
She falls silent. “Yes,” she says finally. “I have a teacher who says, ‘the wise voice is quiet.’ When I listen more carefully, I hear a voice that says that what my son needs is this, what’s happening right now, this kind of being-with. I can’t fix his depression or make him find a job. But I can be with him. And I can be with myself.” She smiles. “If I’m listening to a wise voice, I’m not all alone, am I?”
We sit together in silence. Then she continues, “I feel less helpless and desperate. His depression, my anxiety, they are part of being human. It’s okay.”
She has hit upon the fourth Bramavihara—equanimity. The willingness to be fully present with things as they are. Equanimity acts as a natural brake on compassion and our tendency to become preoccupied with the feelings of others.
“My teacher has taught me an equanimity prayer,” I offer. “I call it ‘a mother’s prayer’. I’ve found it helpful in parenting, if you’d like to hear it.”
“Sure,” she replies.
“It goes like this: ‘Things are just as they are. Joy and sorrow arise and pass away. Your happiness depends upon your intentions and your actions, not upon my wishes for you. I love you, but I cannot prevent your suffering.”
“That’s nice, I like that.”
“I added a line: ‘I delight in your capacity to make your own decisions, even if I don’t agree with them.”
She laughs. “Oy. That’s a tough one. What if his decisions are making us both miserable?!” She pauses and answers her own question. “I understand. I want him to be his own person, and he has to figure out his life from his own experience.”
Mudita, the third Bramavihara, fills us with sympathetic joy in the happiness of others, even if we did nothing to create it.
“I’m grateful for all the times my parents let me make my own mistakes, I suppose I can take pleasure in his being able to do the same. I guess I know what I’ll be practicing this week.”
File under: The Art of Psychotherapy
We explore her good reasons for feeling anxious through a “Positive Reframe” exercise, which comes from TEAM therapy, developed by David Burns. In this exercise, we explore how painful negative symptoms can be useful and can reflect our most deeply held values. “It shows I’m paying attention, it keeps me vigilant about the situation,” she reflects. Indeed, she has been very proactive about helping her son find a good therapist and has been brainstorming with him about leads for a new job. She identifies the values that underlie her worry—“Seeing his pain hurts so much because I care so much about him. But I know my reaction pressures him, and that’s not helpful. I just want him to be happy!”
Most recently, Andrea and I discussed the Buddhist concept of the Four Bramaviharas or the “divine abodes.” They are 1) Metta—loving-kindness or goodwill, 2) Karuna—compassion, the awareness of the suffering of others and the desire for it to stop, 3) Mudita—sympathetic joy in the happiness of others, and 4) Upekkha—equanimity.
When she examines her underlying motivations, it is clear that Andrea is manifesting Metta for her son. She wants him to be happy. She is also demonstrating Karuna, compassionate awareness of his suffering and desire for it to stop. And by coming to see me, she demonstrates both Metta and Karuna for herself: she recognizes a need to bring things into balance and bring down the level of her suffering, which she can see does not help either of them.
She finds this part of our conversation helpful: “It’s a good reminder that I don't need to believe all the things my mind tells me, like that I’m not a good mom. I’m feeling pain because I care about him, not because I’m doing something wrong.”
“And what about the thought, ‘I’m all alone?’” I ask her. “Could there be a kinder way to speak to yourself?”
“What do you mean?”
“Well, what if instead of saying ‘I’m all alone,’ you said, ‘I’m with myself’?” Changing the words we use is an example of one of Burns’ cognitive methods, the “Semantic Technique.”
She looks up thoughtfully as she tries that on. “My first response is that I don’t really want to be with myself. No wonder I feel lonely! It’s interesting to imagine being ‘with’ myself.”
“Are you willing to try that right now?”
She nods.
“Go ahead and turn your attention inward. When you think about your son’s suffering, what comes up for you?”
Her face tightens into a grimace. “I feel a strong tightness in my chest—right here,” she gasps. I feel a swell of admiration for her as she stays with the difficult sensations.
“That’s great, keep going. What else do you notice?”
She falls silent. “Yes,” she says finally. “I have a teacher who says, ‘the wise voice is quiet.’ When I listen more carefully, I hear a voice that says that what my son needs is this, what’s happening right now, this kind of being-with. I can’t fix his depression or make him find a job. But I can be with him. And I can be with myself.” She smiles. “If I’m listening to a wise voice, I’m not all alone, am I?”
We sit together in silence. Then she continues, “I feel less helpless and desperate. His depression, my anxiety, they are part of being human. It’s okay.”
She has hit upon the fourth Bramavihara—equanimity. The willingness to be fully present with things as they are. Equanimity acts as a natural brake on compassion and our tendency to become preoccupied with the feelings of others.
“My teacher has taught me an equanimity prayer,” I offer. “I call it ‘a mother’s prayer’. I’ve found it helpful in parenting, if you’d like to hear it.”
“Sure,” she replies.
“It goes like this: ‘Things are just as they are. Joy and sorrow arise and pass away. Your happiness depends upon your intentions and your actions, not upon my wishes for you. I love you, but I cannot prevent your suffering.”
“That’s nice, I like that.”
“I added a line: ‘I delight in your capacity to make your own decisions, even if I don’t agree with them.”
She laughs. “Oy. That’s a tough one. What if his decisions are making us both miserable?!” She pauses and answers her own question. “I understand. I want him to be his own person, and he has to figure out his life from his own experience.”
Mudita, the third Bramavihara, fills us with sympathetic joy in the happiness of others, even if we did nothing to create it.
“I’m grateful for all the times my parents let me make my own mistakes, I suppose I can take pleasure in his being able to do the same. I guess I know what I’ll be practicing this week.”
***
And so, by sitting with herself, Andrea weaves together the message of the four Bramaviharas, guided by the wisdom of her quiet inner voice.
File under: The Art of Psychotherapy