As you start your psychotherapy journey, here are some questions to ask yourself:

1. What’s happening to you and in your life such that it seems like you will benefit from mental health treatment?

2. What are you looking for? What are you hoping will happen in your mental health treatment?

3. What assumptions do you have about what happens in mental health treatment?

4. What have you tried so far? What has been helpful and what has not been helpful? Can you tell why?

Here are my thoughts about these questions…

1. If what’s happening in your mind – your thoughts and feelings and what you do in response – is causing you enough distress that you think something is wrong (that is, you’re googling about it, you’re asking people about it, you’re preoccupied by it), then you should talk to a mental health professional. You may think that this is a low bar, but you would use the same criteria for any other part of your body. If your tooth hurt enough for you to google it or ask a friend, you should see a dentist. Besides distress, the other criteria is functional impairment. If you don’t do things that you want to do because of what it will make you think or feel, you should seek help.

2. I hope you are hoping to learn how to relate to your internal experiences – your thoughts and feelings and what you do in response – more effectively. We aren’t aiming to get rid of your uncomfortable thoughts and feelings, though you will have certain thoughts and feelings less frequently when you aren’t resisting against them.

3. There are all kinds of myths that still exist about mental health treatment. At this point, going to psychotherapy is as normal as going to the dentist. Dental treatment and mental health treatment are also similar in that being at the dentist is a vulnerable experience that can be painful in the beginning, but then offers long-term relief. If you’re seeing me, I’m assuming something happened, either due to your biological vulnerabilities or your life experience or both, that prompted you to avoid some part of your internal experience in a very specific way that is amplified the experience. We’ll discover that together and help you relate to it differently.

4. When you’re talking about what you’ve tried so far, try to think about the processes, not the logistics of it. “I went to therapy for X amount of time” is less helpful to you than “At this time, my growth focused on these skills or getting relief from that and what I did was helpful or unhelpful in this or that way.”

What do you need to do to get better? In your answers above, I assume you established:

1. Something is happening in your mind that is causing distress or impairment or both.

2. You’re hoping for relief by learning how to relate to your mind more effectively.

3. You assume that relating to your mind effectively is a learnable skill. Rather than feeling ashamed that you need to learn the skills, seeking help is a reason for you to feel proud about how you’re taking care of yourself.

4. When you think of what to do next, you need to be very specific.

At this point, do you know what you need to do to get better? Some people can tell what’s wrong. Some people can’t tell what’s wrong. Either way is fine. It’s important to reflect on it, because I’ll approach our work together differently if your answer is, “I know what to do, but I can’t figure out how to consistently do it” compared to if your answer is, “I have no idea what to do.”

Why are you willing to put in hard work to learn how to relate to my experience more effectively?

Everyone has a different answer. Here are some common themes to get you thinking. Be as specific as you can be in your own answer:

• “I have something important coming up and I want to be present for it.”

• “I want to be able to do something that I can’t currently do because of what’s happening in my mind.”

• “Life seems too hard when I’m responding to it like this. I need a new way of living.”

• “I have felt calm, grounded, connected, and happy before. I want to get back there.”

Everyone has painful internal experiences and most struggle with that pain at one time or another. Emotional disorders occur when the struggle with your internal experience is significant enough to interfere in your life or cause you persistent distress. All emotional disorders have three things in common: individuals experience strong emotions, they find those emotions aversive, and they avoid their emotions in some way.

I believe in a bio-psychosocial model of emotional disorders, meaning that biological processes are involved in the interrelation between your social world and of how you perceive and react to your world.

Psychological flexibility is the foundation of emotional wellbeing. It means being able to show up nonjudgmentally to the present moment and choose your reactions to your thoughts and feelings according to your values. Whereas those with emotional disorders respond to their thoughts, feelings, and behavioral urges with avoidance, responding with psychological flexibility includes openness, curiosity, and willing acceptance. My hope is to help you understand the emotional patterns in which you get stuck in avoidance in order to show you a more flexible way to respond.

Social factors that influence how you perceive and react to your world include everything from your sex and gender and your family culture to the historical context into which you were born. Your race matters. Your class matters. Your language matters. Your experiences growing up, your opportunities and your regrets all matter. Just as some are more privileged than others in the brain chemistry they were born in, some have access to healthier social environments than others. My hope is that this community is a healthy part of the social world you inhabit and that what you learn here helps you create a supportive social world around you.

Genetic and biological processes are more profound in some cases of emotional disorders than others. I believe strongly in the use of medication and interventional psychiatry to manage the biological processes that underlie distress when psychosocial interventions alone do not alleviate it. While I don’t have the credentialing to prescribe medication or other forms of medical intervention, I work with psychiatrists and make referrals to them. Although many people feel fear or shame about using medication to manage their emotional disorder, I believe it is courageous and humble to accept that biological processes occur in our brains without our control. Just as you don’t take your ability to taste or see personally, you shouldn’t take your brain chemistry personally.

You didn’t choose the brain you were born with, but how you respond to it is your responsibility. A bio-psychosocial model understands the limitations of each type of interventions as well as respecting and celebrating how different interventions can build upon one another. Regulated brain chemistry, psychological flexibility, and strong social support are all necessary components of emotional wellbeing.

Treatment for mental illness is a paradox. You must have more of your emotion before you have less of it and you must do it in the right way. The answer to mental suffering is curiosity and compassion.

Mental illness is the only type of illness where you go to the doctor to get relief from a symptom and your doctor prescribes you more of that symptom. It doesn’t make sense. It’s reasonable to be confused and frustrated about your treatment plan and your treatment progress. Let’s talk more about this paradox.

You typically see a medical professional for structural disorders caused by pathology or injury. You need penicillin for an infection and a cast when you break your arm. Your eye doctor will prescribe you glasses as your eyesight declines; your dentist will give you a root canal for a decaying tooth. You are vulnerable to the effectiveness of your doctor, because something is wrong and someone else needs to fix it.

Treatment for emotional disorders involves some important differences.

The first difference is that the experience of anxiety or any other painful feeling is not a structural problem caused by pathology. You don’t have an infection that we can treat with medication. In fact, medication that completely sedates your capacity for emotion would be problematic for you, because it would also sedate all of your other feelings. The appropriate role of medication for emotional disorders is to decrease your sensitization enough to give you the chance to slow down and turn towards your own experience. If you are so overwhelmed by your symptoms that you don’t have the psychological resources to try something different, medication can support you and give you more access to your innate psychological resources.

The second difference is that the experience of anxiety or another painful emotion is not a structural issue caused by an injury. You didn’t break your legs or teeth. There might be a traumatic injury (such as a car accident, chronic lack of emotional attunement in childhood, or a terrifying panic attack) in your past, but talking about that narrative doesn’t fix the distress you have about it in the way a root canal fixes a tooth.

The third difference is that we cannot fix the way your anxiety operates the way a physician sets a broken bone. What maintains suffering long after trauma or bewilderment occurs is the way you respond to it. The role that we play is to help you observe the subtlety of that response pattern and motivate you with curiosity, compassion, and humor to try something different.

What we have in common with other medical professionals is our thinking about blame. A good physician doesn’t blame you for vomiting when you have the flu; I don’t believe that how you respond to your emotion is your fault. In fact, the way you responded and continue to respond was and is your best option at that moment. For instance, if it was actually unsafe for you to be vulnerable about your feelings with your parents while you were growing up, it’s completely reasonable for your system to feel uneasy and anxious when you try to be vulnerable with new people now. What used to be a threat is no longer a threat. It takes a lot of self-awareness and self-compassion to shift the way your mind and brain reacts to something that still seems like a threat. If, in the present moment, despite intellectual awareness of the patterns that maintain your anxiety, you still have trouble doing something different, I assume there is a stuck point we haven’t discovered yet.

What this means for the treatment of emotional disorders is that we have to work together to intentionally create circumstances that trigger your emotion with an attitude of curiosity and compassion, so that we can observe what’s happening and figure out the stuck points. We need to give you the opportunity and practice feeling something uncomfortable, deciding whether it is a threat, and then proceeding with confidence in your decision.

We want you to expose yourself to emotion to learn how to love yourself, not to make it go away.

Modern evidenced-based psychological theory understands psychological suffering to be the result of avoidance of your experience of yourself, including internal thoughts, sensations, feelings and urges, as you respond to external circumstances. Put simply:

Psychological suffering = physical or psychological pain + psychological resistance

Whether the pain occurs due to a tragic, discriminatory, or chronically stressful life circumstance or a thought or feeling that is unpleasant, the pain becomes suffering if you resist against it, avoiding it or/and trying to get rid of the internal experience itself.

From this perspective, wellbeing is a way of life characterized by an absence of resistance to unpleasant or painful thoughts, feelings, and sensations. Wellbeing cannot be forced. When there is no struggle against what is uncomfortable, there is more room for movement of thoughts, feelings, and sensations. More movement of mind creates more opportunity for pleasant states, including happiness, joy, and a sense of calm.

Because the mind is in the habit of protecting itself from pain, oftentimes you aren’t even aware of the thought, feelings, sensation, or urge that you fear and avoid. Through questions and observation, I help individuals identify what they fear and make a plan to open up to it, rather than adding more avoidance and resistance.

Mental suffering starts as avoidance. We're still in a spot in culture where the nature of emotions is not well understood and most of us immediately resist uncomfortable internal experiences (that is, thoughts, feelings, and sensations), rather than practicing accepting them. When you have a lot of private experiences that you think you shouldn't be having and you try to avoid them or push them away, they will get worse and worse.

The degree to which we respond effectively or ineffectively to our private experiences is a spectrum, not a binary category. Because these moments are private and many of the ways that people cope are also private, it's almost impossible to get a good read on how others are coping compared to yourself. It's especially hard to tell what other people are doing well when they do it well.

Psychotherapy does not rescue or protect you from pain, but it can help you respond and relate to the inevitable pain that humans experience with courage and compassion. As we get in the habit of facing painful thoughts, feelings, sensations, and urges, suffering decreases and our sense of wellbeing increases.

I want to teach you to observe and understand your emotional patterns, so that you can see it for what it is when it occurs and get out of it yourself. You learn a way of relating to yourself that doesn’t prevent emotion from occurring, but alleviates the suffering you have about the experience of painful emotion over time. Because it is an entirely different way of thinking about your mind, it will take some time for you to practice enough and work out the details enough to be out in front of the pattern on a regular basis.

Two major challenges about learning to relate effectively to your emotion is that you are actually suffering and your new relationship with emotion changes in the context of your life.

You are actually suffering. If, rather than an emotion coach, I was a basketball coach, it would be easier to teach you how to play the game. Knowing how to play basketball can make your life better, but you don’t suffer if you don’t know how to play. Approaching anxiety and other painful feelings feels like it has urgency because you will suffer until you understand how to play its game better. I know this. I will try to get you some quick wins. That is, I’ll teach you some techniques that can immediately decrease your painful emotions in the moment. I do this just to keep you motivated, not because I actually believe that the techniques will completely eliminate your suffering. I am really hoping that I can reduce your urgency enough for you to be patient with your own process.

I have the best results with people who are able to think about their experience of emotion like a basketball game, even while they are actually suffering from it. If you are able to get distance from what you feel and really get curious about what is happening, you will be in the best position to figure out how to execute on an effective strategy.

Good teams lose games, but focus on their strategy. When you are at the point where you think, “I had anxiety, but my strategy was great,” you are winning. Eventually you will feel very little anxiety and decreased intensity of other feelings.

Your new relationship with emotion happens in the context of your life. While I’m teaching you a more effective way to relate to the experience of anxiety, I also have the reality that life doesn’t stop just because you’ve committed to this process. Sometimes you should actually work to manage your anxiety, rather than surrender to it, so that it doesn’t cause impairment in your life. Examples of anxiety management techniques include taking anxiety medication, getting reassurance in a limited way about certain topics, or avoiding a very anxiety-provoking experience in favor of a more manageable activity. This might seem like a double message, but it is not. In the long-term, I want you to relate to the experience of emotion with friendliness and humor, and while you’re learning to relax into that attitude, I don’t want anything to happen to you that will make a friendly relationship with emotion even harder.

We’ll do a lot of work together, but I hope you remember that learning to relate to anxiety effectively requires a paradoxical effort. If you must work hard, ideally you will work hard to observe what’s happening, work hard to attend to what you’re doing well, and work hard to bring up an attitude of humor and humility when you notice your limitations.

In any given anxious moment, try your best to stop working effortfully to alleviate it and instead get curious about it and watch it.

Change is stressful for everyone. There are some changes, like anticipated life transitions, that feel exciting in addition to being stressful. There are other changes, like managing a physical or mental illness, that feel more stressful than exciting for most people. Learning to live well with a mood or anxiety disorder requires change. Because change is challenging, it is an inherently courageous way to live.

Your anxiety or mood disorder is not your fault. Your biological sensitivities made you vulnerable to these disorders. How you respond will make the symptoms more or less likely. To live well with biological and psychological sensitivities that make you vulnerable to anxiety and depression, you have to change how you respond to your symptoms. Where you used to respond with avoidance, self-criticism, fear, you must learn to respond with courage, curiosity, and compassion. The mind is too mysterious to know it completely, but living by these values will reduce your suffering.

Courage Courage is feeling fear and doing the dreaded activity anyway. People with anxiety and mood disorders feel fearful and interpret that as weakness. The opposite is true. Because life triggers fear in so many ways, living with anxiety and mood disorders is an inherently courageous way to live. When you shift moments where you feel weak to moments where you have an opportunity for courage, and you do it compassionately, any moment can help you overcome helplessness and make you feel efficacious. Having courage in the broad sense of your life means committing to keep trying no matter what you face. Having courage in any given moment means connecting with the demands of the present moment and your values and choosing to live in accordance with them regardless of what it makes you think and feel.

Curiosity Perfectionism can make you want to control, predict, and perfect every aspect of your life, including your mind. Responding to your mood and anxiety disorder with curiosity means that you recognize that striving to understand the patterns that create and intensify your symptoms can help you live life with less suffering, but it doesn’t mean that you’ll never suffer. A curious mind is humble in the face of the mystery of the human experience. Curiosity leads you to reflect on and observe your experiences, rather than denying them, avoiding them, or criticizing yourself for them.

Compassion Self-criticism, self-doubt, and self-loathing reinforce whatever painful thoughts and feeling you are already experiencing. Having self-compassion in the broad sense of your life means approaching your life circumstances and choices with mindful non-judgmental awareness, kindness, and common humanity. Having self-compassion in any given moment means bringing mindful non-judgmental awareness to the moment, responding to yourself with kindness, and connecting with how this moment of suffering connects you to the rest of humanity.

You didn’t choose the body you were born with and many of the factors that influence the mind you have were and are outside of your control. The fact that anxiety and mood disorders are chronic, intermittent conditions doesn’t mean that you will always suffer. You have sensitivities that make you vulnerable to anxiety and mood episodes. The more you know yourself and respond to yourself with courage, curiosity, compassion, the less likely you are to suffer.