March 10, 2011
"Smile, it can't be that bad!" My client Sam had just arrived in my office and was angry and upset that a total stranger had approached him with these words while he was shopping for groceries. "Can you believe that?" he asked before adding, "And that's not the first time that's happened." He was embarrassed that his mood was so obvious to everyone he encountered, yet defiant at his right not to mask his feelings from anyone.
We processed Sam's justifiable upset at the presumptuous stranger who intrusively offered him good-natured feedback. Sam was dealing, after all, with some serious physical issues unknown to anyone but his closest friends and family. He was outraged that anyone would judge him without knowing all the stressors he battled on a daily basis. It was easy for him to focus on the inappropriate actions of this stranger, but then our conversation came back around to his second comment, that this had happened before.
Sam admitted that he was angry and tired after years of juggling HIV medications, physical concerns, and more losses than he could enumerate. He viewed the world skeptically and he didn't dare take the chance on investing too much emotional energy in being hopeful. He found some paradoxical comfort in cynicism, which while often painful, allowed him to move through the world bolstered against disappointments. He had survived a great deal and felt no need to force himself into pleasantries that seemed unnatural. Yet this stranger's remark hit a nerve and was a tipping point in Sam's recognition that he had some power over his feelings as he maneuvered through the world.
Sam had long understood that there is a link between attitude and physical health. He knew, for example, of the placebo effect, in which the power of the mind can influence physical changes in ways that remain a mystery, but he was skeptical of the power of a positive attitude with respect to overwhelming physical problems. He had always been, appropriately, wary of oversimplifying this approach into a belief that could, essentially, "blame the victim." That is, a belief which held that those who become and remain ill somehow have flawed attitudes and beliefs about themselves. Now, however, it occurred to him that while positive thinking might not hold magical curative powers, it certainly could improve his ability to live with his illness, which, in turn, could indeed have health benefits. He began to realize that his negative outlook had evolved without any conscious thought.
That day, and in sessions that followed, we processed Sam's skill in identifying and expressing his feelings. He began to understand that challenges and even tragedies occur in most people's lives and that their significance lies in how we frame and make sense of them. He reacted defensively at first, dismissing a positive attitude as a simplistic form of denial. But Sam began to see shades of subtlety in this approach. He identified a deep-seated fear that if he were to accept that parts of life are truly beautiful, it would somehow negate the terrible things he had experienced along with his pain and struggles. Sam realized that he could honor his grief and anger (and perhaps begin to process them) and still find room for positive and hopeful thoughts. He exhaled deeply when he realized he could begin to redefine his world view.
Over the course of several months, Sam found two exercises particularly helpful in refocusing his attitude. The first was becoming aware of "self-talk," the constant (usually critical) chatter inside our heads. He began to hear the pessimism of this inner voice and, once aware of it, he gained some expertise in tuning it out. He discovered that this chatter rationalized his negativity by saying, "It's just the way I am." He began to see that this wasn't necessarily true and that he had the power to choose alternative attitudes. For example, if he told himself, "There's no way this will work," he then tried to put a positive spin on it by saying, "I can try and make it work." Or if his inner voice said, "This is too complicated," he revised it by thinking, "I'll try it from a different angle."
The second tool was a daily practice of creating a gratitude list. Sam rolled his eyes when it was suggested that each morning he create a list of 10 things for which he was grateful. He reluctantly tried it and soon discovered that this simple practice had great power. At first, it was a struggle for him to identify even five such things, but he eventually acquired the habit of observation and began to naturally notice both his positive and negative experiences and interactions.
Optimism slowly crept into Sam's life in a way that took him by surprise. Of course, he still had bad days that were filled with fear and anger and sadness, but on most of those days he also experienced hints of gratitude and even happiness. After some months, he noted with a sly smile that it had been a long time since a total stranger asked him what could be so terribly wrong.
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