Creating a virtual therapy office

Many therapists have at least dipped their toe into doing online sessions with clients nowadays. I have always embraced it wholeheartedly: I am an alpha geek who was an early adopter for webcasting, long before my own therapy days. Online counseling is often ideal for clients who travel, leave the area, need urgent sessions outside of office hours, or are housebound. At any given time, two or three of my 15 or so weekly sessions are virtual ones.

Online sessions are generally easy to do with a laptop with a webcam and a headset, but my project this Thanksgiving holiday was to take this a big step further: to have a real virtual “office” for online psychotherapy. A space that is warm, inviting, and feels more like a live session than a web chat. And I was fortunate to have the perfect setting: my home’s glass-enclosed living room overlooking the hills outside of Ithaca, NY, with great views and lots of natural light.

My view of the office

The client's view of the office

The results far exceeded my expectations: after investing less than $200 in equipment (in addition to my existing wide-screen HDTV and laptop computer), I now have a real therapy office where my client is visible at close to actual size on the television monitor, we hear each other at a normal voice volume, and I am sitting across from him or her in a comfortable chair taking notes. It now feels a lot like a real therapy session, for everything except the parting handshake. Here is a summary of what I did, as a recipe for creating your own virtual therapy space.

1. Interfacing your computer and TV

It helps a great deal here to have a recent-model laptop computer with an HDMI interface. Most modern wide-screen televisions have HDMI interfaces, which normally give you the highest quality picture. Equally important, HDMI cables carry both video and sound, eliminating the need for a separate audio interface.

I had HDMI at both ends, so all I needed to do was hook up a standard HDMI cable between my laptop and the HDMI 2 input on my 42-inch HDTV. Now, switching between TV and therapy is as simple as toggling between HDMI 1 and HDMI 2 on my television’s remote. If you don’t have HDMI on your computer, you may need to purchase an interface box and cables to convert from your computer’s VGA video and analog audio to HDMI, or to composite video plus audio input. Unfortunately, given the cost (often $150-200), it may make more sense to simply invest $350 or more in a basic HDMI laptop.

2. Webcam

Instead of using my laptop’s low-res webcam, whose narrow viewing angle requires sitting in front of the laptop itself, I installed a Logitech HD webcam - their top-of-the-line Pro Webcam C920 model, costing roughly $75 - that mounts on top of my HDTV and connects to my computer via a USB interface. Its wide-angle view allows me to sit anywhere in my “office,” just like a regular therapy session, and gives the client a great view of the hills outside.

3. Audio

Audio will be your biggest challenge in setting up a virtual therapy office. Why? Because of "lag." When a client speaks, there is a lag time before their voice is audible over your speakers, which can cause an echo when they hear their own voice later. The same is true with your voice if the client is using speakers.

When you both use headsets, this solves the problem by definition, because neither of you can hear the other person's audio output - however, this means that you are "tethered" to your equipment. I have found that using a combination of a high-quality microphone and low speaker volume often prevents the need for a headset.

Currently I use the integrated dual microphones included with the Logitech C920 webcam, together with the laptop speaker located off to the left of my HDTV - not the HDTV's speakers themselves. This also has the advantage of combining the webcam and microphones on the same USB port. Previously I had tried a USB-powered Samson Go Mic (a very good condenser mike), however this only worked if the mic was right next to me with a low speaker volume.

Most of the time this setup works well, and I can speak comfortably and naturally with the client while sitting in my chair. In some cases, however - for example, when the client is traveling to a faraway location and lag is an issue - I use an inexpensive Plantronics Audio 326 headset with a long extension cord to prevent lag from being a problem.

4. Cordless mouse and keyboard

Using a quality cordless keyboard and mouse – in my case, a Logitech K360 keyboard and a Logitech M525 mouse – gives me the range to sit across the room from the TV and computer and still control the therapy session from my chair. These both share the same USB controller, only requiring me to take up one additional USB port for both.

This also has the added bonus of allowing me take notes electronically during the session, with the caveat that you must use an encrypted, password protected drive or disk partition for compliance with HIPAA privacy regulations.

5. Software

Therapists often talk about having “Skype sessions,” however in reality Skype is technically no longer legal for therapy use under current HIPAA privacy regulations. (Skype has in fact always discouraged its use for therapy: its video conversations go through their servers, and they understandably don’t want the hassle of meeting HIPAA requirements.) I use a HIPAA-compliant peer-to-peer solution called VSEE that is both high-quality and free. One note: I had to go through VSEE’s settings and change the default sound output, microphone and webcam to use the HDMI channel and USB devices I added – and then it worked great!

Online therapy: the practicalities
Any drawbacks to online therapy? Just two in my case. One, online sessions are generally not reimbursable by insurance, so it is largely for clients who are self-pay or willing to pay for extra sessions out of pocket. Second, online practice is generally only legal (and covered by liability insurance) when you are licensed in your client’s home state, so my practice is currently limited to New York residents. Eventually I plan to obtain reciprocal licensure in at least a couple more places, starting with my family’s home state of Arizona.

There is a third and more subtle drawback as well: online therapy isn't for everyone. *I* think it's great, of course. But many clients have a hard time wrapping their heads around the idea of having a therapist pop up virtually on their computer or smartphone. Some prefer the richness of a real, live human interaction with another person, where you can see subtle cues of facial expression and body language. Others have legitimate privacy concerns at their end, because of the presence of partners, roommates or family members. And for some forms of therapy, such as EMDR or trauma therapy, eye contact is very important.

For my particular brand of therapy (cognitive-behavioral therapy and relationship counseling), which is very practical and skills-based, the online modality seems to work very well. And as a rule, I find younger clients who are already savvy with computers and social media are much more comfortable interacting online. So I expect the use of this approach to continue growing over time.

I strongly feel that online therapy is the wave of the future, as well as a tool to reach people who ordinarily might not obtain counseling. And with the right technology, it is starting to increasingly resemble traditional live psychotherapy. I hope to expand my own online practice in the future, and would encourage more therapists – and clients – to give it a try!

The do-it-yourself family therapy kit

I sometimes joke that when I am not busy defusing angry people on stage as a public speaker, I put myself in the middle of other people's family conflicts. But seriously, I really do enjoy being a marriage and family therapist. It is gratifying work where couples and families often move from a place of anger and pain to re-discovering one another again, with a little guidance.

At the same time, I have to be honest with you: what I do is really pretty simple. There is more science behind it than you might think. And you can do it yourself in your own relationship. Looking back on a couple thousand therapy sessions or so, I could boil many of them down into five simple rules:

1. No criticism. Ever. Really. Before my first session with a family is over, I tell them my mantra: you can never successfully criticize anyone for anything, ever. There are few less successful undertakings than trying to convince someone else they are wrong.

We all have a hard-wired survival instinct to push back against criticism – listen carefully – no matter how right it is. Get this and everything starts changing.

2. Ask for what you want. So now what happens with all those grievances you have with your loved ones: the crumbs in bed, the bad attitude, the affair two years ago? Here's what you do: ask them for something specific and actionable. And remember, NO criticism.

I can read your mind right now. You are saying, "Look, I've asked my partner over and over and over to stop doing X, and she keeps doing it anyway." No you haven't. You've been complaining to her in a tone of voice that would curdle milk, and she's responded with human nature. So try it again: "Agnes, honey, I see why you do X. It makes perfect sense to me. From my end, I would love to figure out another way that would make us both happy - I might suggest Y. Where could we go with this?"

Maybe the other person will say yes. Maybe they will say no. Maybe the problem is unsolvable, like when she wants children and he doesn't. Either way, you'll be talking productively, instead of watching the other person respond passively or aggressively to your gripes. So ask them to go mountain climbing, see a movie with you every week, or kiss you passionately. Then watch what happens.

3. Ask what they want. What makes your kid happy? What is your partner most worried about? How do they feel about the X that you are asking for? Knowledge is power, and most of us spend too much time wondering what to say to someone and not enough time wondering what to ask.

4. Cheer the other person on. Do you have a rotten kid, or a complaining spouse? Pop quiz – how often do you compliment them, or say things that accept them for who they are, or comfort their mistakes? There is a stronger correlation between these things than you might think. People are capable of amazing transformations when they feel loved and supported.

5. Create your own great life. In grad school, they teach us a spectrum. At one end people are "enmeshed" – highly reactive and dependent on others for their emotional well-being. At the other end they are "differentiated" – loving and secure, but not needy. We want you to be more differentiated and less enmeshed. So start being a great partner or family member by making yourself happy.

Is that all there is to it? Well, not always. But as long as you both care, and aren't beating each other with sticks or recovering from trauma, this is actually a pretty good summary of where a family therapist might lead you. Try it for yourself, and watch some amazing things start to happen with the people you love.

You're stressed - now what?

I recently did a radio interview about the Anxiety Camp group program I run here in Ithaca, and the host asked me a great question: "Everybody feels anxious in certain situations. So what do you do when you first feel that tinge of fear?"

My answer was a correct one, but not a very good one - partly because the real answer is more complex than a short sound bite. So now, with a whole blog to work with, I am going to take another crack at it.

You see, I focus on treating anxiety *disorders* like fears and phobias. They are frankly not the same thing as stress. And there is a clear, well-established approach for treating these issues: understand the self-talk about your fears and make it more rational, create a hierarchy of your fears, expose yourself them gradually, and learn to be fully present as you take these small baby steps, with lots of support and feedback. Easy peazy. That's why these disorders are highly treatable.

But normal stress? Here was my correct-but-not-very-good answer: Be aware that your stress is happening before it boils out of control, change the way you think about the situation (preferably ahead of when your fear starts to mount), and learn to gradually get used to the stressor.

Here is a longer but much better answer. When you feel stressed - right now, in the present moment - what lowers it depends on who you are and what the stress is. For example, one person may be working too hard and needs to relax, while another may be frightened about a health crisis and needs support. So in addition to the basics above, learn what kind of "first aid" works best for you and start using it sooner rather than later. When you feel your anxiety starting to creep up, try one - or more - of these techniques:

Slow down. This is the place I like to start. Why? Because anxiety expresses itself physically through things like shallow breathing, rapid pulse rates, and emotional overload. Amp down your workload if you can, focus on relaxed, natural breathing from your diaphragm, give everything more time, and learn progressive muscle relaxation - try these free resources . All of these will strengthen most people.

Connect. Some people calm down by withdrawing to a quiet space, but for others silence can be maddening - because they gain strength through the fellowship and validation of others. If you're the latter, get out of the house, pick up the phone, or even chat online, and harness the healing power of community.

Get moving. Exercise releases endorphins that improve your mood and your emotional resilience, and even a walk around the block can re-engage you both physically and emotionally.

Be mindful. Mindfulness exercises that engage all of your senses - like this one - are particularly good at dissipating anticipatory anxiety, and help you learn to observe rather than react to your feelings.

Be grateful. What has been clinically proven to be the biggest component of happiness? Showing gratitude to others. Watch this video, and see if making other people happy lifts your mood too.

Most important of all, remember that everyone is different. One person may find calm at a spiritual retreat, and another might find sitting in a white robe and staring at a candle to be like watching broccoli grow - and make them feel more stressed! Gratitude may be a powerful antidote to emptiness in your life, but do nothing at all if you are dreading a final exam. Explore who you are and what works best. And try to stay away from false cures like food or alcohol if you can - they wear off quickly and eventually cause problems of their own.

Finally, if you are chronically anxious or first aid isn't enough, there is no shame in getting a professional involved. Anxiety is very treatable, and talking with a counselor or physician about it is a sign of good judgment and pro-active self care. Good luck and have a stress-free week!

The case for humor in the therapy room

You wouldn't ordinarily think of psychotherapy as a barrel of laughs. But more often than not, I actually think it should be. Here's why:

It breaks the ice. My very first session as an intern, I saw a woman whose family had just experienced a terrible tragedy. As soon as I softly closed the door, she burst into tears, and apologized for being so emotional. My response? "You might be interested to know that during my practicum, I found that men actually cry in session with me more often than women do. But we still don't ask for directions!" She laughed, the ice was broken, and we started off a long counseling relationship as equals.

It de-pathologizes the client. I believe that one of the lowest points in a client's life is when they realize their struggles are so bad that they need help. The act of coming to a first therapy session, by its very nature, can feel very shaming. So I often put myself emotionally at "eye level" with a client with lines that are actually part of a thoughtfully composed performance to normalize the situation:

(During the initial phone call) "Here is where we will meet Thursday. Look for a guy who looks like a typical therapist, with a beard and glasses."

(On entering the office) "Welcome! Please sit anywhere you like. One of these days, though, someone is going to sit in my chair, and then I'm going to have to figure out what to say to them."

(After they sit down) "It wouldn't quite feel like a counseling session without the paperwork: here is an informed consent form I would like you to look over and sign."

It opens communication. Suppose that you take the brave step of opening up to a counselor about a really tough childhood - or perhaps a bad experience with another counselor. Very serious subjects. Of course, I will listen intently and empathize with everything the other person is saying. But sometimes being too dry and serious can make it hard for a client to share painful experiences.

If I sense that the client is feeling shameful or embarrassed, sometimes a little gentle humor can send a powerful signal that I am both listening to them and still like them. For example, I might say, "Wow, it sounds like you were raised by wolves! But you found a way to survive - tell me more about it." Or in the case of the bad counseling experience, I might say, "Sounds like this person put the 'psycho' in psychotherapy for you. How did you feel?" And then the other person starts to open up.

It makes tough messages easier to hear. Suppose a couple is in conflict, and uses harsh language with each other. I could try telling them to be nicer, of course. Or I could teach them what kinds of language to use. But when I tell them a funny story about when I said the wrong thing to my wife - and how badly it turned out for me - they are listening and learning as I gently make fun of myself.

Of course, I am not implying that you should always take strong feelings, difficult situations or tragedies and turn them into a barrel of yuks. There are many times that I am completely serious and focused on another person's story, or on their pain. But when your gut tells you it is right, I honestly believe that more humor and more fun leads, in many cases, to better therapy and stronger client relationships.

My own approach to humor doesn't really spring from what I learned studying therapy. (In fact, far too often in my past, my own counselors would sit there in dry silence.) Rather, it springs from my Irish-American cultural traditions. I'll never forget attending my first family funeral as a child, trying to sincerely express my sympathies to the relatives - and getting laughed at. They weren't there to mope and be sad, they were there to have a party! Everyone laughed heartily and cried heartily, and it was our way of saying that life goes on and you're OK.

So my advice to fellow therapists would be to try being a little more Irish, if it suits your personality. A surprising amount of laughter goes on in my own sessions, and I feel that is a good thing. Try it yourself and see what happens!

What to say to a bully at work

I often teach training programs on difficult situations in the workplace, and one of the topics I am often asked to cover is working with bullies.

Type “dealing with bullies” in your favorite Internet search engine and you will get nearly a quarter of a million hits. This is no great surprise: according to a recent poll by the Workplace Bullying Institute and Zogby International in late 2007, over a third of employees report being bullied, half of them to the extent that it affects their health. That represents a lot of misery out there.

But here is the real surprise: type in the exact phrase “what to say to a bully at work” and you get *zero* hits. Simplify it to “what to say to a bully” and you will get about 50 hits, some of which are from people trying to sell you a book or program, and none of which appear to actually tell you what to say to a bully.

Why so much silence on such an important subject? Because bullies are seen in most of these resources as one-dimensional enemies to simply be fought or avoided – some even flatly recommend that you do not engage a bully. As a result, nearly all of the advice out there revolves around the legalities of handling bullies: documenting specific abuses, when to speak with you HR department, what your legal rights are, and the like.

Perhaps a more balanced view comes from the government of South Australia, which has strict legal protections against workplace bullying. A recent report from them describes workplace bullies (the majority of whom are supervisors) as people who often lack basic management skills and do not know how to behave differently. In their words, “They believe that good management is "tough" management which involves making instant decisions, tolerating no dissent or disagreement, driving people to work harder or faster, dispensing with anyone who cannot keep up and generally treating everyone in a harsh and unfeeling manner. Such managers also believe that if they do not behave in this way they will be seen as "weak" and therefore unlikely to survive in their position.”

Of course, some bullies cross the line into inappropriate behavior, like this one who knocks over filing cabinets to make a point. (I have a good three-word technique for this situation: “call the police”) Others may be sexist, racist, or out to exploit power for their personal gain. But for others – perhaps the majority – I honestly feel that the right communications skills can help defuse these situations and build mutual respect.

Here is my view as a communications skills expert:

We tend to view bullies as evil villains, and this view colors our responses. But bullies generally respond to being challenged the way most of us do, by fighting back and rationalizing that you are the problem. This is nothing more than classic cognitive-behavioral psychology.

If you change the script of what you say, you can often change the outcome – particularly if you speak to their interests while maintaining your own dignity and boundaries. So here is my advice on what to say to the garden-variety, non-sociopathic office bully:

1. Start the conversation in a safe place by acknowledging and validating their agenda. For example:

-When someone has an angry outburst, say, “I can tell by your tone of voice that you are pretty upset.”
-When someone has been spreading rumors about you, say, “I understand you have some concerns about my performance” or “”I understand you aren’t happy about what I said to Sally.”
-When someone is pressuring you to do an unrealistic amount of work, say, “It sounds like we are under a lot of deadline pressure. Tell me about it.”

Yes, it feels funny to talk like this with someone who acts like a jerk. It feels like sucking on a lemon for most of us. And no, it doesn’t always work, particularly when things cross the line into discrimination or abuse. But perhaps 70% of the time, this will get you into productive dialogue. Try it and see what happens.

2. Ask non-threatening, factual questions about their behavior. In general, when you make statements and tell people what do to, they push back – but when you ask questions, you are both giving them the floor and holding them accountable. For example:

-“What would you have liked me to do instead?”
-“How would you have preferred that I handled things with Sally?”
-“Tell me more about what our clients are expecting by the deadline. Do we have any flexibility with them? Could I speak with them directly and see how we can help?”

3. Set boundaries while offering to address their agenda. Bullies usually fight back when they are challenged, but a surprising number of people will respect you for standing your ground if – and this is a big if – you also speak to their interests. For example:

-“I don’t want to see you upset, and I don’t want to be yelled at in the future. Where can we go from here?”
-“I don’t want you to feel criticized, and I also want to be free to be honest with other people. How can we solve this in the future?”
-“I want to make the client happy, and I feel I can honestly do X much work between now and then. How should I best use my time between now and the deadline?”

I feel that everyone is entitled to a workplace that is free from harassment, and fully support legal protections designed to put an end to workplace bullying. But in the meantime, I also feel that in many cases, your communications skills can make a big difference in stopping these situations in their tracks.

In my world, nothing ever goes wrong

Normally I am not a big "motivational slogan" kind of guy. (Here is why.) But a while back, I did hear one quote that has stuck with me for months now. It comes from self-help author Dr. Wayne Dyer, who quoted someone as saying:

"In my world, nothing ever goes wrong."

In other words, everything is a learning experience. Our life is constructed around how we react to both the good and bad things, and these reactions – in and of themselves – are much more important than what actually happens.

This resonates with me. Much of my own happiness today rests in dealing with life as it is, and not just how I wish it was. I discovered over time that a cancelled flight, a delayed project, or even a personal struggle need not define my mood: we cannot control life events, but we can choose (with time and perspective) how we interpret many of these events. Everyone has ups and downs, but I look back on my life so far and see lots of lessons, none of them bad in the end.

Along the same lines, I recently heard some research that completely stunned me: people who win the lottery are generally no happier a year after they win – and people who become paraplegic are generally no *less* happy a year after their accident. So look at the people you know. The people who constantly bitched about life years ago are, by golly, still bitching now, right? And I'll bet the people with positive outlooks haven't changed much either. So guess who I choose to associate with?

Slogans have their limits, of course – I wouldn't try to tell someone who has just experienced a tragedy, for example, that nothing ever goes wrong. But for the most part, I feel that learning to accept things, overcome them, or let them point me in a new direction has a lot to do with why I am a pretty happy guy most of the time. Because in my world, nothing ever goes wrong. What do you folks think?

What to say to someone at risk of suicide

This blog discusses something I strongly feel everyone should know, just like we learn first aid or CPR. Most of us have the best of intentions when someone in our life is depressed – but in reality, we have no clue what to say. So we say things that don't help – or make the other person feel worse – or worst of all, we say nothing at all. (As one example, most of the things we think will motivate or cheer on a depressed person do not actually help.)

In 2005, when I was a crisisline counselor, I penned an anonymous piece for the Ithaca (NY) Journal about what we are trained to say to people in crisis. (Crisisline counselors, while actively serving, remain anonymous in the community.) I personally did not know these skills until I was taught them. If everyone learned them – especially how to really listen, without giving advice or "fixing" the other person – it would have a real impact.

People may not realize that crisis counseling is incredibly effective. Informal studies have shown that people who call crisislines are much more likely to stay alive afterwards. So if you are hurting, please, please call 800-273-TALK from anywhere in the USA, 24 hours a day. Be safe and be well.

* * *

As a volunteer for Suicide Prevention and Crisis Service, I am fortunate to work alongside a great team of staff and volunteers. Together, we help over 10,000 callers a year from all walks of life - and while the calls themselves are anonymous and confidential, some of the life lessons they teach us are worth passing along to all of us.

First of all, you might think that the main function of an agency called Suicide Prevention and Crisis Service is to prevent people from committing suicide. Wrong. That happens to be the most critical thing we do, and we are highly trained for it. But what usually happens day in, day out, 24 hours a day on the SPCS Crisisline is something that is even more important: we show respect, dignity and understanding to a great many people who often experience none of these things in the rest of their life.

You see, the typical Crisisline caller isn't about to commit suicide. The typical caller may be a teenager whose parents constantly scream at him about his clothes, his tattoos and his attitude - but is feeling lonely and scared. Or a severely mentally ill person who is keenly aware of the strange looks she gets from passers-by, and feels ignored and rejected by her family, friends and caregivers. Or a retired professional who feels alone and useless, as his once-busy days now drag on endlessly. Or someone who feels compelled to cross-dress, or cut themselves, and feels out of control.

They could be any of literally thousands of people in this community who are hurting in ways that make them feel alone and different from the rest of us - and desperately need to talk with someone.

Here are some of the things that crisis counselors do when these people call the SPCS Crisisline:

Really listen. When someone has a problem, human nature is to give advice - or criticism. Crisis counselors never do either. Instead, they listen - and continually acknowledge the feelings of the person they are listening to. This creates a zone of acceptance where people can truly open up and start to examine and solve problems.

Check for safety. Many of us are afraid to say anything when we are worried someone might hurt or kill themselves - sometimes, tragically, until it is too late. Crisis counselors check with every person, on every call, to make sure they are safe. Never be afraid to ask frankly if someone has been considering suicide.

Focus on the present moment. Crisis counselors cannot cure mental illness, take away losses, or fix someone's life. What they can do, perhaps better than anyone, is look for the one most important thing bothering someone right now. These "focusing questions" help shift the dialog toward making small, positive steps - the act of which is very important in crisis.

Explore alternatives. The next step in someone's life might involve a community resource, like counseling or shelter. Or it might just involve discussing feelings and alternatives with an empathetic and non-judgmental person. Crisis counselors help people explore their options, and make choices that are best for them.

Establish a safety plan. Above all, if someone has expressed a risk of committing suicide, work with this person to develop a plan for what they will do when they are overwhelmed - who they will call, what health care providers will be contacted, where they will go. Then ask this person to contract with you to execute this safety plan - and call you, or a crisisline - before they decide to act on feelings of suicide.

If we each started treating the people in our lives like this - whether it is our spouses, our children, our co-workers, or even the person sitting next to you at the bus stop - the difference would be truly life-changing, for them and for us. And in some cases, perhaps life-saving.

Raisin consciousness

I was talking back to a box of raisins this morning at breakfast.

No, don't go packing me off to a therapist yet (never mind that I *am* a therapist). These raisins and I have had a relationship going back for years. In fact, I blogged about it previously. For years, Sun-Maid Raisins has put motivational or inspirational sayings on the flaps of their little raisin boxes. Usually good advice about things like smiling more often, or the occasional raisin-centric plug. For a long time, I've enjoyed starting my day seeing what the raisins have to tell me.

I wasn't too happy with the raisins today, however. And there is a good life lesson on communication here that is worth sharing with all of you: when you cross the line from being supportive to telling people what to do, you start getting yourself in trouble.

Today, the raisin box said, "Pick up what you tripped over, so no one else does!" Including the exclamation point. My first reaction? I don't take orders from a box of raisins. And I certainly didn't ask them to be my mother. Their job is (a) to get sprinkled on my oatmeal and eaten, and (b) perhaps to make me smile and feel good. Anything else is shoving their oar in, even if they are a bunch of dried grapes.

A little later, I sat down and examined this reaction. After all, I am one of the most responsible people I know. I'm a mature adult approaching retirement age. I probably would pick up something I tripped over. So if this bothered *me*, how would other people react?

And that is exactly my point. Too many of us - including me sometimes - act like the raisins. We try to correct people. We try to "help" them. We give them advice. We show them the error of their ways. And then we wonder why they never listen to us.

I know the raisins mean well. But in my view, there is only one truly effective way of motivating people: Listen to them. "Get" them. Cheer them on. Understand and empathize with their struggles. And then, if you absolutely must give them advice, do it gently as an equal. Whether you are a person or a box of dried fruit.

Down with willpower!

Almost all of us make resolutions to ourselves, based on willpower - especially on New Year's Eve. A lot of them involve Calvinistic promises to eat less, exercise more, be nicer to Mom, or work harder at your business. And you are probably going to fail at all of them.

Here is why I am so sure about that. These resolutions all involve willpower. And you may not realize it, but willpower is often the worst thing you could try to develop in your life. In fact, I would like you to start looking at willpower for what it really is: the enemy of success.

For my first example, let's take something I see every week as a therapist: conquering your fears. If you are afraid of driving on the freeway, you might think that the best thing to do is screw up your courage, get behind the wheel, and point your car resolutely toward the on-ramp. You know, like all those platitudes about "doing the thing you fear."

Wrong-o. What you are actually doing is sensitizing yourself to your fears, and probably making no progress at all - or worse, setting yourself back. Clinically, the most effective way to conquer fears is to change how you think about them, and then take tiny baby steps that desensitize you. Ironically, while having fears is very scary, getting well from them is often painless if it is done correctly.

For example, I once used to be afraid to fly. (Never mind that I am a former engineering supervisor at Boeing Aircraft.) And I had "exposure" out the kazoo, logging over a quarter million air miles during my management career, all the way up to 19-hour flights to Asia. But then one day I had a two-hour telephone counseling session from a pilot-turned-therapist who runs www.fearofflying.com, focusing on how I viewed the experience of flying. I literally hung up the phone from that session and said to myself "Now I'm ready for this." And ever since, for 50,000 air miles and counting, flying has been like stepping on a bus.

Now, let's take dieting. Something I've done often. What happens every time is that I cut back my calorie intake, get on the treadmill three times a week, and lose exactly 10 pounds. And then get stuck. And stay there, seemingly forever. After which I get fed up and go back to my normal eating habits. So this New Year's, I am not "going on a diet." Instead, I am going to talk to a nutritionist and learn how to eat better for the rest of my life.

Moving to more sensitive territory, let's talk about your career. Do you think that working harder is the cure for your job woes? That is how your boss thinks, of course. I've got a much better idea: pick the most fun thing you could possibly be doing and become absolutely incredible at it. When I finally left corporate life to spend every day doing what I love, many years ago, it wasn't just the best emotional move I ever made - it was the best financial one as well.

Finally, let's look at difficult situations with other people. Resolving to simply been braver or be nicer to others never works - you either slip back into your old habits, or you open your mouth and nothing comes out. Most people feel like deer frozen in the headlights in their most difficult situations, until they are taught to say the right things. Then it becomes incredibly easy to be nice to people, resolve conflict, and negotiate what you want. then watch what happens when you replace willpower with a much more potent force: skill power.

Feel the fear and *don't* do it anyway

Hi there, all you people who write motivational articles about how to "go for it," "feel the fear and do it anyway," and "get out of your comfort zone." I really appreciate what you are trying to accomplish with these articles.

Now, respectfully, could you all please knock it off?

Since I began practice as a psychotherapist, I have done a lot of work with people with anxiety disorders. These are not people with quote-unquote too much stress, but rather people who suffer from issues like fears, phobias, and compulsions. They can't board airplanes, drive over bridges, or stop washing their hands 50 times a day. And whether you know it or not, articles like yours are part of their problem.

Since early 2009 I have been running a group program called "Anxiety Camp," and to a man or woman, its participants all tell me the same thing: well-meaning friends and relatives have always pushed them to engage in "Nike therapy" about their fears (e.g. just do it). The results are always the same. At best they suck it up, muddle through fearful situations, and then feel no better the next time they face them. More often they freak out, have setbacks, and end up worse off than where they started. And then everyone assumes that the sufferer simply isn't trying hard enough.

In reality, trying hard *is* the problem. It goes against your neurobiology. Being afraid is a survival instinct that protects us, and when we try to short-circuit that instinct, our subconscious pushes back - hard. So how do you get well from anxiety disorders? In tiny baby steps. While paying a lot of attention to what you tell yourself. That way, you start re-programming your circuits about what is frightening to you, as you gradually expand your comfort zone.

You see, the suck-it-up types want you to face your fears by gritting your teeth, putting your head down, and enduring situations. At best, doing this simply distracts you and teaches you nothing. At worst, it sensitizes you to situations you really want to become *de*-sensitized to. I want you to learn to become fully present in feared situations. And that almost always requires experiencing them gradually.

To be fair, I do understand the value of these motivational articles. Sometimes people decide to make brave, fundamental moves that change their lives. They choose to take control instead of take cover. And sometimes it works. For example, the day I leaped without a net from corporate life into self-employment will always rank up there as one of the most life-affirming things I've ever done.

But that is not the same as dealing with the fears that, statistically, one in five of us struggle with. And when fearful people read these articles - or worse, are handed them by well-meaning others - they become disheartened. And worst of all, don't realize that from a clinical standpoint, these words are often leading them toward illness and not wellness.

Conversely, when people start taking tiny baby steps from within their comfort zone, magic often starts to happen. I've watched this happen over and over. Anxiety scores drop, limits start disappearing, and people develop a renewed sense of faith in themselves. So if you're fearful, remember: learn all you can about your fears. Take things one small step at a time. And stay far away from motivational speakers.