The Wegmans Test

How can you tell how strong your relationship is?

As a marriage and family therapist, I use a number of assessment tools to test this. They tell me, in gory numerical detail, where a couple's strengths and weaknesses lie. But I have a much simpler one you can use on your very next trip to the grocery store: I call it the Wegmans test.

Here in upstate New York, Wegmans is an extremely popular local supermarket chain. Their stores are huge, and going there is a bit like grocery shopping at Disneyland. Here in my native Ithaca, NY the local Wegmans is roughly the size of two football fields, has everything from dry cleaning to a pizzeria, and is open 24 hours a day.

Which means that aisles at Wegmans are huge. Now, suppose you turn the corner into one of these aisles, and you suddenly catch a glimpse your partner off in the far distance. What is the very first thought that immediately enters your mind? That is the Wegmans test.

When I first see my spouse at the other end of the store, my first thought is always to smile and think, "Ahh ... there goes my beautiful wife." This powerful first relationship-defining thought is what lies underneath whatever ups or downs are going on between us that day. It undoubtedly governs the stance I take toward her when all else is at rest - the words I choose, the emotions I feel, and the level of partnership I bring to the relationship. It is likely the reason I am still deeply in love with her after over 40 years together.

Now, suppose you see your partner and your subconscious gut reaction is "Ugh, there is the curmudgeon I have to go home with." In all likelihood, your communications, your mutual problem-solving style, and your motivation to improve the relationship are very different from mine. And that, in turn, is why you are both so unhappy most of the time.

Marriage therapists like me make a profession of helping couples get closer, starting with learning new ways to talk - and more importantly, listen - to each other. But I could teach you all the communications skills in the world, and none of them would help if that basic, underlying spark isn't there. In fact, more often than not it would be like trying to bring a dead fish back to life. That is why the Wegmans test is so important.

So what should you do if the two of you flunk the Wegmans test? For starters, ignore most articles on how to be a closer couple. Candlelight dinners, holding hands, and even good listening skills aren't going to cut it when you fundamentally get under each other's skin. 

Instead, be honest with yourself - and better yet, each other - about what you might both need to change to bring the spark back. It might be as simple as learning to respect each other's preferences, or as complicated as unearthing past hurts and traumas in therapy. Either way, the keys to a good relationship are waiting for you right there in the produce aisle.

Of elevators and exposure

An old joke describes someone who gets stuck in an elevator, and the emergency phone rings a long-changed number that is now a therapist's office. At first the therapist tries to explain that he can't help him, to which the person exclaims, "Can't you do anything for me?" After a long pause, the therapist replies, "How do you feel about being stuck in the elevator?"

There is some truth in jest to this joke for me. I am a psychotherapist who specializes in treating anxiety disorders, and decades ago I recovered from some severe and crippling phobias myself with the aid of good therapy. Nowadays I am a pretty happy guy who experiences very little anxiety on a day-to-day basis. But one issue I've never really bothered to deal with is that I am claustrophobic and don't like to ride in elevators. And yes, I have been stuck in them before.

In a way, I am almost glad to have one piddling fear left, to observe and work with what I prescribe for others. For one thing, it isn't very life-limiting. When I go to Manhattan and have a meeting on the 38th floor somewhere, up the elevator I go. But if I am at a five-story hotel, I will ask for a lower-floor room and take the stairs. Either way there is very little motivation for me to work on this fear, so I just put up with it or accommodate it.

But what if I suddenly needed to be taking elevators a lot? Here are some of the things I would do if I were treating myself for this problem:

1) Examine my thinking. My fear is ultimately caused - and sustained - by a great deal of self-talk, most of which is false. "If we get stuck between floors, no one will know and we'll die like rats." "I'll yell and scream and make a fool of myself." "I am taking a big risk."

All of these statements are rich in what we call cognitive distortions, or errors in thinking. Elevators have alarms, emergency phones, and even the sound of my voice to people on a nearby floor. My cell phone will often work from inside the elevator. I can count the number of times I've actually been stuck on the fingers of half a hand or so, and in each of those cases I was out again within minutes. So changing my self-talk to be more accurate and rational can help the way I feel.

2) Create a gradual exposure hierarchy. I generally prescribe approaching a fear in small steps, and learning to be fully present at each step. But how can you gradually expose yourself to an elevator? After all, once the door shuts you're in, right?

In reality, there are all sorts of steps you can take with an elevator fear. Do you feel anxious just standing near an elevator, or watching people get on and off? You can start there! Then try going in and right back out of the elevator, or perhaps just go up one floor. And there are different kinds of elevators: fast, slow, glass-enclosed, and the like. Taking a small step and learning to lower its anxiety will strengthen you for every other step you take.

For example, when I did my psychotherapy internship at a large super-regional hospital in Pennsylvania, its 10-story hospital wing had slow, creaky elevators that I hated. But its attached five-story clinic had brightly-lit high-speed elevators that were always full of people - and in time, I actually learned to ride comfortably on these elevators.

3) Practice, practice, practice. Which leads to my last point: practice, even at low levels, will inevitably chip away at your fears and create progress.

During my internship, for example, I got a chuckle out of one of my fellow interns as I described how we were going to get to a meeting on the eighth floor of the hospital: walk over to the clinic, take the high-speed elevator to the fifth floor, walk back to the hospital, and go up three flights of stairs. But there I was on an elevator - and eventually I took this elevator regularly with much less fear.

Will I get over my fear of elevators someday? Stay tuned. In the meantime, there are evidence-based tools I can use if I ever need them. And I can keep them in mind even as I make my way up and down the stairs.

Coming of age

2014 was, among many other things, a year of coming to terms with age – my own, and others. My mother, who suffers from dementia, has sadly declined to the point where it is difficult to carry on a conversation with her. My mother-in-law also experienced a severe cognitive decline affecting her judgment, and after falling once too often, is now in a care facility. And this past year I reached the great age of 60 and am now preparing for my own retirement, a couple of years after my own spouse’s transition to Medicare and Social Security.

More than anything, I am confronted with the fact that if we are fortunate to live long enough, we often need the care of others. Walking through the halls of a nursing home surrounds me with an overwhelming sense of finality: no more trips to Paris, starting a new consulting project, or ducking out for a movie. Just one day after another in the same hallway, with televisions blaring, neighbors muttering incoherently, and activities that feel like being back in third grade, because you can no longer hoist yourself on the toilet or be left alone safely.

Right now, I can be smug that I will walk out the door after each visit and return to my normal life, as I hope to for many years to come. But I can’t forget that this was once the case for each of the dozens of names on these doors as well, including people I love. So what could I - and each of us - do to prepare for this day? Here are some of my thoughts:

1. Learn to live in the moment. For me personally, this will be the hardest part of my journey. I live incessantly in the future, and my good life often revolves around my next “thing.” But we all ultimately live from moment to moment. I see many good moments of connection between people in a nursing home, and I can perhaps best honor their worth by finding more joy in my own moments.

2. Have a voice in our own aging process. If there is one trait that seems to permeate an entire generation above me, it is denial. It saddens me when people insist they are fine when they clearly aren't, or refuse to have a discussion about possible next steps, and I ultimately watch decisions being made for them against their will. Few people suddenly wake up one morning with dementia or degenerative illness, and if that is my lot someday I hope to be part of the dialogue about my own care. 

3. Plan ahead. I hope that someday I will know when it is time to raise the white flag - and I am sure this will be much harder than it looks when the time comes. Especially for someone like myself who has no children to serve as truth-tellers and advocates. But if circumstances permit, I would much rather have a game plan than just hope for the best.

None of us knows what the future holds. I could be like my grandmother, who was lucid and funny right up to the end of her 96-year-old life, or my late father, whose last conversation was about his field of finite element analysis with a colleague in Europe. Or I could be run over by a beer truck tomorrow. (Don’t laugh, I live on a major highway.) Or my wife and I could end up like our mothers. Either way, I am glad to be growing older – especially given the alternative. And my goal for 2015 and beyond is to start learning to age mindfully and enjoy this mystery we call life, for as long as I possibly can.

Investing in yourself

Many years ago, after purchasing a vehicle, one of my co-workers sourly observed, "You'll never get rich buying new cars."

But actually, he was wrong. Years later, when I was starting a consulting practice, getting a new car - at a time when I had no income whatsoever - turned out to be one of the smartest moves I ever made. And perhaps one of the smartest moves YOU could make too. Allow me to explain.

Here's the backstory. In 1996, after a pretty good first year as a consultant, everything came to a very hard stop. All of my projects and clients ground to a halt at nearly the same time, and my income with it. From there, I couldn't get myself arrested. Three months later, adding insult to injury, my wheezy old car with six figures on the odometer needed major repairs.

With my tail between my legs, I went to my local dealer to try and trade for a passable used car while I got back on my feet again. Instead, the salesperson wheeled out one of the most gorgeous vehicles I'd ever seen - a brand-new, full size car with metallic paint, a sunroof, and a premium stereo system. And explained how leasing it for two years would only put a small amount of my assets at risk.

His numbers actually made sense. I could essentially "borrow" this beautiful car for two years for a modest cost, and then turn it back in if I still wasn't successful. I will never forget the feeling of having had no income in three months, no idea when I would ever work again, and driving off the lot in the nicest car I had ever owned.

Here is why it actually made good financial sense. Every time I got behind the wheel of this beautiful car, I FELT like a successful person. And ACTED like a successful person. Which made a real, tangible difference as I started knocking on doors, lining up gigs and clients, and planning my future. Soon I was back in business again, and I proudly paid that car off early and kept it for seven years.

Think about it. If you are trying to make an impression on others - for business or personal reasons - what would give you your best chance of succeeding: feeling hot, sweaty, and dirty, or feeling freshly showered and clean in a nice suit? Either feeling transmits itself to other people, and the same thing is true for the rest of your self-image. And what they perceive, in turn, ultimately governs your success.

I am not suggesting that you start taking stupid risks with your life, or your cash flow. But I do want you to rethink the hair-shirt view that self-denial is a necessity for success. What works for those types frankly wouldn't have worked for me - and I feel strongly that you should do whatever will make YOU most successful.

Nearly two decades later, I still drive around in a nice car, because I firmly believe that how you FEEL and how you ACT are major determinants of success. (My current ride is pictured above.) So whatever it takes to make you feel awesome - and then share that awesomeness with the world - seriously consider it as part of your life plan. Invest in yourself and your self-image, and I believe the rewards will often come back to you many times over.

How to choose the right therapist

The small town in upstate New York where I live has over 100 licensed psychotherapists. We sometimes joke that there is one therapist here for every four people. All joking aside, however, it can be a real challenge to find the right therapist, particularly when your issues need specific expertise. Picking people at random from a list of practitioners can be very frustrating – and worse, it can lead to bad outcomes.

So how do you find the right therapist for you? Here are some thoughts from my end:

1) Start with expertise

Suppose you are dealing with PTSD. Or OCD. Or chronic illness. Or domestic violence. Most therapists can hum a few bars on any of these problems, but in my view, the difference between a specialist and a generalist can be huge. It is no different from trying to see a general practitioner when you really need a dermatologist.

There is a real risk in choosing a therapist at random from a directory: this person might say “yes” and start treating you, when you would have done much better with an expert. How do you find these experts? Drill down into their websites, search online to see what they talk and write about, and ask other health practitioners. Visit my website, for example, and you will discover that my specialties include marital counseling, treating anxiety disorders, and workplace interventions.

Another good test is to look for professional credentials or certification: for example, I am a clinical fellow of the American Association of Marriage and Family Therapy, a graduate of the International OCD Foundation's clinical training program, and the author of several books on workplace communications skills. You can also check websites of support organizations for specific issues, many of whom have therapist directories.

Finally, some issues usually demand the resources of a mental health agency or hospital. When someone is actively suicidal, suffers from severe or persistent mental illness, has behaviors that put others at risk, or needs a level of care that goes beyond a weekly psychotherapy session, private practitioners may lack the resources or expertise to manage these issues. Start with your local, county, or hospital mental health unit in situations like these, and get the help you need.

2) Chemistry matters

I am always delighted when a new client tells me that they are evaluating several therapists before choosing the best one. It tells me that this person is proactive about taking good care of him or herself. I strongly encourage this, and wish it happened more often. I personally do not care at all about whether I "win" or "lose" in these situations, as long as people are getting the right care.

When you don’t connect personally with an auto mechanic, they can still do a good job of fixing your car. Even a doctor with poor bedside manners may have strong clinical skills. But in psychotherapy, wellness pivots around a strong therapeutic alliance between you and the provider. This means you should trust your gut about how you feel personally about the therapist. At a minimum, he or she should make you feel heard, understood, and accepted as you share your issues.

Finally, this is a good litmus test for how secure the therapist is in his or her own practice. Run – don’t walk – from any therapist who gets upset about comparison shopping or tries too hard to “sell” you.

3) Look at the practicalities

Once you find one or more therapists who have the expertise AND the personal chemistry to help you, you can explore the specifics of how this therapist works:

• Does the therapist have evening or weekend hours?
• Does he or she accept your insurance coverage?
• Will the therapist call or see you off-hours in an emergency?
• Can you easily cancel a session when needed?
• Can a family member join you for a session?

Remember, the therapist is just a consultant, and you are the boss. Good luck, and be an educated consumer!

Dragging your teenager to therapy

I have a word for those of you who are concerned about your adolescent’s moods or behavior, and are thinking of insisting that they see a counselor. Two words, actually:

Please don’t.

The reason is simple and self-explanatory: remember what you were like as a teenager when your parents made you do anything? There’s your answer. But in case your own adolescent memories are a bit hazy, let me spell it out for you.

First, it doesn’t work. Good therapy never happens at the point of a gun. Explore one’s feelings and strategizing new behaviors needs the kind of conscious, willing effort that no one can ever be talked into.

Second, it is miserable for your kid. Even when people want and need it, psychotherapy usually ranks pretty low on most people’s lists of fun things to do. Add in the punitive atmosphere of being “sent” to counseling, and it becomes almost impossible for positive change to happen.

Third, it is miserable for the therapist. Ever heard of a “shruggie”? That’s what we call an adolescent client who sits there for the whole hour and responds to every statement with a shrug. Good therapists are usually gentle and kind with shruggies, but in terms of any real benefits taking place, you would be better off bringing a potted plant.

My biggest concern is that when sullen teenagers are dragged to therapy, they learn to associate counseling with resistance, stigma, and parental pressure. Which makes it that much less attractive to them in the future, even if they might want or need the help.

Here is an analogy: when I was growing up, my father always tried to get me to read great literature. Was it effective? You bet. Despite being a prodigious non-fiction author for nearly all my adult life, to this day I neither read nor write a word of fiction.

So what can you do when you are worried about your adolescent?

1. Talk with your kids – and more important, listen to them. Listening without judgment and taking their feelings seriously – even when you might not agree with them – starts building the new adult relationship you are both headed toward, and helps them open up to you when they really need help.

2. Make them a free trial offer. If you think your teen isn’t wild about therapy, but really needs the help, suggest what we therapists often propose: go for three sessions, and then let *them* decide whether it is helping them or not. (And then be sure to pick a great therapist who really “gets” adolescents.)

3. Go to therapy yourself. “But I’m not the problem, my kid is!” Fair enough. But therapy is fundamentally a skill-building process, and if you learn skills for how to deal with your teenagers and bring them home, that may be the most effective way to help them. Besides, you might be surprised to learn how many of your adolescent’s problems are actually a dance with two partners.

4. Know when intervention is needed. Some situations do call for counseling, whether or not your teen is willing. The threat of self-harm, suicide, severe mental illness, or risk to others are good examples of this. A good social service agency or crisisline should be able to guide you in situations like these.

Finally, there is the best reason of all to send your son or daughter to therapy: when they ask for help themselves. When it is their independent decision to get counseling, you can become part of their support team – and in the process, start building an adult partnership for good mental health.

A practical guide to keeping yourself alive

Like everyone, I am shocked and saddened by the death of Robin Williams – someone whom I honestly felt was the most brilliant funnyman of our era. While it was no secret that he suffered from depression and alcoholism for much of his life, I will not try to analyze what led him to make this choice – only pray for him and his surviving family.

But I do want to say something to an equally important person: you. You are still alive and reading this. And if you are feeling desperate, hopeless, or unloved, I would like to chat with you for a minute.

If the thought of suicide has crossed your mind, then more than anything, you are probably feeling overwhelmingly alone. You may be thinking thoughts like these:

-“This pain is never going to end.”

-“I have struggled for so long with (mental illness, substance abuse, disability, or whatever) things will never get better.”

-“I feel so humiliated by something I did – or failed to accomplish – or that happened to me – that I can’t face the judgment of others.”

-“Because I am (unemployed, poor, divorced, retired, flunked out, or whatever) my life has no value.”

-“People would be better off without me.”

I would love to talk you out of these thoughts. And it would be tempting to try, because they often turn out to be untrue in the long run. But I probably can’t. So instead, I would like to try and share a little behavioral science with you. Here are just three simple things I would like you to remember:

1) Realize that you are feeling alone. Which has a simple and proven antidote: DON’T BE ALONE. Don’t try to figure out your thoughts quite yet. Just share them with someone. Perhaps someone who cares about you, or perhaps a crisisline or mental health professional. (Incidentally, calling a crisisline is one of the most effective public health interventions in existence.) Whatever you do, please bring other people in on your situation. This one simple guideline is more likely to keep you alive than any other.

2) You need a safety plan. Willpower is the worst thing you can depend on to do anything, including staying alive. Instead, you need a plan that will always be there for you. Know who you will call, where you will go, and whom you will stay with when life gets overwhelming. And then make a contract with yourself and others that you will always execute that plan.

I recommend making at least one professional part of your plan, whether it is a therapist, a crisisline, the police, or your local hospital. Why? Because of another fact that may surprise you: friends and family are often your worst resources in a mental health crisis. Unless they have been trained, you may get pat answers, pep talks or awkward silences when what you really need is competent help and support. So if possible, make the right professional(s) AND the right loved ones part of your plan.

(P.S. If you are wondering what to say to a loved one who is at risk of suicide, I have written a detailed blog on this, linked here.)

3) Don’t wait until you are in crisis. I often suggest that therapy clients call a crisisline for fun, just to see what the experience is like – and as a former crisisline volunteer, I can tell you that they will welcome the call. Knowing that there are *always* people who will listen and talk with you, 24 hours a day, about anything that bothers you is powerful and strengthening.

Another reason not to wait until you are in crisis is that professionals vary like anyone. (You’ve probably heard the joke about what they call the person who graduates last in medical school: “Doctor.”) If you don’t feel you connect with a therapist, prescriber or care facility, try another one. You deserve to have the very best people on your team when you need them.

I am by no means implying that these three steps might have saved Robin Williams. That would be horribly unfair to him and his surviving family, because we will never know what happened. Instead, I mourn his passing and wish them peace. But for many of you who feel desperate and hopeless right now, these steps will give you a much stronger chance of staying alive: don’t be alone, have a safety plan, and don’t wait until a crisis erupts. Good luck and be well.