Psychology of self-change
Artwork: Pneuma (c) Kelsy Landin
Artwork: Pneuma (c) Kelsy Landin
Note: I have not individually vetted each of these resources (except where otherwise indicated), though they generally come from reputable colleagues and/or are based in well-established therapeutic techniques and principles. Nonetheless, as with everything, I encourage you to use your own judgment and consider your own individual context when deciding whether and how each recommendation applies to you.
Some experiences have the power to focus one’s ambition and intentionality about life. For Steve Jobs it was, famously, a near-death experience. For others it may be a timely encounter with a work of art, a memorable conversation with a role model, an unexpected triumph, or an epic failure.
For me, it was the birth of my first child, Alice Sophia Bateman, just over a week ago. She has strengthened and clarified my purpose, not just in that I’d do anything for her—which I would—but in that she’s moved me to double down on the riskiest, least certain aspects of my career and life.
As testament to the latter outcome, I present to you this—my inaugural blog post entry—whose arrival is, in some ways, an even more momentous event for me than the birth of Alice.
For roughly a decade now, I’ve been setting various forms of ”writing for a general audience” intentions as New Year’s Resolutions, monthly personal goals, weekly to-do tasks, and so on. Yet I’ve never generated a strong enough impetus to push myself into acting on any of them. But here I finally am, pushing against perhaps the strongest inertia I’ve managed to accumulate with regard to any long-desired and correspondingly long-avoided professional endeavor. Fittingly enough, the topic of this post will be the same as its source and inspiration: it will be all about Alice.
In my long-standing avoidance of writing for a general audience, I’ve dealt with the resulting guilt and pent-up need for self-expression by writing the occasional poem instead. I’ve genuinely loved writing these poems and am overall glad they exist. But they’ve also admittedly functioned for me as a kind of “safety behavior”: a “quick fix” anxiety-relief strategy that shields me from having to fully do what I want but am afraid to do.
Here’s the 1st poem I wrote during my early pregnancy with Alice. Then follows the “slow fix” of explaining it more fully in prose.
Something from Nothing
On flying back together
From a city now at peace
With the villainies it weathered
In its days of “West” and “East”,
I scan my awkward body
For the latest signs of you,
And I relish every soreness,
Every muscle ache that’s new.
Are these among the stories
You will someday hear me tell,
As today your grandpa glories
In his tales of Soviet hell?
But what a silly question
When we haven’t even met;
Did I read it in the books and blogs
That clamor in my head?
It’s under all the clamor
Of predictions and advice,
Of the ads for “pregnant glamour”
And the listings-out of vice,
That I am soaked in silent,
The knowledge of your coming;
The magnitude of this.
But such intense emotion
Is difficult to bear,
So I channel my devotion
Into “ordinary” cares—
Like trying to get work done,
Or complaining when I fail,
As I bounce from nascent projects
To commitments old and stale…
But this is just more clamor,
Just more dithering about;
It would take a mighty hammer
To demolish all my doubts:
Ought I to be a scholar?
Am I wasting too much time?
Should I not instead devote myself
To callings more sublime?
Yet, under all that doubting,
I know just what I must do.
I must dip into that longing
Which has always pulled me through:
That longing for the nurturance
Of healthy human souls;
The chance to lift and liberate,
To arm with self-control;
The nurturance of potential,
Of the noble and the true.
The nurturance of untarnished youth—
The nurturance of you.
It took Alice’s actual emergence —in all her wrinkly, adorable flesh—for the meaning and power of this poem’s sentiment to fully sink in for me. (In fact, it happened right around the moment I felt her approach; but more on that part of the journey in my next post.)
And what is really so special about Alice? After all, she is pretty boring company, and she drains me of the time and energy I might otherwise devote to more reciprocally rewarding interactions. Have I been taken in by her cuteness, as some evolutionary psychologists might claim, or else fallen prey to popular convention? Neither of these hypotheses explains the depth of what I feel toward Alice, nor why, in committing to her, I find myself committing more eagerly and fully to life itself.
As Matt and I put it in our Facebook announcement of Alice’s birth:
“Over the last few years, Gena and I have both experienced, separately and jointly, an unusual surge of coherence. In work and in love, our lives have come together to resemble the vision with which each of us started. But there was still one missing puzzle piece: both of us have, as long as either of us can remember, badly wanted children. …Gena gave birth to our tiny missing puzzle piece this afternoon. We were delighted to meet Alice Sophia Bateman, and we are excited for many of you to meet her soon.”
This “puzzle piece” metaphor is precisely descriptive of Alice’s role in my life. The core themes of my personal and professional endeavors to date have converged upon the nurturance of the struggling, striving, growing person, be it myself, my therapy clients, my students, or my readers. In all my day-to-day decisions about what research or writing projects to prioritize, what therapy clients to take on and how to work with them, what content to cover in my graduate psychology courses, my guiding vision is that of the struggling, striving, growing person, and of the knowledge and ideals that empower and inspire such a person.
That vision is my raison d’etre; it is the essence of what I want out of my life. Put another way, it’s the picture to which I want the puzzle pieces of my life to add up. It’s what empowers and inspires me toward continued struggle, striving, and growth.
Yet I’ve often found it hard to keep that vision consistently vivid in my mind. For instance, I might focus all my energy on applying for a grant that, if I’m lucky enough to get it, will allow me to run a pilot intervention study that, if it generates meaningful results, will eventually help me develop a treatment strategy that people might (or might not) discover and use some 10-15 years from now. To think about and move towards any such activity, I need to zoom out enough to see how the pieces might eventually connect, including the uncertainties and opportunity costs. But conjuring up so many hypothetical pieces and the different ways they might fit together is itself a highly demanding and often anxiety-inducing task.
In the work of assembling the puzzle of one’s life, piece-by-piece, the easier approach is to follow an existing blueprint that’s already been written by others, and hope that it is a close enough approximation of the vision one was aiming at. The most plausible such blueprint in my line of work, should I choose to follow it, is to focus on the academic activities that typically lead to tenure. Even if this metric is difficult to achieve, it is fairly easy to understand and use.—And it’s not entirely at odds with my picture of the life I want.
What is less clear, however, is the shape of the other plausible paths, alternative or complementary, that I might focus on if I weren’t exclusively focused on the standard academic one. Equally unclear is how their potential reach and impact compares. And, if I’m honest with myself, one thing I know with reasonable certainty is that writing for a more general audience, though it will not help me get tenure, will be part of any path that truly satisfies my vision.
In this way, “doing what gets me tenure” has also functioned as a kind of safety behavior: by giving me the comfortable illusion of a clear, well-drawn path to my desired life, it has kept me orbiting in place instead of truly, thoughtfully growing.
Or so it did, anyway, until Alice came on the scene. This wriggly little creature who began her growth inside me and is now devoting every reflex, every little grunting noise and semi-voluntary wiggle, every ounce of her living energy to growing farther; and who needs a generous supply of my and Matt’s living energy to help her grow. Never has the meaning of my life—to foster human growth—been more vividly, constantly, delightfully presented to me. And never have I been more willing to do the work and overcome the fear of really living that life.
This has manifested most directly in my decision-making about Alice’s care, both prenatally and postpartum; the sheer number and intensity of “existing blueprint”-style recommendations that have been thrown at me, and my efforts to chart out my own scientifically-informed and Alice-tailored path in the face of them, will be the subject of a later post. For now, I want to reflect on how Alice’s clarifying presence has extended to all the other realms of my life, insofar as they involve my own growth or the growth of those I care about.
To give but one example: For all the love I already felt toward Matt, our 1 week of parenting together has already further concentrated and intensified the feeling. How did a helpless little pooping, peeing, feeding monster manage to work such marital magic? By showering us with a sudden flood of new particulars to reaffirm and intensify the love we already felt. In just these 7 days, we have seen each other through several tearful bouts of emotional overwhelm ranging from sudden, unexpected ecstasy at her adorable sighing noises, to equally sudden pangs of doubt about whether we’re doing something wrong; we’ve cycled through several failed attempts at a mutually agreeable sleep and feeding schedule, and finally settled on one that seems to be working for all 3 of us (not that we’re holding our breaths!); we’ve had and thoughtfully resolved our 1st parenting “fights”, and somehow emerged as even stronger allies and collaborators at the end of both.
And the same mechanism has already begun to operate in the rare moments when I’ve had at least one hand free to write or answer emails or otherwise catch up on work. For that, this blog post, written largely while pumping or nursing, is its own best example.
When seen in this light, I think my complete and unconflicted devotion to Alice—and my willingness to push harder than I’ve ever pushed, in every sense of the term, now that it is for her sake and in her honor—is a more genuinely selfish motivation for parenting a child than any of the “tricked by cuteness” sorts of accounts that get bandied about by evolutionary psychologists (though it certainly doesn’t hurt that Alice is the cutest baby I’ve ever laid eyes on). Of course, I recognize that this motivation is deeply personal to me; not every parent will have devoted her life to the nurturance of human growth, be it in the form of mental health treatment (as in my case) or education (as in Matt’s case). In fact I imagine the particular motivations that make parenting a deeply gratifying and personally worthwhile endeavor will vary widely from parent to parent. This is one reason why I think the choice of whether to have kids should be a strictly and exclusively personal one, and that not having kids should be the assumed default, rather than the other way around (but more on this in a future post).
With all that said: for those of you who do make the choice to parent—or any choice that’s life-altering and irreversible, for that matter—I wish you the kind of distilled clarity and eagerness of purpose that Alice has bestowed on me, as the constant reward for making her my all.
This is the unabridged version of my Psychology Today blog post by the same name. Among the bonus content are links to several competing therapist directories that I was asked to cut from the Psychology Today version (for understandable reasons).
Given the limited openings in my private practice, I spend a lot of time playing therapist-client matchmaker to the kinds of people who tend to reach out to me. The process has given me a lot of sympathy for those who get disheartened and either stop looking, or settle for a therapist who isn’t great for them. It’s hard enough to know what qualities to look for in a therapist when you just have a “standard” problem, like an uncomplicated case of depression or social anxiety. It can seem nearly impossible when your problem is that you’re not sure what your problem is, or that your depression is inextricably connected to what makes you great at your job (and every therapist you’ve seen has just told you to find a different job), or that you’re doing “fine” by conventional standards but have a nagging feeling that you could be getting so much more out of life. How can you guess from a particular therapist’s profile whether they’ll really “get you,” whether they’ll ask the right questions and attend to the right details to help you untangle the knot of longings and fears and hangups that has kept you from growing?
To some extent this is bound to be a trial-and-error process, of course; but what I can offer are some strategies for increasing the proportion of “hits” to “misses,” and for knowing a “hit” when you find one.
There’s already lots of good general guidance available for finding and vetting a therapist, so I would start by reading some of this general advice (such as here, here, and here) if you haven’t already. Then I would use the tips below to help you further tailor this process to fit your particular, non-cookie-cutter needs.
When reading a given therapist’s online profile or professional website, ask yourself some targeted questions:
1) Does their distinct style, approach, and personality come across?
A generic or otherwise lackluster profile shouldn’t be a dealbreaker; many fantastic therapists have lackluster online profiles. But if a profile is written in a more thoughtful and distinctive way, then you might want to bump it up in your queue.
2) Does their written style resonate?
If you like their written voice, you’re more likely to like them in person. If they provide a video introduction, that’s an even closer approximation.
3) When examining their list of specialties and therapeutic approaches, does it seem like they checked off every box indiscriminately?
This is generally a red flag for me, unless their profile gives a very compelling explanation for why and how they combine so many approaches. I would have the highest trust in a more selective list, particularly if it includes one or two “specialty” approaches (like “acceptance and commitment therapy” or “family systems”) that seem to hang together.
If you’re not familiar with a given approach, do a quick Google search and read a description of that type of therapy. Pay particular attention to a) whether the approach seems to have some scientific grounding and legitimacy (as described by a relatively “neutral” source, not just by its originators or direct affiliates) and b) whether it sounds potentially well-suited to you and your situation.
Finally, as a general rule-of-thumb, I would lend a bit more credence to a therapist who says they are “integrative” than one who says they are “eclectic,” as the latter usually signals more of a grab-bag than a coherent, independent-minded synthesis of the best elements of multiple approaches. Again, though, this should by no means be a “dealbreaker”—just a tentative heuristic to help speed up your search, all else being equal.
In addition to searching Psychology Today’s Find a Therapist database—which provides the most comprehensive listing of therapists who fit your general search criteria— it can be helpful to search some professional websites that require therapists to jump through certain special hoops to get listed. While this is by no means a guarantee of high quality, it tends to be biased toward therapists who maintain active relationships with their colleagues, seek out ongoing professional training, and generally approach their work in a thoughtful and self-reflective way. The particular database(s) you want to consult will partly depend on the therapeutic approach (see above) and the areas of specialization (e.g., depression, anxiety, OCD, grief, trauma, addiction, relationships, etc) that you want your therapist to have. Below are the databases I tend to use, which lean “cognitive-behavioral” simply because that’s the community I’m most familiar with (but I’ve also listed a couple more psychodynamically-oriented sources that I’ve gotten from trusted colleagues).
In addition to these national and international databases, it may also be worth searching for specialty-based professional organizations within your state.
If a provider seems promising, you have much to gain and virtually nothing to lose by reaching out to them. Even if they’re not taking new clients or their fees are outside your price range, for example, they may still be able to recommend others like them in the area. The more information you can provide about yourself and what you’re looking for, even in that initial contact email or phone call, the better they will be able to tailor their referrals.
The analogy to dating is hard to avoid when talking about the therapist search, and with good reason: many of the same principles and pitfalls apply. For instance, the first date tends to go better if you let your guard down and ask a few “sensitive” questions; the more first dates you go on, the better your chances of finding a good match; and so on.
But there are also important differences: for instance, you don’t need your therapist to share your core philosophical beliefs or want the same lifestyle as you. What you need is a therapist who can accurately comprehend and skillfully promote your chosen path to self-creation—whether by helping you choose a path you genuinely and unconflictedly desire, or giving you the tools to identify and remove any roadblocks in your way.
How can you guess from a first encounter whether a therapist is likely to be up to this task? While it’ll usually too early to know for certain, here are some telling signs to watch for:
1) Are they making their own effort to get to know you and evaluate the fit? For instance, do they frame their initial impressions as hypotheses, rather than foregone conclusions? Do they encourage you to ask questions about the therapy they do, and help you make your own informed decision about whether it suits your needs? Or do they forge ahead on the assumption that they are obviously the best therapist for you?
2) Do they calibrate their questions and responses over the course of the session based on what they hear you saying (or, perhaps, not saying)? For instance, if their first attempt to describe what you are feeling does not quite hit the mark, do they notice this and try again? If you’re not fully bought in to some aspect of their approach, do they either shift gears or help you express your reservations and work through them? Or do they seem to be following a pre-written script?
3) Do they bring out the best, most honest and courageous within you? Do you find yourself sharing things you hadn’t previously admitted even to yourself? Do you leave the session feeling called to purposeful action and reflection? If there’s a nervous knot in your stomach, is it the kind that forebodes a rocket launch? Or the kind you get when you’re doubling down on the procrastination tactics that have kept you grounded?
With all these tips comes a crucial caveat: a motivated, optimistically oriented client can derive some benefit from almost any therapist. This has been borne out by research, and it closely jibes with my own experience from both sides of the couch. A standing appointment with a trusted confidant whom you’re paying to scaffold your self-improvement can be an incredibly powerful source of insight, momentum, and accountability, even if you’re generating most of it.
In this light, you might ask: “then why not just eliminate the middle-man?” And indeed, depending on the nature of your struggles and the tools or insights needed to resolve them, you may be better off pouring your energy and creative effort into solving the problem yourself than into finding and working with a therapist–just as you might be better off managing your own investments than finding and working with a portfolio manager. The cost-benefit analysis involved is analogous: would the value added by a well-chosen expert outweigh the costs of finding and employing such a person? In both cases, the answer depends on your particular goals and priorities; and the size of the value-add depends on the thought and effort you put into finding someone good. The strategies I shared above should hopefully guide the thought and effort you put in, assuming you do decide that the value is worth it. For instance, perhaps you’ve already read a hundred self-help books and still haven’t found a solution to your problem; or perhaps you simply don’t have time to read a hundred self-help books, so you’d rather invest the time and energy to find a professional whom you can trust to distill their insights for you.
As you weigh the decision, just know that competent, insightful, trustworthy therapists are not as rare as they might seem. I’ve met many of them on my personal and professional journey. There are therapists whose masterful weaving together of deep scientific knowledge, emotional attunement, and individualized insight and connection-making I can only hope to equal someday. I would not hesitate to refer a client or loved one to any one of these therapists, both because I know they’re good, and because I trust them to know their limitations and make an appropriate referral if they find they’re not well-suited. The trick is to find your own version of such a therapist, as determined by your own goals, priorities, and circumstances (including your geographic location and financial constraints). This search is yours to create. I can only arm you with some tools and a general vision of the transformative growth that might await you on the other side.
The psychotherapy field suffers from a serious and persistent lack of theoretical unity. Other scholars have written at length about what might account for this and how severe a problem it poses for the field. Here I want to suggest that reconceptualizing the existing therapeutic frameworks in terms of their promotion of agency through knowledge, as described in my previous post, may be an important step toward establishing a common core, as it would help reconcile some of the seeming conflicts that have kept the field divided.
To take just one example, the field is currently entrenched in a conceptual standoff between those who regard the process versus the content of human thought as more important to target in psychotherapy. Interestingly, therapeutic approaches rooted in the Psychoanalytic and Behaviorist traditions have largely converged in their prioritization of process, albeit in different ways and for somewhat different reasons. The psychoanalytic tradition explicitly views conscious thought content as being at the constant mercy of reality-distorting motives and defenses that operate outside of awareness. As such, any effort to engage directly with this content—such as by offering counter-evidence or checking its logical validity—would just perpetuate the illusion of objectivity created by the patient’s defensive processes, instead of bringing those processes to light. Meanwhile the Behaviorist tradition explicitly regards thoughts as conditioned behaviors controlled by environmental contingencies, leaving no theoretical room for checking their veracity or modifying them based on evidence (e.g., Gross & Fox, 2009). Both traditions thus emphasize the importance of changing the process by which patients relate to their own thoughts: how attached they are to those thoughts, how flexibly they are able to move between or away from them, and so on. One might say that these traditions emphasize agency while deemphasizing knowledge.
By contrast, traditional cognitive approaches rooted in “information processing” models of human cognition tend to focus on correcting the distorted content of patients’ thoughts and beliefs, but are less attentive to the different motivations that might energize a person’s thought processes. As such, a cognitive psychologist might err on the side of trying, in effect, to force knowledge on someone who defensively resists it, without first identifying or addressing the source of that resistance. The tendency to view people as mere information processing machines, in other words, may lead to an emphasis on content but an underemphasis on agency in choosing whether and how to engage with such content to begin with.
If we adopt the agency through knowledge model I’m proposing here, the apparent conflict between content- and process-focused approaches would dissolve. Rather, we would come to think in terms of an agential metacognitive process that has working knowledge—i.e., accurate and useful content—as its goal. The motivation to work toward knowledge must itself come from past or current experience of the rewards this work can bring: more effective decision-making, increased confidence in one’s choices, and the sense of vitality that comes from being awake and alive to the full reality of one’s experience. Many existing interventions already get at these ideas in many different ways, using many different terms (such as “willingness,” “acceptance,” “self-congruence,” “metacognition,” and “mindfulness,” just to name a few). Having the unified perspective I’ve proposed here would allow us to develop a common language for what we are really doing when we utilize these various strategies. For instance, we can now speak in terms of summoning the courage to face painful truths, arming oneself with knowledge, doing the work to make one’s knowledge fully real to oneself, valuing one’s need to really know, etc. It would also allow us to be more judicious about when and how to use them, based on an assessment of what working knowledge a patient currently needs in order to make more effective choices in her identified problem area; what information, inspiration, or experience she needs next in order to work toward that knowledge; etc.
In this way, the “agency through knowledge” model can provide us with a parsimonious understanding and vocabulary for the many stages and manifestations of the therapeutic change process. Thus clinicians can learn and capitalize on the distinctive strengths of each therapeutic approach, while keeping in mind the fundamental task that unifies them all.
Recently I got to present this early version of a project I’ve been developing with some of my colleagues:
Given the surprising amount of positive feedback this poster has gotten from researchers and practicing therapists alike, I’ve been inspired to do a deeper conceptual dive into the “meta-process” we’ve identified. Below is an initial preview of my evolving thoughts on what I believe is a common mechanism of many forms of therapy, and of many paths to psychological growth. I invite any and all feedback as I work to flesh out and refine these ideas for a forthcoming manuscript.
Each of the major therapeutic modalities shares, implicitly or explicitly, 1) a core aim of helping individuals exercise greater agency over their own lives; and 2) an assumption that this is achieved primarily by helping them exercise greater agency over their own working knowledge base.
The Thesis Explained
By “agency,” I mean here the capacity to choose and direct one’s own life. An “agent”, according to Merriam-Webster, is “one that acts or exerts power” or “produces or is capable of producing an effect.” Applied to one’s own life, this means one has and exercises the power to produce life experiences and circumstances of one’s own choosing—be that a particular career, a loving family, a group of trusted friends, a life of serene contemplation or adventuresome travel, a home one is pleased to inhabit, etc. Exercising agency is not the same as being all-knowing or all-powerful, nor does it guarantee that all of one’s chosen goals will be fulfilled. Rather, it means that one does the things that constitute self-authorship and tend to generate success: one is able to choose one’s own goals and strategies based on the information available, and to take action in light of them; to solve problems in flexible and creative ways; to learn from failures and setbacks, and adjust one’s goals and/or strategies accordingly. In short, it means that one is a competent and responsible manager over the overarching project of living one’s life.
By one’s “working knowledge base,” I mean one’s actively maintained, updated, and integrated understanding of whatever aspects of oneself and the world are relevant to managing one’s life. This includes, for example, a working knowledge of what kinds of careers or relationships or lifestyles are possible; what steps, activities, or challenges are involved in pursuing each one; how and why one thinks and feels toward each; one’s strengths and weaknesses; the nature and malleability of human beliefs, emotions, and habits, including one’s own and other people’s; and, indeed, what further knowledge or skills one needs in order to figure all of this out. To have a working knowledge of any of these things means that you can access it when you need it, and that it has fully “sunk in” for you; that is, it has the power to stir your emotions and motivate your actions. To have a working knowledge, as opposed to just any set of beliefs and attitudes that stir and motivate you, is to have done the work of forging your beliefs and attitudes through active engagement with reality—which includes gathering the needed data (both introspective and extrospective), reflecting on it critically, and checking and updating your conclusions through continual experience. This is hard work, and it is work that never stops. It is chosen, self-directed work. For individuals struggling to make sense of deep loss, failure, misfortune, or injustice, it can be very painful work. But it is work that needs doing if one wants the power to envision and enact a more satisfying life. It is agential work. The fundamental task of therapy, I contend, is to inspire and empower this work.
Below are examples of the knowledge work needed to inform and motivate two very different kinds of therapeutic change, along with the role that various therapeutic approaches and techniques might play.
Example 1. Suppose you’ve expressed a desire to quit smoking cigarettes, but you just haven’t been able to do it. What working knowledge would you need in order to inform and motivate this change?
Above all, you would need to really know that the act of smoking hurts you more than it benefits you, all things considered. If you can recite the claim that “smoking is bad for me” but you feel no aversion or dread as you light up your next cigarette, then this knowledge is not really “working” for you yet. To make it real to yourself, you would likely need to:
These processes are covered by the psychoeducation, motivational enhancement, stimulus control, and mindfulness-based components (respectively) of the most well-established therapeutic treatments for smoking cessation.
Example 2. Suppose you find yourself stuck in an abusive relationship of many years. Perhaps you believe “on an intellectual level” that “my life would be better if I ended it,” but you cannot begin to imagine what such a version of your life might look like, nor specify any concrete steps you could take to bring it about. Your belief is at the level of a vague, untested speculation, and is unlikely to motivate you to leave. To turn this belief into “working knowledge,” you would need to do a lot of work to specify, in vivid enough detail, the realistic costs and rewards associated with staying in the relationship versus leaving it. Consider some of the steps this work might involve:
Each of these varied therapeutic approaches, I contend, derives its value from the role it plays in helping people engage in the active, non-defensive pursuit and internalization of new knowledge about what is really true and what they really want, so that they are empowered to act accordingly. Stay tuned for my further reflections on what this might mean for psychotherapy researchers and practitioners.
It is only by understanding our physical survival needs in terms of what they mean to us, and by drawing self-esteem from their pursuit and achievement, that we can sustain the motivation and courage to fight for them.
For the first time in most of our lives, humanity is truly in “survival mode”. COVID-19 poses a great threat; as of this writing, the daily death toll in the US is still accelerating. Economy-decimating lockdowns to mitigate this threat have created threats elsewhere. There are countless people whose cancer surgeries and potentially life-saving organ transplants have been canceled or postponed, countless others who may fall ill with other life-threatening illnesses whose diagnosis and treatment will be delayed, and still others facing imminent homelessness . Even food is among the basic needs whose satisfaction is now less assured for many people who are unaccustomed to going hungry.
In the face of challenges, we search for understanding—not just of the threats but of the character of our lives under threat. We need to know not just what to do, but how to cope, how to make meaning of all this. Maslow’s hierarchy of needs is a framework that purports to provide just such an understanding. It’s been circulating in various adapted forms since the start of the pandemic:
It is interesting how much this motivational framework has permeated popular discourse, given that its core assumption (as interpreted by contemporary audiences)—that the “lower-order” needs have causal or chronological precedence over the “higher-order” needs—is demonstrably false. Science indicates that people’s prioritization of different sorts of needs is much more individually and culturally variable than that. This observation is also at the heart of some of the more humorous (pre-pandemic) memes inspired by the famous pyramid:
And yet this framework clearly has profound intuitive appeal. Despite its chilly reception by the scientific establishment, it is one of the most widely known and referenced motivational theories among the general public. Perhaps that’s because it reminds us of the validity and importance of attending to needs we might otherwise take for granted: to secure our next meal; to find a reliable wifi connection; to have a sane, functional family routine; to enjoy a game night with friends.
But in spite of—or perhaps partly due to—its intuitive appeal, this framework has a number of negative psychological ramifications for those already struggling to cope with this crisis.
1) By implying that our physical needs are more “basic” and “essential” than our emotional, intellectual, and spiritual needs, it trivializes the devastating mental health effects of this pandemic. In particular, the people least likely to receive sympathy and support from a “hierarchy-of-needs” perspective are those whose lifelong dreams and ambitions have been indefinitely suspended while the virus rages on: the professional musicians, dancers, actors, restaurateurs, small business and gallery owners, athletes, “non-essential” medical providers, early childhood educators, and so many others who have lost the work that gave meaning and purpose to their lives. Ironically, this includes many of the same people who have willingly traded off physical comfort or security for the sake of their art or their business venture at some point in their careers. Yet some have already had to declare bankruptcy and say “goodbye” to their beloved ventures, and others are hanging in limbo, with no knowledge of whether, when, or how they will be able to resume their life’s work. The anxiety and grief of these losses can take a psychological toll not unlike the loss of a loved one, and all the more so when society ignores and downplays them. Yet this is the natural result of treating higher purpose and meaning as disposable luxuries.
2) By implying that the prioritization of our more “basic” needs should mean the de-prioritization of our “higher-order” needs, this framework robs people of the motivational resources needed to secure their “basic” needs to begin with. The fact is that our physical and spiritual needs do not come apart like the hierarchy-of-needs framework would suggest: they are inextricably integrated. It is only by understanding our physical needs in terms of what they mean to us, and by drawing self-esteem from their pursuit and achievement, that we can sustain the motivation and courage to fight for them.
The ones who cope most resiliently with life-threatening challenges are those who define themselves by their fundamental capacity and willingness to overcome such challenges. They are the ones who embrace the threat of death as part of life, and the responsibility for staving off that threat as part of the human condition. They imbue their so-called “basic survival needs” with profound meaning. They recognize that the distinctly human capacities to respond creatively to adversity, to endure the present for a better future, to make do, to step up, to reset, to problem-solve—these capacities have deep spiritual meaning and moral significance.
Imagine for a moment (assuming you are not already living it) that you have been laid off, and that you are now uncertain about how long you can pay for your meals or the roof over your head. What kinds of things might you need to do to cope with your situation?
First and foremost, you will need to acknowledge and grieve the loss of whatever value your job was providing in your life, whether that was a sense of fulfillment, a well-defined plan for the future, a source of daily social connection and shared purpose with colleagues, a means to provide for your family or put your best foot forward on dates, or a path to financial independence. Perhaps you will need to “swallow your pride” and get in line at a food bank, which takes considerable courage for someone who’s unaccustomed to going hungry (one of my students’ therapy clients was recently in this position). Meanwhile, you will need to grapple with the challenge of forming a new plan and finding new sources of income in a context of high uncertainty about when this pandemic will end and what the post-pandemic world will look like.
Perhaps you’ll decide to take a temporary job in food or grocery delivery services. Even in making this “simple” decision, you will likely face various forms of social and emotional resistance: but what if you get sick? But will it pay enough to be worth it? But will it leave you with enough time to study, or practice your instrument, or stay in touch with your customer base for when you can hopefully one day reopen? To work through all these questions and make an informed decision, you will need to get clear on your personal risk profile, your values and priorities, your cost/benefit tradeoffs. And even having weighed all these factors, you will still need to accept some degree of uncertainty about how either course of action will pan out. Then, having chosen a given course, you will need to stand firm against all the contrary voices that will still continue to clamor in your head.
Meanwhile, you may need to think about how and whether you can continue working toward whatever long-term goals have been disrupted by the pandemic: are there free online courses you can take to develop the skills you will likely need down the line? Are there ways you can be practicing your craft even while stuck at home? Are there ways you might offer a virtual version of your distinct product or service, even if this seems initially impossible? Perhaps you might draw inspiration from some of the creative solutions others have found: for example, this virtual “quarantine speakeasy” featuring musicians and dancers from around the world; this distance learning platform for very young children and their parents; these stories of the various scrappy survival strategies by which food businesses have managed to stay afloat and to feed their own.
To be entrepreneurial and solutions-oriented in the context of great adversity and uncertainty requires courage, creativity, and self-assertion. These you can only hope to muster if you see your predicament as deserving of your courage, creativity, and self-assertion. A fight for survival can and should be seen as having the character of a quest, an occasion worth rising to. You will need to “dig deep,” often against emotional resilience, for the inspiration and sense of purpose to see it through. And the more desperate things get, the deeper you must dig.
Those who approach crises in this way tend to emerge from them with greater strength and clarity of vision than they had going in. The research on posttraumatic growth and resilience suggests that at least some people are able to “rise to the occasion” in this way. Psychologist Victor Frankl, who survived 3 years in a Nazi concentration camp—where hunger is the least of one’s troubles—wrote of his experience: “He who knows the ‘Why’ for his existence is able to bear almost any ‘How’.”
Why, then, do more people not bring this ennobling perspective to their fight for survival? A major reason, I suspect, is that this is a counter-cultural narrative. The message we routinely get, which Maslow’s pyramid only reinforces, is that survival is the “lowest” of our needs; it is only once our physical survival needs are taken care of and “out of the way” that we can concern ourselves with nobler, more distinctly human ends—like exercising our creative faculties, finding higher meaning and purpose in our lives, and so on. And how do we get our survival needs met in the first place? Alas, this is not a question that most modern-day Westerners have had to think too much about.
It’s high time we started thinking about it.
There is no built-in survival instinct that tells us how to face off against all the various threats that nature indifferently throws at us, infectious diseases being among the most commonplace. Instead, evolution equipped us with an intellect capable of creativity, long-term planning, and meaning-making. It was by the application of these faculties that humans invented such survival mechanisms as agricultural science, constitutional government, refrigeration, electricity, airplanes and automobiles, central heating and air conditioning, iPhones and dating apps, Amazon Fresh and Grubhub, vaccines and antiviral treatments. There is no nobler application of our distinctly human faculties than in figuring out how to survive in the face of existential threats. The more urgent and dire our survival needs, the more creatively we need to think, and the more desperately we need inspiration and moral courage to power our efforts. Just ask the NYC ED doctors when they’ve needed to be the most creative and clear-minded, and when they’ve had the most acute need for someone to remind them of who they are and why they chose this line of work.
Whether you’re barely making ends meet or are finding opportunities to innovate in this crisis—whether you’re working to manage your anxiety or push back against mounting indifference—whether you and your loved ones are maintaining your good health or fighting back illness—this is the stuff of life, of your life. The thought and virtue demanded are as worthy of admiration and self-respect as ever, are as constitutive of who you are as ever. The abnormality of it all can make it feel otherwise. But if you step back and take an elevated perspective on this crisis, you will see that it is a highly concentrated instance of the kinds of choices and challenges you face throughout your life. The less you can take for granted, the more responsibility you have for figuring things out. And with great responsibility comes great power: the power to write your own life’s narrative, by being hyper-intentional about which needs you want to prioritize and the manner in which you want to fight for them.
When you look back on the COVID-19 chapter of your life, what will you want to have been fighting for?
As is in the nature of crises, this pandemic has led me to reflect on what I really value in my work, and where I want to focus my efforts going forward. Throughout my career I’ve struggled to identify myself with a particular “specialty.” This is partly because I have the soul of a generalist, but also partly because my emerging specialty doesn’t fit neatly within the field’s conventional format for classifying specialties: usually something along the lines of “I study and treat psychological problems A and B in demographic groups X and Y.” Rather, I study and treat people who are seeking to ignite a certain kind of vital energy in themselves; people who are seeking to “launch” themselves in a certain way. This can take many forms, from the college athlete seeking the inspiration and mental focus to break through a performance plateau, to the wife seeking the courage to end a 15-year loveless marriage, to the would-be entrepreneur seeking the impetus and clarity of vision to quit his 9-to-5 job and pursue his startup venture full-time.
To be sure, most of my clients also struggle with psychological problems, sometimes severe ones. But that is not what sets them apart in my mind. Nor is it what distinguishes my evolving therapeutic approach from the standard “empirically supported treatments” (ESTs), on which I draw extensively. What does distinguish my approach is that it addresses the distinct needs of “my kind of client”—needs that today’s ESTs are ill-equipped to meet. For instance:
Why are these needs overlooked by most ESTs? Part of the answer, I suspect, lies in my field’s current methodology for developing and validating ESTs. Most of these treatments were developed and tested with reference to the “average” person with such-and-such DSM diagnosis who enrolls in the randomized controlled trials (RCTs) used to show that a given treatment “works.” As some critics have argued, this “average” participant is a mythical entity stripped of all the “confounding” complexities and “noisy” idiosyncrasies that make up even the individual people enrolled in the studies, much less the people excluded from participating because their struggles did not fit one of our cookie-cutter diagnostic categories.
To be fair, important efforts have now been made to adapt existing treatments for those with more complex or underrepresented needs, such as racial/ethnic and sexual minorities, the recently bereaved, or those with multiple diagnoses or co-occurring medical problems. Yet such efforts have not been extended to individuals whose underrepresented needs stem from the highly ambitious and innovative endeavors they are undertaking, for example. Indeed, the very idea of developing a standardized, experimentally testable treatment protocol for this “group” implies a certain level of uniformity in the group members’ treatment goals, and in the psychological and therapeutic processes required to help them reach those goals. But what unifies the clients I work with is precisely that they defy uniformity: they are struggling to cast off conventional models and social norms, to find their own voice and choose their own way.
They are struggling to self-innovate.
Part of what I love about working with such clients is that it demands constant innovation of me: there can be no cookie-cutter recipe for helping someone do something for which there is no cookie-cutter recipe. Every innovation process will be different, and will require a different mix of psychological tools and insights and metaphors to support it. There are overarching principles, of course, but there is nothing approaching a “script” for applying those principles to the unique generative process of each wonderfully complex and unreplicable individual.
This also means a need to innovate in the realm of psychotherapy research methods: the current methods either do not adequately capture the individual variability and complexity of the self-innovation process, or do not allow for the generalization of broad therapeutic principles that can be flexibly applied to any such process. This is why I have been thinking hard about how to integrate qualitative approaches into my research, while also drawing inspiration from methods of systematic evidence-gathering and theory-building in philosophy and education.
Enter the current pandemic, and the need to cast off conventional models and innovate is suddenly much more pressing for many more people than ever before in my lifetime. For the 23 million who have lost their jobs, this means seeking new income sources in a devastated and transfigured economy; for the parents working from home, it means figuring out how to homeschool their children in-between figuring out how to navigate Microsoft Teams; for those getting married or grieving the loss of loved ones, it means finding new, socially distanced ways to celebrate and to mourn. The normal challenges of pursuing innovative solutions to one’s problems are also more intense and concentrated than usual: the knowledge terrain is insanely complex, the uncertainty is high, the stakes are catastrophic, and the voices of social pressure are strident, clashing, and ever-present. Proposing new solutions in this context can feel like stepping into a minefield. Even for such small innovations as fashioning a mask out of a scarf, one must deal with conflicting advice from public health experts, the risk of public ridicule, and lingering uncertainty about whether or how well one’s scarf-mask will actually do its job.
Yet plenty of people are innovating: in tech, in education, in biomedicine, in manufacturing, in research funding, in healthcare access, in entertainment, and in their individual lives. Perhaps this is precisely because the stakes are so high, and so little can be taken for granted; now as much as ever, we can clearly see that it’s on us—on our own fresh thinking and creative innovation—to get ourselves through this crisis.
For my part, I’ve never felt more engaged or “in my element” as a therapist, even despite all the extra grief and terror and rage and despairing loneliness I’ve been helping people process, and have sometimes had to process myself. Nearly every client I see is facing a painful new reality and, with it, an opportunity to self-innovate. Some of them don’t immediately see it this way; they think they are hampered by the loss of their old routines, or by their sudden inability to live up to the expectations other people have set for them. But often it is precisely this departure from old routines and expectations that sets them free to launch in a new direction of their choosing. My job is to help them see the runway, and to arm them with the psychological munitions they need to fuel and direct their own self-defining journey.
There is no job on earth I’d rather be doing. And in doing it, I’ve gained some insight into my own distinctive “specialty” and corresponding mission statement as a psychologist: To empower and inspire self-innovation in the people who need and can benefit from it most, in the times when it’s hardest.
Plenty of excellent resources have already been circulated for coping with COVID19 stress and anxiety; see my compiled list of recommended resources here, and check back often as I continue to add more.
Not much has been said about coping with anger, though, which has arguably been running just as hot for many of us as panic and fear.
Unlike fear, which signals a need to run and hide from a threat, anger motivates us to fight—for better or worse. For better, when it alerts us to real wrongs that our actions can help set right. For worse, when it is either 1) founded on a misjudgment (as our emotions often can be, especially in times of crisis) and/or 2) a defensive reaction against feeling scared, powerless, or some other more vulnerable emotion. This latter can take some ugly forms, such as scapegoating entire nationalities to give oneself an illusory sense of control and predictability. And it can also take more banal and innocent forms, such as getting caught up in counterproductive vents among like-minded Facebook friends when there are more helpful ways to be spending one’s time.
The only way to know for certain which type of anger you’re feeling and, thus, how (and whether) to act in light of it, is through conscious, uncensored reflection. Fortunately there are many tools to guide you in this reflection, a few of which I outline below. I have also created a custom spreadsheet (adapted from standard “thought record” tools used in cognitive behavioral therapy) that might help you structure this self-reflective process. The example I’ve filled out on the 2nd page of the spreadsheet illustrates how this process unfolded for me about a week ago, culminating in my decision to write and publish this post.
Watching through my apartment window as my beloved NYC has emptied and dimmed, I’ve had the creeping feeling that the whole city—and with it, the whole country—is running out of air. As if in sympathy with the staggering numbers of critically ill in our overwhelmed and under-equipped ICU’s, the rest of us, too, seem to have slowed our breathing and resigned to the helpless wait for a ventilator that may or may not come.
I immigrated to the U.S. with my parents from the former USSR when I was 7 years old. I still have a vivid memory of the Statue of Liberty coming into view as our jumbo jet descended into JFK. “She’s welcoming us to America,” my dad explained. I remember my first experience walking through an automatic door; my first astonishing encounter with an American grocery store; my first day walking through the friendly, colorful halls of my new Indianapolis elementary school and being greeted by my smiling ESL teacher. I remember my lingering joy and relief at having entered a brighter, livelier, kinder world than the one we had fled. In retrospect, my love affair with NYC—and with the freedom, prosperity, and growth it represented—began with that first sighting of Lady Liberty some 27 years ago, and was consummated 2 years ago when I made this city my home.
In these last few weeks, I’ve watched with acute heartache as NYC descends into an increasingly Soviet-esque mode of existence, complete with economic shutdown, medical supply shortages, tight rations on diagnostic testing, empty grocery store shelves, and vague, ever-changing political decrees. What disturbs me most is not that we are in this mode, which may well be necessary right now in our fight against COVID19. What scares and angers me most is that many New Yorkers—and Americans in general—seem to have resigned too easily to this indefinite suspension of their freedom, prosperity, and growth, which they’ve historically valued as much as life itself.
Indeed, many of my friends and colleagues seem to have embraced this state of affairs as the “new normal”, even suggesting that compliance with shelter-in-place orders is a no-brainer for anyone with a conscience (in the words of one popular meme: “Your grandparents were called to war. You are being called to sit on a couch! You can do this!”). In an effort to convince others to abide by this new status quo, many have even started to engage in “quarantine shaming” of anyone who leaves home for “non-essential” reasons. But such messaging seems blithely oblivious to the catastrophic costs that millions of people are already experiencing as a result of the “shelter-in-place” approach—including unemployment, social isolation, loss of cherished civil liberties, and increased risk for suicide, to name a few. In their panicked rush to adopt this new blanket moral norm, highly educated and well-meaning Americans have begun to sound like the dogmatic authoritarian rulers they normally disdain.
My goal here is not to question whether mass shutdown is the correct and necessary course of action for us to take now, given the unchecked spread of the virus to date and how utterly we failed to prepare for it. But it’s crucial to remember that it didn’t have to be this way; it was human folly that forced us into this horrific tradeoff between lives or livelihoods. As leading epidemiologist Amesh Adalja recounts, infectious disease experts like himself have been warning policymakers for decades to prepare for just this sort of pandemic, and their warnings have gone largely unheeded. Then, when the novel coronavirus began its exponential spread and the imminent threat posed to the U.S. became evident, that threat was flagrantly denied and dismissed by the Trump administration for months despite multiple admonitions from public health experts, while a tangle of regulatory red tape led to unconscionable delays in the availability of widespread diagnostic testing. Had the leaders of the world’s richest nation taken responsibility for mobilizing or even just getting out of the way of the scientists and innovators eager to implement large-scale diagnostic screening back in January and February, we might have successfully flattened the curve without ever needing to put our economy on hold (as attested by South Korea’s example, among others).
As a result of these accumulated failures to get ahead of the virus through widespread testing and strategic isolation, we must now resort to the blunt-instrument measure of mass social distancing while public officials and health providers scramble to make up for lost time. But the moralistic tone with which this “shelter-in-place” measure is now being promoted risks papering over the tremendous costs of doing so and the negligence that has made it necessary.
One could argue that now is not the time to worry about how we got into this catastrophic mess, since we need to focus all of our efforts on getting out of it. But there is a version of this rhetoric that has served dictators and power-hungry opportunists throughout history. If we want to get out of this pandemic having spared not only as many lives as possible, but also as much of the American way of life as possible, we need to be vigilant against the loss of both.
Besides, it is precisely our love of freedom, prosperity, and growth that is needed to help us defeat this virus. It is not sheltering at home that will ultimately save us, but work. This includes the scientific work of developing new vaccines, treatments, and diagnostic tests, the design of new technologies to mass-produce personal protective equipment, and the removal of bureaucratic restrictions on the freedom of those trying to fund, distribute, and use these innovations. It also includes the work that we all do, that adds up to an economy of wealth and comfort, where we have the luxury to devote resources to predicting and preempting far-off black swan events. And it includes the distinctly American insistence upon giving a damn about one’s work, about finding in it virtue and meaning, such that when we are threatened our response is to double down on being industrious, rather than resign to panicked passivity.
My friend Doug Peltz (known by his wider audience as Mystery Doug) recently shared a reflection on Facebook that aptly illustrates the resignation I’ve observed, and goes on to model an alternative perspective more befitting of the American spirit I know and love:
My daughter chipped a tooth badly yesterday and—thank god—our local pediatric dentist was able to see her and repair it.
He’s closed for business otherwise, seeing 2 or 3 emergencies each week, even then, hesitantly. I told him how grateful we are, and asked nervously: how will your business fare if this goes on for two or three months? He said it’s likely his business, and nearly 80% of other dental offices, will be out of business.
My father was a dentist. Dentists aren’t scientists, but I know that many of them have a scientific, medical bent. With this in mind I felt a ray of hope and said: “Based on clearer knowledge of how this virus spreads, surely there could be some way to keep business open, like if there were widespread testing, stricter protocols around bleach wiping all surfaces, spacing patients out using scheduling so that they aren’t in a waiting room at the same time, etc.?”
He shrugged his shoulders, looked down and said “No, I’m afraid not. That won’t work. I’ll have to close the business.”
I was shocked at how resigned he seemed to a damning fate, the destruction of everything he’d worked for, the complete lack of curiosity about a way out of this. This is not punishment from some deity. It’s a smutty, grubby little microscopic entity that can’t even survive ultraviolet light.
…[T]his restauranteur takes the same view on his business that our daughter’s dentist seems to take, and it is clear he is coming from a place of deep caring and empathy. But I pose the question: are his actions coming from a place of clear thinking and knowledge? I really fear that this man’s resignation, like that of the pediatric dentist I spoke to yesterday, is horribly misplaced. If this way of thinking is widespread, it’s going to destroy a lot of livelihoods, all while having–perhaps–zero effect on the spread of the virus itself.
We need infectious disease experts to speak up quickly, for surely there must be some way for us to adjust our lives and keep in business more of those who cannot work remotely. At the very least, we should not jump quickly to the awful conclusion that livelihoods must be sacrificed in order to slow the exponential spread of this microbe.
This isn’t about money, this is about lives. This is about science, about knowledge being power. This is about not resigning ourselves to a choice between slowing the spread of this microbe and destroying livelihoods. There is a door #3. But like all door #3s in life, we will only find it if we look for it and believe that it’s possible.”
Granted, there is only so much creative planning and problem-solving that private individuals can do amid continued uncertainty about when or how the forced cessation of their productive activity will be relaxed or lifted. But what we all can do is vocally refuse to accept this as the “status quo”. This may mean insisting on clearer answers and more proactive, strategic solutions by those with the power to implement them, or speaking out on behalf of whatever freedom-, prosperity-, and growth-promoting solutions we encounter, or simply celebrating and calling attention to the value of such solutions. Indeed, such advocacy appears to be having some positive effect already, as it puts pressure on policymakers from Trump on down to shift toward offering more specific, reality-based proposals for getting us out of this mess.
So thank you to all those who, like Doug, are not resigning to passive or preconceived solutions in the fight to keep my beloved city—and all that it stands for—alive.
On this occasion I decided to try my hand at my first-ever tweetstorm, which the Twitter-savvy among you can read and engage with here. For the rest of you (of whom I was recently one, after all), here’s the complete “unrolled” version below:
Recently I tweeted this post on the need for “self-honesty” to help us resist unconstructive, avoidance-driven worry about #COVID19: https://genagorlin.com/2020/03/12/self-honesty-pt-2-prepping-versus-pretending-to-prep/ .
But now I see a deeper, wider need for self-honesty: to remediate our culture-wide response to this pandemic.
Each of us has been called upon to take a stand on the individual and collective measures needed to slow COVID’s spread. This is immensely hard on two fronts:
1. It is really hard to think realistically about exponential growth, and thus to properly assess the looming risk.
2. It’s at least as hard to think realistically about all the economic, cultural, and personal costs that mass social distancing will incur.
What’s more, we’re all prone to ignore one or the other side of the equation:
Those who can more readily appreciate the economic costs—e.g., because they risk losing their livelihoods and ability to feed their families—are motivated to downplay the dire implications of COVID’s exponential spread.
And those of us who have the luxury to work from home (or enjoy a conveniently-timed maternity leave 🙋🏻♀️) are motivated to signal our mathematical sophistication and righteous concern for the sick and elderly by preaching that everyone “stay home” & help “flatten the curve”—without giving due consideration to what this will mean for the whole economic infrastructure that enables such luxuries, or for those working to keep it afloat.
(And each group’s preferred media sources tend to reinforce their respective biases, of course.)
Such is the cultural state in which COVID finds us. We’re as vulnerable as ever, b/c we haven’t been taught or incentivized to think, independently and rationally, about complex problems like this.
Such thinking is counter-cultural; it runs against our grain. Sometimes it leads to unpopular conclusions, thus incurring moral censure from one faction or another. Yet such unfettered, reality-based thinking is our only weapon against this (or any) pandemic.
It will take a heroic feat of self-honesty to take full stock of this insanely complicated, uncertainty-fraught situation and develop a truly realistic cost-benefit framework to guide decision-making about COVID.
Who out there is attempting to do this? And how can I help?