The One Question Therapists Don’t Often Ask–but Should

It takes a great deal of courage to make an appointment with a psychiatrist. Oftentimes there is a lag between obtaining a therapist’s number and making the call to set up an appointment. I can only imagine how many crumpled up pieces of paper with a psychiatrist’s name and phone number are buried in coat pockets and at the bottom of handbags representing a fleeting moment of intention.

People usually make an appointment to see a therapist during periods of change or transition–in between relationships, in between jobs, in between the known and the unknown. Turning points bring people to the threshold of a therapist’s office. The psychiatrist inquires about symptoms and tries to help them figure out ways to successfully navigate their way through this difficult time. “So, tell me, what is bothering you?” is a common icebreaker.

The focus is on what is going wrong in their lives. After all, that is what brought them in the door. It makes sense.

Or does it? A few years ago a patient, let’s call her Claire, made me question this approach. I had been seeing her for several weeks when she abruptly terminated treatment.

All we do is talk about all the bad stuff in my life—what I worry about, what’s upsetting me. I sit in your office and complain for 45 minutes straight. Even if I am having a good day, coming here makes me think about all the negative things.

I never saw her again but her words stayed with me. They stung. She was right. All we did was talk about what was wrong. I had spent years studying damage, deficit and dysfunction in the human mind. It never occurred to me to focus on what was right.

Research suggests it might be time to turn this strategy on its head. Instead of focusing exclusively on repairing a patient’s negative thinking and behavior, therapists may want to consider spending some time building upon their patients’ strengths.

In a study, patients with depression were divided into two groups—half received a classic “deficit-based” treatment that was tailored to work on their weaknesses and symptoms. The other half participated in a strengths-based treatment that targeted the patient’s capabilities and the skills the patient was already good at. The researchers found that deliberately capitalizing on an individual’s strengths outperforms a treatment that compensates for an individual’s weaknesses. This challenges the assumption held by many health professionals that we need to fix the problem before focusing on anything else.

Today, instead of exclusively troubleshooting with my patients, I also look for bright spots. I inquire about what they are like at their best. I recommend they write down what went well at the end of each day. We explore their strengths and I ask them to use them in new ways. I ask them to consider how they might creatively use that strength to help them navigate their way through a challenging situation. I suggest they look for strengths in others. Thinking about what they admire in someone provides a shift in perspective. Rather than focusing on what they don’t like about that person or their negative qualities, they are reminded of what they appreciate.

We can all benefit from a similar shift in perspective. Catch your child doing something right today. Give a compliment to a friend. Congratulate a co-worker for a job well done. Thank a loved one for a gesture you take for granted. Focusing on what’s right in yourself and others may be just what the doctor ordered.

I wish you all the best,

Dr. Samantha Boardman

Is Sitting the New Smoking?

Scientists estimate that most people over the age of 12 spend the majority of their time—at least 8 to 10 hours a day—sitting down. All of this sitting is taking a serious toll on our mental and physical health. As Tom Rath, author of Eat, Move, Sleep, writes:

Every hour you spend on your rear end — in a car, watching television, attending a meeting, or at your computer — saps your energy and ruins your health. Sitting also makes you fat.

A number of conditions are caused or worsened by a sedentary lifestyle including depression, hypertension, angina, obesity, ADHD, anxiety, diabetes among others. Scientists believe prolonged sitting may even increase the risk of cancer.

The bad news is that going to the gym for an hour each day is not enough to offset the serious health consequences of chronic inactivity.  In an NIH funded study that followed 240,000 adults over a decade, even the adults who exercised vigorously, seven or more hours per week, had an increased risk of death if they sat for long periods of the day.

Build Activity Into Your Day

Part of the problem is that we tend to think of exercise as something outside of our daily lives rather than something that is built into our day. The good news is that this is just a mindset and simple to fix.

1. Stand up at least once an hour

Whether watching TV or sitting at your desk, stand up, stretch your legs and move around.

2. Seek out opportunities to move

Schedule walking meetings instead of office meetings. Take the stairs. Pick up lunch instead of ordering in.  Get off the subway a stop early and walk the rest of the way. Park the car at the far end of the parking lot. Visit a museum. Get a dog.

3. Monitor yourself:

Tracking your activity with a pedometer or Jawbone will keep you motivated.

As recent studies show, daily “non-exercise” activities like mowing the lawn, doing housework, gardening and even mushroom gathering have a positive effect.  Sneakers and spandex aren’t required to reap the mental and physical benefits of staying active in fun and creative ways.

I wish you all the best,

Dr. Samantha Boardman

Mind Over Matter: Can You Cut Calories With a Mindset?

Harvard Professor Ellen Langer’s research reveals a surprising way to burn calories: be aware of and believe in the health benefits of the activity you engage in.

Langer and her team told 80 housekeepers at various hotels in the Boston area that their work, cleaning rooms, was good for their health. The housekeeping staff at the other hotels were not provided with the same information. Each group engaged in the same amount of physical activity at work as they always did – an average of 8 hours of cleaning per day. After one month, without making any changes in their lifestyle, the women who were informed of the health benefits of their work lost an average of two pounds, while the uninformed women didn’t lose weight

Athletes are well aware of the difference a mindset makes. When you’re head isn’t in the game, performance suffers.

Even non-athletes should pay attention. Langer is confident that by,

putting your mind in an exercise place, your body will follow.

When you go to the gym, don’t just go through the motions.  By being in the right mindset, you engage your body in a different way.  Truly believing that your actions have health benefits is the key.

So, is thinking you’re getting a workout while you sit at your computer going to burn calories? It’s certainly worth a try.

I wish you all the best,

Dr. Samantha Boardman

Are You a Windbag? 5 Ways to Avoid Being a Know-it-All

“You should speak to an expert.” This is the standard advice we dole out whenever anyone has a problem or a question. But is expertise all that it is cracked up to be?

A recent article entitled, Are Good Doctors Bad For Your Health? may make you think twice. According to a study, patients in cardiac arrest did BETTER when the senior cardiologists were out of town.

Related research shows how arrogant CEOs can put companies at risk. Apparently, 94 percent of college professors think they do “above average” work which is impossible, statistically speaking.

Along similar lines, 60% of college freshmen rate themselves as “above average” in intellectual skills. In comparison, in 1966, under a third surveyed considered themselves to be above average intellectually. A number already think of themselves as “experts” though it is unclear what their expertise is in.

The common thread is overconfidence. As the lead researcher commented:

It’s not just confidence. It’s overconfidence.

When people are overconfident, they lose touch. They dismiss other perspectives and don’t question their beliefs. According to research, people who are even temporarily given the feeling that they are experts become more rigid and close-minded. Scientists call this the “earned dogmatism effect.” It occurs when people feel superior and believe they have earned the right to close their ears and eyes to another point of view.

Beware of know-it-alls and make sure you don’t become one:

1. Say “I don’t know” when you don’t know.

2. Stay in learning mode.

3. Listen.

4. Ask questions.

5. Question your questions to make sure you aren’t just confirming what you already believe.

 

I wish you all the best,

Dr. Samantha Boardman

At an Impasse: Who is the Best Person to Ask for Advice?

At inflection points in life—when graduating from college, in between jobs, in between relationships—we do two things:

1. We engage in some form of soul searching.

The idea is to reflect and reach deep inside ourselves to figure out who we are and who we want to be. We read self-help books and talk to therapists hoping to gain insight and answers.

2. We talk to our closest friends and family.

The assumption is that they know us better than anyone we know and will offer the best advice.

While both self-reflection and guidance from people who know us well is helpful, Cornell University’s Karl Pillemer suggests a different strategy.

If you want access true expertise, Pillemer recommends searching outside of yourself and beyond your immediate circle. Specifically, he recommends seeking out an older person—a much older person – who embodies the “self” you would like to be.

Pillener cautions not to look for someone in the next generation:

You don’t want a 40-year-old if you are 20; you want someone in his or her 80s, 90s, or a centenarian if you can find one.

As Pillemer asks, who better to answer questions about the purpose of life than someone who has been living theirs for a long time? He recommends finding a “maven”—a trusted expert and reliable source of accumulated wisdom.

We know from research that people make better financial and ethical decisions when they are primed to think about their future self. Looking at computer-generated images of their 80-year-old self has been shown to increase responsible behavior. Unfortunately, time travel is not yet available so the next best thing is to speak to someone as close as possible to your imagined future self.

Debating a career in medicine? Find a doctor who loved what she did. Worried about whether you can balance your values with a career in the financial services industry? Find an older person who struck that balance and made it to the end of life without regrets. Planning to work on an undemanding day job so you have the energy to paint/write/act in your spare time? Some very old people did just that.

Yes, times have changed but the hope of living without regret endures. Mavens bring a timeless perspective to contemporary problems. Their insights may help you see the world with fresh eyes.

I wish you all the best,

Dr. Samantha Boardman

Can Bad Manners Kill?

The world was my oyster but I used the wrong fork.

Oscar Wilde’s amusing observation highlights the negative impact of bad manners. We all know bad manners are toxic. New research now shows that bad manners can kill. In the study, when doctors spoke rudely to their staff, both accuracy and performance suffered. The medical teams exposed to bad behavior and nasty comments demonstrated poorer diagnostic and procedural performance than those who were not exposed to incivility. As the lead researchers commented:

Relatively benign forms of incivility among medical staff members — simple rudeness — have robust implications on medical team collaboration processes and thus on their performance as a team.

Rudeness undermines people’s ability to think clearly and make good decisions. It steals confidence and weakens motivation.

I vividly remember working with a senior physician who always barked at the team. We all hated working with her and she certainly did not inspire hard work or optimal performance. Her harsh words and non-stop criticism made us lazy and passive aggressive. While I don’t think our behavior killed anyone, we definitely were not at our best when working with her.

Next time you are looking for a doctor, pay attention to his or her manners. It may be the difference between life and death.

I wish you all the best,

Dr. Samantha Boardman