Mental Health

"What if...?

Has this happened to you?  You’re faced with a complicated problem.  You think you’ve identified a solution.  You’ve talked both the problem and solution through with a friend, and your friend agrees that the solution you’ve identified is viable and likely to lead to a positive outcome.  You’re feeling affirmed and hopeful about solving the problem.  And then you think, “what if…?”  You begin to doubt the viability of the original solution because an entirely new scenario arises, one where the original solution won’t work.  A second “what if…?” arises, and then a third, a fourth.  Your good feeling dissipates, and you’re left feeling disheartened, anxious, and a bit hopeless.  You feel stuck.

Over the years, I’ve worked with many clients for whom the question “what if…?” creates and sustains anxiety, and paralyzes them from taking action.  They get stuck in a maze of “what if...?” and have a hard time finding their way out.

·         “What if I move and find myself in a worse situation?”

·         “What if I tell my husband I’m feeling emotionally disconnected and unsupported in our relationship, and he leaves me?”

·         “What if I go to the doctor and she tells me that I have some incurable disease?”

·         “What if I take this medication and it doesn’t work, and I feel worse?”

·          “What if I break up with my boyfriend and then am alone for the rest of my life?

Notice that the “what if” question is usually followed by some negative or catastrophic prediction.  And notice the feelings that arise when you have these thoughts.

“What if…?” can create anxiety—the fear of some unknown but predicted future event.  Anxiety is the fear of some future threat, and anxiety worsens the farther into the future one tries to lives. “What if” disconnects you from the present and thrusts you into an unlivable future. 

It is important to differentiate “what if” thinking from having aspirations and plans.  “What if” thinking tends to create anxiety and tends to shut down hope.  Aspirations and plans tend to do the opposite:  they create excitement and open up possibilities.  Ask yourself this:  when the “what if” thought arises, what do you feel?  If you find yourself shutting down or feeling dread, you may want to get help and find another way of thinking about yourself in relation to the problem you seek to resolve.  You're apt to spiral into anxiety and hopelessness.

(A reminder:  you can plan for the future but you can only live in the present.)

When clients get caught up in a cascade of “what if” questions—questions tinged with dread and that result in paralysis—I invite them to explore the source of the anxiety.  Often, the questions are rooted in the client’s beliefs about control and competence.  The client holds onto beliefs about his/her ability to respond to an unknown future.  Many clients believe they are incompetent and further believe that they will be humiliated if they take problem-solving action.  “What if”, then, becomes a strategy to avoid incompetence and shame.  “What if” thinking does not work very well since it subverts meaningful planning and active problem-solving. 

Addressing “what if” thinking in therapy ultimately centers on finding alternative ways of thinking about problems and developing new beliefs about yourself.  When you become mindful of “what if” thinking and its consequences you've taken the first step toward restructuring those anxious thoughts, developing new beliefs about yourself, and taking meaningful action.

The Hokey-Pokey Clinic

Several years ago, a friend gave me a plaque for my newly opened psychotherapy practice.  The gift was her witty affirmation of my work.  Over the years, I’ve displayed it in various locations, and it never fails to elicit a chuckle. 

I love this plaque.  Those of us of a certain age probably will probably recall the song and even doing the motions as children.  It was a catchy tune and a simple dance—perfect for children.  However aside from eliciting childhood memories, my friend’s gift also humorously reflects simple but deep wisdom about psychotherapy and the healing/change process.

You do the hokey-pokey
And you turn yourself around—
That’s what it’s all about.

People usually enter psychotherapy to “turn [their lives] around.”  Crises, situational discomfort, chronic dissatisfactions and unhappiness, emotional pain in the form of depression or grief, anxiety, relationship issues—all these cause people to seek help.  Further, people seek therapy because the stories they tell themselves about themselves have grown stale and leave little room for meaningful growth.  Old coping strategies don’t work anymore. 

And so they seek help which manifests in the form of a therapist whose job it is to help clients see and understand the origins of the problem(s), perceive their lives in new ways, and develop new strategies for moving forward in the world.

An important point here:  while many clients want and need to solve problems (and therapy facilitate problem-solving), real healing goes well beyond problem-solving.  Meaningful healing requires that you reorient yourself—you look in new directions to turn your life around.

Meaningful change and healing is often slow in coming.  It takes time to exercise the courage and deeply look at yourself.  It takes time to understand of how you got to where you are.  It takes time to discern that you can genuinely make other choices for yourself.  It takes time to actually implement those choices.  And it takes time to feel confident about the choices you’ve made.  It bears repeating:  meaningful change rarely, if ever, happens overnight.  Changing your perceptions, your ways of thinking, old behaviors require mindful practice before they are fully integrated. 

Therapy can be pokey, at times. 

Most clients, upon seeing the plaque, are amused but don’t stop to reflect upon the fact that the plaque signals the path of healing:  a slow, deliberate, careful reorientation and reconciliation with your life that can be helped with a small dose of humor and a wise, compassionate and experienced guide. Healing is both that simple and that complicated.

Indeed, “that’s what it’s all about.”