About 53,000 children pass away each year in the United States and nearly 19% of the adult population has experienced such painful loss¹. The death of a child is a severely traumatic event for parents and represents a major risk for future emotional, psychological and physical problems.^{2, 3, 4} The loss of a child challenges parents’ expectations for the natural order of life events and shatters hopes and beliefs for the future.⁵ Some psychologists suggest that parental grief is more severe that other types of grief and lasts longer, presenting with more serious psychological, physical, behavioral and social issues. ^{1, 6} This may be explained by the special role that a child plays in a person’s life – the child represents a unique amalgam of feelings for parents, as it is both part of themselves and representation of their feelings for each other.⁷ In essence, bereaved parents mourn the loss of self, their hopes and dreams.²

The fact that parents think of their child as a “part of, and the same as themselves” ^{7, p. 234} suggests that the loss of a child is very much the loss of a part of one’s self and represents a unique challenge.

The Shock of Sudden and Unexpected Death

The death of a child has become rare in the Western world, due to improved prenatal and perinatal care, it is considered exceptionally painful and traumatic, with parents not being prepared to face such loss.^{8, 9} Nowadays, pregnancies continuing after the 20th week are usually wanted and anticipated with joy and commitment. In the case where such joyous event ends up being a tragedy, parents face a major challenge. For many young parents, this may be their first experience with death and loss.⁸ When the death occurs unexpectedly and suddenly, as opposed to following a long disease or terminal condition, the shock, guilt and bewilderment experienced by the parents are much more severe and long lasting.^{1, 3} Although a long and debilitating disease is another source of trauma for parents, it provides an opportunity to psychologically prepare for the death and understand the cause of death.^{3, 10} In fact, sudden and unexpected loss is correlated with higher levels of distress and parents are at much higher risk of experiencing complicated grief.⁹

In one study¹ researchers interviewed and assessed bereaved parents about 20 months after the child’s death. Their results showed that mothers who experienced the sudden death of a child had more prolonged grief than those who anticipated the grief. Results from the same study did not support expectations that mothers experience more severe grief than fathers. A Swedish population-based study⁵ by demonstrated that fathers’ opportunity to know about the impending death of a child in advance is correlated with better prognoses of grief processing. These results indicate that medical practitioners need to be honest with parents, when the death of a child is concerned, to allow time for accepting and preparing for the imminent death. However, research finds that physicians are aware of a child’s terminal prognosis 3 months before parents are (Wolfe cited in ⁵).

Findings about the profound negative effects of sudden loss explain why parents who experience Sudden Infant Death Syndrome (SIDS) face especially troublesome complications and adjustment problems. These parents suddenly have to deal with the unexplained and, possibly unpreventable, death, the sudden severing of the the attachment and bonding and the involvement of other agencies in the investigation process.¹¹ Currently, SIDS is identified as “the sudden death of an infant younger than one year that remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene, and review of the clinical history.” ^{12, p. 870} It is the leading cause of death among healthy infants and accounts for about 2,200 deaths each year.¹²

(For additional information about Sudden Infant Death Syndrome, including statistics and risk factors, see here)

References:

A man who dared to live up to his own dreams and changed the world while doing it.

This video clip is from Steve Jobs’ 2005 Stanford Commencement Speech, when he urged young graduates to find love in life and make the days count.

Transcript below is from the Stanford University website.

‘You’ve got to find what you love,’ Jobs says

This is a prepared text of the Commencement address delivered by Steve Jobs, CEO of Apple Computer and of Pixar Animation Studios, on June 12, 2005.

I am honored to be with you today at your commencement from one of the finest universities in the world. I never graduated from college. Truth be told, this is the closest I’ve ever gotten to a college graduation. Today I want to tell you three stories from my life. That’s it. No big deal. Just three stories.

The first story is about connecting the dots.

I dropped out of Reed College after the first 6 months, but then stayed around as a drop-in for another 18 months or so before I really quit. So why did I drop out?

It started before I was born. My biological mother was a young, unwed college graduate student, and she decided to put me up for adoption. She felt very strongly that I should be adopted by college graduates, so everything was all set for me to be adopted at birth by a lawyer and his wife. Except that when I popped out they decided at the last minute that they really wanted a girl. So my parents, who were on a waiting list, got a call in the middle of the night asking: “We have an unexpected baby boy; do you want him?” They said: “Of course.” My biological mother later found out that my mother had never graduated from college and that my father had never graduated from high school. She refused to sign the final adoption papers. She only relented a few months later when my parents promised that I would someday go to college.

And 17 years later I did go to college. But I naively chose a college that was almost as expensive as Stanford, and all of my working-class parents’ savings were being spent on my college tuition. After six months, I couldn’t see the value in it. I had no idea what I wanted to do with my life and no idea how college was going to help me figure it out. And here I was spending all of the money my parents had saved their entire life. So I decided to drop out and trust that it would all work out OK. It was pretty scary at the time, but looking back it was one of the best decisions I ever made. The minute I dropped out I could stop taking the required classes that didn’t interest me, and begin dropping in on the ones that looked interesting.

It wasn’t all romantic. I didn’t have a dorm room, so I slept on the floor in friends’ rooms, I returned coke bottles for the 5¢ deposits to buy food with, and I would walk the 7 miles across town every Sunday night to get one good meal a week at the Hare Krishna temple. I loved it. And much of what I stumbled into by following my curiosity and intuition turned out to be priceless later on. Let me give you one example:

Reed College at that time offered perhaps the best calligraphy instruction in the country. Throughout the campus every poster, every label on every drawer, was beautifully hand calligraphed. Because I had dropped out and didn’t have to take the normal classes, I decided to take a calligraphy class to learn how to do this. I learned about serif and san serif typefaces, about varying the amount of space between different letter combinations, about what makes great typography great. It was beautiful, historical, artistically subtle in a way that science can’t capture, and I found it fascinating.

None of this had even a hope of any practical application in my life. But ten years later, when we were designing the first Macintosh computer, it all came back to me. And we designed it all into the Mac. It was the first computer with beautiful typography. If I had never dropped in on that single course in college, the Mac would have never had multiple typefaces or proportionally spaced fonts. And since Windows just copied the Mac, it’s likely that no personal computer would have them. If I had never dropped out, I would have never dropped in on this calligraphy class, and personal computers might not have the wonderful typography that they do. Of course it was impossible to connect the dots looking forward when I was in college. But it was very, very clear looking backwards ten years later.

Again, you can’t connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something — your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.

My second story is about love and loss.

I was lucky — I found what I loved to do early in life. Woz and I started Apple in my parents garage when I was 20. We worked hard, and in 10 years Apple had grown from just the two of us in a garage into a $2 billion company with over 4000 employees. We had just released our finest creation — the Macintosh — a year earlier, and I had just turned 30. And then I got fired. How can you get fired from a company you started? Well, as Apple grew we hired someone who I thought was very talented to run the company with me, and for the first year or so things went well. But then our visions of the future began to diverge and eventually we had a falling out. When we did, our Board of Directors sided with him. So at 30 I was out. And very publicly out. What had been the focus of my entire adult life was gone, and it was devastating.

I really didn’t know what to do for a few months. I felt that I had let the previous generation of entrepreneurs down – that I had dropped the baton as it was being passed to me. I met with David Packard and Bob Noyce and tried to apologize for screwing up so badly. I was a very public failure, and I even thought about running away from the valley. But something slowly began to dawn on me — I still loved what I did. The turn of events at Apple had not changed that one bit. I had been rejected, but I was still in love. And so I decided to start over.

I didn’t see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.

During the next five years, I started a company named NeXT, another company named Pixar, and fell in love with an amazing woman who would become my wife. Pixar went on to create the worlds first computer animated feature film, Toy Story, and is now the most successful animation studio in the world. In a remarkable turn of events, Apple bought NeXT, I returned to Apple, and the technology we developed at NeXT is at the heart of Apple’s current renaissance. And Laurene and I have a wonderful family together.

I’m pretty sure none of this would have happened if I hadn’t been fired from Apple. It was awful tasting medicine, but I guess the patient needed it. Sometimes life hits you in the head with a brick. Don’t lose faith. I’m convinced that the only thing that kept me going was that I loved what I did. You’ve got to find what you love. And that is as true for your work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don’t settle.

My third story is about death.

When I was 17, I read a quote that went something like: “If you live each day as if it was your last, someday you’ll most certainly be right.” It made an impression on me, and since then, for the past 33 years, I have looked in the mirror every morning and asked myself: “If today were the last day of my life, would I want to do what I am about to do today?” And whenever the answer has been “No” for too many days in a row, I know I need to change something.

Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life. Because almost everything — all external expectations, all pride, all fear of embarrassment or failure – these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart.

About a year ago I was diagnosed with cancer. I had a scan at 7:30 in the morning, and it clearly showed a tumor on my pancreas. I didn’t even know what a pancreas was. The doctors told me this was almost certainly a type of cancer that is incurable, and that I should expect to live no longer than three to six months. My doctor advised me to go home and get my affairs in order, which is doctor’s code for prepare to die. It means to try to tell your kids everything you thought you’d have the next 10 years to tell them in just a few months. It means to make sure everything is buttoned up so that it will be as easy as possible for your family. It means to say your goodbyes.

I lived with that diagnosis all day. Later that evening I had a biopsy, where they stuck an endoscope down my throat, through my stomach and into my intestines, put a needle into my pancreas and got a few cells from the tumor. I was sedated, but my wife, who was there, told me that when they viewed the cells under a microscope the doctors started crying because it turned out to be a very rare form of pancreatic cancer that is curable with surgery. I had the surgery and I’m fine now.

This was the closest I’ve been to facing death, and I hope it’s the closest I get for a few more decades. Having lived through it, I can now say this to you with a bit more certainty than when death was a useful but purely intellectual concept:

No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life’s change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.

Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma — which is living with the results of other people’s thinking. Don’t let the noise of others’ opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.

When I was young, there was an amazing publication called The Whole Earth Catalog, which was one of the bibles of my generation. It was created by a fellow named Stewart Brand not far from here in Menlo Park, and he brought it to life with his poetic touch. This was in the late 1960′s, before personal computers and desktop publishing, so it was all made with typewriters, scissors, and polaroid cameras. It was sort of like Google in paperback form, 35 years before Google came along: it was idealistic, and overflowing with neat tools and great notions.

Stewart and his team put out several issues of The Whole Earth Catalog, and then when it had run its course, they put out a final issue. It was the mid-1970s, and I was your age. On the back cover of their final issue was a photograph of an early morning country road, the kind you might find yourself hitchhiking on if you were so adventurous. Beneath it were the words: “Stay Hungry. Stay Foolish.” It was their farewell message as they signed off. Stay Hungry. Stay Foolish. And I have always wished that for myself. And now, as you graduate to begin anew, I wish that for you.

Stay Hungry. Stay Foolish.

Thank you all very much.

About 1/3 of patients with acute illnesses fail to follow their doctor’s recommendations for short-term treatment (such as completing an antibiotic course). The rate is even higher among those who suffer from a chronic illness.¹ In fact, about 50% of patients fail to adhere to long-term treatment plans.² This is a little ironic, don’t you think? On one hand, feeling ill leads to actively seeking out medical help and advice; on the other hand, the advice and prescription for medical regimens quickly go out the window after leaving the doctor’s office.

Since there has been a significant increase in the prevalence of chronic diseases, poor patient adherence to treatment has become a major health care problem. More than 90 million Americans live with some sort of a chronic illness³ and these people account for 70% of the annual mortality in the United States.⁴ Poor adherence to treatment is linked to more than 125,000 deaths each year, not to mention, innumerable and completely unnecessary clinic appointments, emergency room visits, hospitalizations, nursing home admissions and additional diagnostic tests. The estimated annual cost of such unnecessary procedures and treatment complications is anywhere between 13 and 15 billion US dollars, which is a tremendous financial strain.^{1, 2, 5} To sum up, poor adherence to treatment is costly, complicated, painful and can even cost one’s life. So, why do we do it?

The term adherence suggests that the patient plays an active role in treatment and the healing process.⁶ No doctor can wave a magic wand and make problems disappears. Usually, healing requires efforts and persistence on the side of the patient, especially when dealing with chronic illnesses. Often times, a major lifestyle change is required, such as changing your diet, exercising or quitting a bad habit. If you’ve tried any of those (or, as in my case, all of them) you know it is a daunting task, which requires will power and patience. What makes matters worse is that it takes a long time before you begin to feel better or experience any other benefits from your efforts. That explains why more than 75% of patients neglect recommended lifestyle changes or are unable to follow through.⁷

However, noncompliance does not always suggest willful disregard of professional advice. We also see cases of doctor-patient miscommunication, patient’s failure to accurately remember the advice or mere knowledge and skill deficits among patients.⁶

Failure to Remember

One study⁸ investigated how many of doctors’ recommendations were actually understood and remembered by patients (and their parents) in a a childhood diabetic clinic. On average, the health-care provided gave about seven recommendations per patient, with both the child and parents present. However, when asked about those, patients and parents recalled only about two recommendations. Shockingly enough, in 40% of the cases, the remembered “recommendations” were never made by the doctor (but were probably some outside information or false memories).

Another study⁹ observed that patients recalled only about 50% of the physician’s instructions.

When elderly patients suffering heart failure were interviewed, 45% of them could not remember the name of the medication prescribed, 50% could not remember the prescribed dose and 64% could not remember when they were supposed to take it.¹⁰

These are just a few examples that show the difficulty of treatment adherence, even when both the patient and health care provider are well-meaning.

Keep this in mind next time you visit your physician. The advice and recommendations they provide may be perfectly clear at the moment, but may soon fade away. There is nothing shameful about taking notes, for example. After all, the faintest ink is better than the strongest memory.

Patient-Doctor Miscommunication

What about the cases when professional advice is so vague that is practically useless? Then patient will be in trouble, even if they remember exactly what the doctor said.

Sometimes, physicians forget that technical knowledge which is a given for them is alien to most of us. Therefore, they may quickly go over diagnosis and treatment, leaving you nodding along, not understanding any of it. In this case, you should not feel intimidated and should not hesitate to ask questions until you clearly understand your situation and recommended treatment. After all, your physician is there to help you.

Other times, health-care providers only give advice in general terms (“Get more exercise” or “Avoid high-fat foods” or “Cut off the alcohol”)⁶. This is not specific enough for most patient to comprehend and break down in small and measurable steps, so they can measure progress and get more motivated. On the contrary, such a general suggestion can be overwhelming, causing you to give up easily. Other times, people make some change, but it’s hard to know if that is what the doctor had recommended. For example, what does “more exercise” suggest? Taking the stairs instead of the elevator? Walking for 30 minutes each week? Running for half an hour three times a day? Which is it? Make sure you can answer questions like these before you leave your doctor’s office.

Knowledge and Technical Skills Deficits

Quite often, treatment involves behaviors and procedures performed by patients, that require some level of skillful administration (insulin injections, glucose testing, using an inhaler, etc). Many researchers have studies these disease management behaviors in patients and have found out that even when people were certain they did everything right, there were mistakes than tempered effective treatment.⁶ A study of asthmatic children¹¹ observed that 93% of them used a deficient meter-dose inhaler (MDI) technique and their parent were also unaware of it. Among adult asthma patients, more than 75% made at least one technical error in the MDI process (even after having received previous training)¹². Glucose testing errors and deficient insulin injections have been documented multiple times among children and adults with diabetes.¹³ After closely studying parents who were giving factor replacement therapy to their hemophiliac children, numerous administration errors were recorded even after years of experience.¹⁴ This is not tho say that parrots and patients don’t care, but simply shows how easy it is to make mistakes and be inadvertently non-compliant with treatment. Just keep that in mind and take any steps necessary to get trained and repeatedly supervised by professionals.

You can never be too careful with matters of health. It is the single most important thing we possess, so cherish it and take good care.

If you would like to learn more about adherence to treatment and disease prevention visit the Center for Disease Control and Prevention.

References:

1. DiMatteo, M. R. (1994). Enhancing patient adherence to medical recommendations. Journal of the American Medical Association, 271, 79-80.   2. Rapoff, M. A. (1999). Adherence to Pediatric medical regimens. New York: Kluwer Academic/Plenum Press.   3. Centers for Disease control and Prevention. (2004). Chronic disease prevention.   4. Centers for Disease control and Prevention. (1999). Chronic Diseases and their risk factors: The nation’s leading cause of death.   5. Mistry, S. K., & Sorrentino, A. P.  (1999). Patient nonadherence: The $100 billion problem. American Druggist, 216, 56-62.   6. Johnson, S. b. & Carlson, D. N. (2004). Medical Regimen Adherence: Concepts, Assessment, and Interventions. Handbook of Clinical and Health Psychology, Vol. 2. American Psychological Association, Washington, DC.   7. Epstein, L.  & Cluss, P. (1982). A behavioral medicine perspective on adherence to long-term medical regimens. Journal of Consulting and Clinical Psychology, 50, 950-971.   8. Page, P., Verstraete, D. G.,  Robb, J. R., and Etzwiler, D. D. (1981). Patient recall of self-care recommendations in diabetes. Diabetes Care, 4. 96-98.   9. Falvo, D. & Tippy, P. (1988). Communicating information to patients: Patient satisfaction and adherence as associated with resident skill. Journal of Family Practice, 26, 643-647.   10. Cline, C. M., Bjorck-Linne, A. K., Israelsson, B. Y., Willenheimer, R. B., & Erhardt, L. R. (1999). Non-compliance and knowledge of prescribed medication in elderly patients with heart failure. European Journal of Heart Failure, 2, 145-149.   11. Winkelstein, M. L., Huss, K., Butz, A., Eggleston, P., Vargas, P., and Rand, C. (2000). Factors associated with medication self-administration in children with asthma. Clinical Pediatrics, 39, 337-345.   12. Larson, J. S., Hahn, M., and Ekholm, B. (1994). Evaluation of conventional press and breath MDI technique in 501 patients. Journal of Asthma, 31, 193-199.   13. Perwien, A., Johnson, S. B., Dymtrow, D., and Silverstein, J. (2000). Blood glucose monitoring skills in children with type 1 diabetes. Clinical Pediatrics, 39, 351-357.   14.  Sergis-Deavenport, E. & Varni, J. W. (1983). Behavioral assessment and management of adherence to factor replacement therapy in hemophilia. Journal of Pediatric Psychology, 8, 367-377.

A sleep-deprived nation

Sleep – everyone does it. It’s so simple. No one taught us how to do it. We just surrender in its sweet embrace… or do we?

In 2008 the National Sleep Foundation asked Americans about their sleep habits. The results confirmed what psychologists and medical doctors already knew: people don’t get enough sleep and even when they do, it is often poor quality sleep. People explained their sleep deprivation with increased work hours and not having enough time.

• One third of people in the survey complained they get a good night’s sleep only a few nights each month.
• 20% shared they have often lost interest in sex, because of feeling too tired and sleepy.
• 29% said they regularly felt extremely sleepy during the day or fell asleep at work.
• 36% of drivers admitted to have nodded off in the past year. Rates are even higher among daily commuter drivers.

Why do we sacrifice sleep?

That same year USA Today survey revealed that 57% of the interviewed sacrificed sleep in order to get more work done. This is partly explained by our society’s attitude towards sleep. We just don’t think it’s all that important or even consider it a waste of time. We say “I’ll sleep when I’m dead” or “Life is too short to sleep.” We’ve fallen for the illusion that we don’t need sleep. That’s why we run on coffee and energy drinks, trying to get 5 more hours of energy, ignoring our bodily signals: fatigue, distractability, aches, altered mood and  irritability.

Ironically, we sacrifice sleep in order to get more done, but we end up messing up the work we’re doing. It either takes us longer, because we’re simply not able to focus and carry through tasks as productively as when we are well rested, or we make mistakes and bad decisions because sleep deprivation reduces mental capacity and flexibility. In the end, no one wins when we deprive ourselves of this natural biological need, that’s no different from the need for food and water.

How much sleep do we need?

Not everyone needs to get 7 or 8 hours of sleep every night. While this is considered the optimal amount for adults, there’s nothing magical about it. Some people need as few as 5 or 6 hours to wake up rested and refreshed, while others can’t function without their 8 or even 9 hours. We have found that those who need less sleep simply sleep more effectively. Scientists know this from studying people in Sleep Clinics. The number of such clinics in the United States has skyrocketed in recent years.

Don’t kid yourself, we all need sleep. Sleepless nights might actually sound like fun when you’re 20, but the truth is lack of sleep is altering our natural sleep-and-wake cycle, which can predispose to insomnia and other sleep-related disorders. Not to mention, we are purposefully depriving our bodies and brains of the vital rejuvenating power of sleep (that has shown to improve memory, concentration, physical and mental performance).

There are more than enough drivers nodding off as it is. There are more than enough people who cause accidents at work because they don’t get enough sleep. You really don’t want to be one of them, do you?

My advice?

If you are sleep deprived, just go to bed! You will get things done in the morning. Your body will thank you later.

What would you do, if you were given an extra day?online surveys

In 2008 a USA Today survey of more than 2,000 Americans asked about their work, personal life and the 24/7 war on time.

The results confirmed what most of us already know intuitively:

• 70% complained they were very busy.
• 50% said they were busier now than the previous year.

• More than 60% said they were angry with slow services, traffic and people being late for appointments, meetings, deadlines.
• More than 30% were consistently angered by slow PC start-up and slow downloads.

People consistently complained about the sacrifices they have to make in order to get work done.

• 45% said they sacrifice time spent with friends.
• 30% regularly sacrifice family time.
• Overwhelming 57% sacrifice sleep (shocker!)

• A confident 90% wished they had more time to spend with their family and friends.

Here comes the paradox! All participants were asked what they would do if they were given an extra day.

• Only 9% said they’d spend the time with friends.
• 31% said they’d spend the day with family.
• 25% wanted to have fun.
• Most (35%) wanted to get more work done.

So, most people wished they could have more time with family and friends, and yet, if given an extra day, they would use it to get some more work done?! Is it just me, or this really makes no sense?

The truth is that with the internet, globalization and being able to work remotely, there will never be enough hours in a day, or enough days in a year to get it all done. This really is the age of information. The competition has never been more fierce. Snooze for an hour and you lose. What you read in the news this morning, is already old news. It just seems we can never know it all and trying to keep up in the hamster wheel soon gets us real exhausted and desperate … Desperate to have more time, when what we really need is not more time. What we need is to set our priorities straight, so that if we want more family time, we make more family time. If we want more work done, we get more work done. Just make sure you are consistent with what you want to do with your time and what you actually do with your time.

So, what would you do if you had an extra day?

Image: Miguel77

“Remember this, that very little is needed to make a happy life” ~ Marcus Aurelius

Effective listening is one of the most essential qualities in friendship. It is also one of the most attractive male qualities (hint, guys: listening can be a very sexy thing).

Being able to share with another person, without interruptions or judgmental attitudes is comforting and provides an outlet for anxiety and stress. It’s not surprising that many people seek therapy and literally ‘buy’ an hour of uninterrupted listening! We all need care and attention, but we need genuine, not illusory attention.

When was the last time anyone really listened to everything you wanted to say, without looking at their watch or starting to talk about themselves 5 minutes into the conversation?

For most of us, it has been a while. Effective listening is not just a rare occurrence. It is an endangered species! Some have never seen it! They’ve heard of it, as a mystical creature of old times, when people used to sit on their porches and just talk and listen, and then listen some more.

I think modern men and women are deprived of effective listening and desperately need it. So I encourage you to slow down for a moment, turn off your cell phone, instant messaging and twitter feeds and really devote yourself to the person you’re with … and just listen. Miracles will happen and you will give someone a wonderful gift. If you don’t believe me, consider it a thought experiment and just see what happens.

Here’s what you need to do:

1) Be silent

You might wonder how this can have any beneficial effect, but it is an essential component to effective listening and a basic counseling skill. You need to give the person enough time and space so they can really open up. Sometimes we just don’t shut up long enough to see what others have to say. A silent pause of 5, or even 10 seconds allows the other person time to collect their thought, without feeling hurried.

2) Focus on feelings

Enough talk about baseball games, Lady Gaga’s meat dress and the pilot episode of CSI (I know, I know, I like the show too). Enough ‘he said, she said’! It’s time to talk about the real things: the contents of our emotional world that have been neglected for so long. I find that when I ask people how they feel, they can’t even name their emotions. That’s how detached we’ve become from our own feelings. We’ve been mislead into believing that our feelings don’t matter and that we can “get over” them. It’s time to get back in touch with feelings. Don’t just ask about things, but the feelings that these things evoke (“How do you feel about it?”).

Remember, that feelings are neither right or wrong. Every individual is entitled to their feelings, and you don’t have to justify or negate them. What if tell you, “I get very angry when my colleague leaves his cup of coffee on my desk.” You might say: “I don’t see why something silly like that should anger you” or “Just bring it back to his desk.” To either of those responses I might become defensive or hostile. After all, I felt what I felt (silly or not) and I should not make excuses for my feelings.

3) Accept the person’s view

Each of us experiences reality slightly differently, because we live in different psychological worlds. The purpose of listening is not to ‘correct’ another viewpoint and make it sound more like mine. The purpose is to understand another viewpoint. As with feelings, everyone is entitled to their unique point of view. This is not to say healthier alternatives can’t be suggested later on, but listening and acceptance come first. A person who feels understood, rather than attacked, is more likely to reexamine their own perspective and change it.

4) Avoid giving advice

When we begin to share, many people assume they must solve our problem (this is more characteristic of men than women). Remember that the goal of listening is to understand and accept, and not solve problems.

Psychotherapist Eric Berne expled the ‘advice giving game’ and established the pattern we’ve all seen: A: “I have this problem.” B: “Why don’t you do this and that?” A: “Yes, but ...(reasons why the suggestion won’t work).” B:”Then why don’t you … (another suggestion).” A: “Yes, but…“

Sounds familiar?

The reason why this happens is either there is something else to the story the person has not shared, or there are other reasons they avoid your advice. Time is much wiser spend hearing all about the problem and the feelings around that problem than trying to solve it in a haste. Don’t assume that person doesn’t need help with their problem. Oh, yes, they do, but this is not the way to help them.

Of course, if someone explicitly asks for advice, that is a whole different story.

5) Reflect on their thoughts and feelings

Every psychologist will tell you that one of the most effective things you can do to offer support is providing feedback by restating what has just been said. This seemingly repetitive manner actually helps the person who is talking identify their feelings and thought better, especially when they feel lost and overwhelmed. It also makes sure that you understand them. If you paraphrase what they’ve just said, and they tell you, “Oh, no, that’s not what I meant,” the miscommunication is eliminated right then and there.

6) Ask open-ended questions

Open-ended questions (“What would you like to do this weekend?”) encourage free expression, whereas closed questions (“Do you want to go skiing this weekend?) only require a ‘yes’ or ‘no’ answer.

On a day-to-day basis we feel so rushed, there is just not enough time to ask open-ended questions. ‘Hey, I’m making plans to go skiing this weekend and just want to know if you’re in. (I don’t have time to explore what you want to do.)’ I get that, but when you really want to show someone that you care about their thoughts, feelings and plans, you need to ask open-ended questions.

7) Clarify the problem

In order to discover a solution, you need to identify and define the problem. If I’ve told you I get really angry when my colleague leaves his coffee on my desk and you’ve suggested I should just bring the cup back to his desk, that is not very helpful. The chances are that the problem extends much deeper than that. My anger might be provoked by how much I dislike my colleague in general, or how dissatisfied I am with my job. More adequate solutions would be talking to my manager, going to a different department or just finding another job, none of which will be achieved if I put the infamous cup of coffee back where it belongs. An effective listener can help me clarify the problem by doing all of the above.

I don’t think you can or have to solve anyone’s problems, but you can empower people so they can take care of themselves, and that’s often done by mere listening.

Image: Joseph Gilbert

As discussed in a previous article, we all have essentially common emotional experiences, problems and fears. Although each of us is a unique amalgam of personality traits, cultural background, attitudes and experiences, we still seem to be very similar in our basic problems. This is the concept of universality.

‘Secrets’ are something we definitely have in common. That doesn’t have to be a dark secret of the past. Sometimes, it is just doubts and fears that we don’t share, because we don’t want to acknowledge such weakness, or don’t want to appear inadequate in front of others. Research and the experiences of psychotherapists reveal that we have very similar secrets, indeed.

A simple study¹ was done to illustrate this universality of human fears and emotions.  Medical students, nurses, psychiatric residents and psychiatric technicians were asked to write down anonymously their ‘top secret’ – one thing they would never share with others. The results were startling. There were three types of secrets that were overwhelmingly similar among all these people:

1) The most common secret was a fear or conviction of ‘basic inadequacy’. People feared they are incompetent in their work and life!

2) The second most frequent secret was a ‘deep sense of interpersonal alienation.’ The fear of being unable to have deeply meaningful relationships with others and love them seems to be very common.

3) Third in frequency came some sort of a sexual secret.

If these qualified and educated professionals had a dark secret fear of inadequacy in life, I wonder how many more of us have a similar fear?

So, if any of those have been troubling your mind, at least you now know you are not alone. In fact, it would be safe to say that whatever troubles your mind, you are not alone and your secret might just be the same as mine.

If anyone tries to sell you the secret to success, walk away because they are trying to rip you off. There is no magical solution and no mystery to it. In fact, there is no secret!

Scientists have repeatedly studied people who do well in life, solving problems effectively and almost effortlessly. Based on this, they have compiled a list of things that you need to do.

No one can sell you success, but you can achieve it for yourself!

Psychologist John Bransford, backed up by extensive research and a team of scientists, has identified five steps that lead to effective problem solving – identify, define, explore, act, and look and learn – ideal, you might say.

1. Identify your problem.

As we’ve discussed before, you can’t begin to solve a problem if you don’t know what it is! Problem solving is not time to be overly emotional, panicked or overwhelmed. Quite the opposite, it is time for rational observation and decision making. So, try to gain some perspective and see the big picture, until you see clearly where and what your problem is.

2. Define your problem clearly.

Once you pin-point the issue, it’s time to look at it from all angles, define and understand it’s nature. Is it an economical problem? An emotional problem? A health problem? Is it an issue in your relationship with your partner, boss, parent or child?

At this stage you need to be open and honest with yourself. After you understand your problem better, you’ll begin to understand yourself better.

3. Explore possible solutions and relevant knowledge.

After you’ve defined your problem, you should already have a better idea how to go about it. In addition, you’ll need to spend some time exploring possible solutions and gathering relevant information. At this stage, it’s normal to consult with  specialist (and/or your friends), to spend hours on Google, or just brainstorm possible options.

Don’t become overwhelmed if you find there is a lot to learn on the issue. After all, we live in the Information Era, and apart from the internet, there is no single expert on a topic. Don’t try to become one either. Just gather enough information, so that you can make informed decisions. You want to be prepared for action.

4. Act. Try out the possible solutions.

Chances are that your problem is not going to disappear or solve itself if you just ponder on possible solutions. Sooner or later, it’s time for action. Even if you don’t feel you’ve found the best solution, don’t get discouraged. Give it your best try and you might as well succeed. If you don’t, you will at least move a little closer to where you want to get.

5. Look at the results and learn from them.

Whether you succeed or not, you should take a moment and evaluate the results.  Learn from them! If you have failed, you apparently need to make some improvements to your approach and try again. “Why would I sit down and reflect if I’ve just won the battle?”, you might ask. Well, it’s simple – perpetual self-improvement. If you look back on the whole process, you might realize that you could have spent more time doing one thing and less time doing another. When you have a similar problem in the future, you’ll be able to tweak things and get even better results.

No problem is unique.

In times of misery, problems and depression, people have the tendency to feel alone and unique in their troubles.

“No one can really relate to me. No one’s gone through the same.” It is this idea of ‘no one understands me’ that draws people to isolation and even depression, which only exacerbates the problem.

Maybe it’s true that people around you cannot relate to your problem. Maybe they’ve never faced a similar difficulty. Maybe they really don’t get you. Does that mean that you’re alone? No. Never!

If you think you have unique issues, thoughts, obsessions, fears or fantasies, think again.

“There is no human deed or thought that lies fully outside the experience of other people,” says renounced psychiatrist Irvin Yalom. In fact, his research and years of experience in work with clients are a manifest of this statement.

If you suffer emotional pain, you need support and understanding. We are all social beings that cannot live entirely solitary lives. However, if you’ve tried to reach out to others and they couldn’t provide the understanding you dearly need, you might withdraw, losing any hope of finding understanding. In times like these, you risk casting yourself on an deserted island of pain and loneliness, where it’s even harder to confide in others, be comforted and accepted. Unfortunately, the very people who can understand you are often on their very own island.

Who can offer you support?

One way to find a strong support group (if your immediate social circle cannot be one) is through group therapy. This is a very effective form of psychotherapy that has proven to have many benefits.¹ It usually involves up to 10 people who meet on a regular basis. Each meeting is held by a therapist who is the formal leader of the group.

There are many types of groups out there: Life skills groups, Recovery Inc., Alcoholics Anonymous, Survivors of Incest, Mended Heart, Men Overcoming Violence, Compassionate friends (for bereaved parents), behavior-shaping groups, communicational skills groups, transitional groups, among others.

These often involve quite different strategies and focus of treatment, but one of their common therapeutic traits is universality.

Why is it important to find people who share your misery?

Dr. Irvin Yalom’s experience shows that “the disconfirmation of a client’s feelings of uniqueness is a powerful source of relief.” He further explains, “After hearing other members disclose concerns similar to their own, clients report feeling more in touch with the world and describe the process as a ‘welcome to the human race’ experience.”²

No matter how different we are in our background, personality and relationships, most problems, fears and emotions are simply common for the human condition. They are universal. So, never think you have to face emotional suffering alone. Help is available. Just surround yourself with the right people.