Running Behind

Many of my patients come in because they feel that they have not accomplished what they feel they should have accomplished for their age. I frequently hear “I should have …. by now” or “Everyone else I know is …. but I am not even close”. These thoughts generally lead to anxiety and a feeling of being “lost” in life.

We grow up with a timeline in our heads that tells us when we are supposed to be working, or buy a house, or get married and have kids. As time goes by we realize that there were so many other choices in life and that even if we plan for something to happen a certain way, it usually happens in its own time. Even so, there tends to be social pressure and self pressure to reach goals in a certain way or timeframe.

Today, social media adds to the pressure. Not only do we hear what they should be doing from the people around us, but everyone else’s accomplishments are clearly visible. It is easy to fall into a bad habit of comparing our lives to others. This adds to the idea that we are not doing enough, that everyone else has found their path and that we are far behind.

The truth is, there is no timeline. Each person needs to ask themselves what makes them happy and follow that path, wherever it may go. Goals are important but each person establishes their own goals and the timeframe in which they would like to reach them. Many unexpected events happen in life and planning for the future can only help us focus on our purpose but cannot guarantee a result. There is no late. There is no being behind. There is no should have. There is only the beauty of each individual path.

Acceptance Or Denial

Throughout the course of my career, I have come across many patients who in the first session establish that they do not have family or childhood issues. The common ways that this is expressed are “My childhood was difficult, but I am ok with that” or “My parents made mistakes, but I have forgiven them”. These comments are usually followed by an adamant “We do not need to get into those issues”.
That is usually my first signal of alert to the fact that they have not actually worked through their issues with their childhood and parents.
One thing is acceptance, which usually implies a long process of talking about, grieving and a certain degree of peace with the past, that allows the person to work on themselves and how they relate to other people.
A different concept is denial, which implies avoiding a process to go directly to “It was ok”, in order to avoid having to look at painful aspects of a life story or having to feel negative emotions towards family members.
People that have resolved their issues in a healthy manner, through different processes, tend to be open to discussing most aspects and will describe their emotions openly, as well as the painful events.
People whose defense mechanism is denial, will tend to be defensive towards any felt criticism, comment or questioning of past events and the nature of the family interactions.
When painful events of the past are being worked on or are resolved, people can establish a healthy balance in their life, especially relationships. When denial is the mechanism, relationship issues and difficulties will come up repeatedly, until they are resolved.

Parents With Alcoholism And The Effect On Children

There are specific family dynamics and patterns when one or both parents are alcoholics. These dynamics have a lifelong effect on children and it is possible to identify symptoms in adult children.

When parents are emotionally mature, they can provide children with a sense of identity, protection and respect. This becomes the development basis for adults that have positive self-esteem, a strong sense of self and the ability to face important life challenges.

In families where there is alcoholism, there is a strong sense of uncertainty. The child must predict the unpredictable: their parents’ erratic behavior. Children grow up feeling the need to take care of their parents and be the “adults” in the house. Lies are necessary in order to keep the family dynamics functioning and secrets are kept by all. Children attribute the problems in the house to themselves and feel responsible for their parent’s problems, developing an intense inner critic. Fun is an unknown concept, because it is not permitted or can be ruined in one second. Children learn that the world is unstable and unpredictable. There is an underlying feeling of not knowing what “normal” is.

It is important to consider that children in families with alcoholism either cut off ties with their parents or decide to be caretakers  during their adult lives. All the aforementioned characteristics affect the way these adult children establish relationships in life and how they set and achieve goals and how they view themselves.

Close Or Enmeshed?

Many patients consult about dynamics in their relationships, either with their family of origin or with their partners. One of the main questions that arises is: Are we too close?

There is an important difference between emotional intimacy with the people that we love and emotional enmeshment.

In a relationship with emotional intimacy, the people involved have the right to be themselves and express themselves due to a high level of acceptance. Trust is built, differences are valued and each person in the relationship feels supported.

In enmeshment, a low level of emotionally maturity of the participants determines that they try to define themselves through the intense relationship, depending on the other person’s opinion or role in order to define their own place in the world.

In the first case, people can be flexible, change and adapt throughout life, because they do not depend on each other in order to know who they are themselves.

In the second case, roles are rigid and the people involved must comply with the needs of the other person. There are rigid established dynamics that when broken can cause anxiety and angst. Manipulation is necessary in order to keep everyone in the order and the relationship stable. The relationship is a mirror, reflecting who they are back to them instead of an individual contruction of self.

In families this can be observed in rigid rituals that must be maintained, parents that have difficulty accepting their childrenˋs new stages in life and also mutual demands that no longer makes sense for a determined stage in life.

In romantic relationships, this can be observed through conflicts that come up when any of the parts want to progress individually, when one the parts tries to change the dynamics in any way or when something happens to affect the purpose of the relationship.


Many patients come in feeling distraught after a whirlwind relationship gone wrong quickly. They describe it as perfect in the beginning, suddenly awkward, then a dramatic end that usually involves the other person disappearing into thin air. They are left with the feeling that they never really knew the other person at all.

This is the relationship pattern of psychopaths. It is a cycle that includes: reeling the person in, devaluating them and, finally, a disappearing act or a painful break-up.

What are the red flags?

In the first stage, the psychopath seems perfect. They like everything you like. They listen to your every word. They declare their love intensely and quickly and promise you everything you had ever dreamed of.

In this stage, what they are actually doing is evaluating and studying you. They need to know how your mind works, what motivates you and, mainly, what makes you insecure or vulnerable. Do not confuse this with empathetic communication. This is a person carefully evaluating their victim in order to see what hurts the most. They need to feel powerful and that they have the tools to leave you feeling that you are worthless.

In the second stage, which come after a fast “I love you” and “I want to spend the rest of my life with you”, the psychopath begins to devaluate you in a very subtle manner. It is almost unperceivable: little comments, jabs, jokes just to see how you react. My patients describe feeling very insecure during this period of the relationship. They feel something is wrong but are not sure what it is. When they confront the psychopath about their comments, they usually are called “oversensitive”. Another common feeling is that the amazing person that was there in the beginning has begun to disappear and they sometimes only get a very blank, indifferent look when trying to explain how they feel. It is as if the charm in the first period of the relationship suddenly just shuts off, and there is only coldness and distance left.

When the psychopath realizes that they are losing power over the person, that they are being evaluated or studied, they reel the person back in with compliments and gifts. This cycle of pushing away and pulling back in can last a very long time. The other person is always hopeful that the psychopath has changed, but have been made to feel so insecure that leaving the relationship is difficult.

The psychopath is always looking for new victims, so as soon as they are bored with one, they move on to the next. They also have simultaneous relationships in order to guarantee that they always have someone to abuse. The main goal when they get tired of the relationship, is to destroy the person they were with, so they look for the most painful way to break up with them and/or just suddenly disappear.

What is a psychopath’s main motivation?

To use and hurt people as much as they can. To drain them for attention and whatever needs they have. They do not feel guilt, so reasoning with one is not effective. If you suspect that you are in a relationship with a psychopath, get professional help immediately in order to learn to break away and heal.

Panic Attacks

A common reason to consult a therapist are panic attacks. It seems that the amount of people that experience this particular symptom has steadily increased in the past years.

People that have panic attacks tend to state that they cannot think of any reason that they are having them. They say that it is not associated to any specific event and the scariest part is that they cannot predict when they will feel one.

Most people look for psychiatric treatment first and are sent to therapy after receiving their prescription. They come in asking for breathing techniques and relaxation methods in order to deal with what they believe is a problem of general anxiety.

It is my belief that panic attacks are not brought on by general anxiety nor by a directly related trigger. I think that they are a symptom of a more complex process.

We build what we think about the world and life as we live it. I think of every rule that we internalize as a puzzle piece in a giant puzzle of thoughts. As time goes by, some of the pieces of the puzzle do not fit as well as they used to.

For example: You believe that you must support everyone in your family financially or emotionally because that is what you learned at an early age (rule). This thought worked well within the puzzle for a while, but now you are 38, overworked and exhausted. You feel like you cannot fail the people that count on you for help. Your actions comply with that thought but your reality is showing you that doing this is not possible and maybe very hurtful towards your mental state as well. Since you are not aware of this battle consciously, you are not even thinking about this, it manifests itself in this symptom.

It is my belief that in order to eliminate panic attacks, we must examine the set of beliefs that are making you unhappy, the pieces that no longer fit and incorporate new, more appropriate pieces that allow your rules to be in harmony with your reality.

I Do, Therefore I Am

Many patients describe anxiety related to who they think they are. Most people describe themselves in terms of what they do: where they work, what they have accomplished and their future goals. In these cases, their self concept has been associated strictly to actions and external measurements and, while having goals in life is important, many people have forgotten (or never learned) the fact that they are valuable as people, no matter what they do.

This concept is especially foreign in cultures where success is vital and goals are what make you a  “productive” human being.

The root of this concept may also stem from families in which children were not taught that they were valuable just because they exist and that there is no reason to do anything in order to be worthy of love and attention. When children must struggle to obtain unconditional love from their parents, only feeling acknowledged when they perform greatly (or perfectly), then they go on to become adults that can only measure themselves by these standards.

Anxiety arises when there is a feeling that no matter what they have already done, they must achieve more and more, nothing is enough, therefore they are not enough either.

Few people define themselves by their intrinsic characteristics: funny, caring, intelligent, creative, etc. Most people describe what they are in relation to the standards that they have incorporated in their minds to be “acceptable”, to their families and external witnesses.

Must you “do” to be you? Can you describe yourself independently from external standards that you have been taught or do you always associate yourself to external factors?

Limited Options

One of the common reasons couples come into therapy for is because they need to make a decision about something. An important decision. Something that will change their life forever. And they have different perspectives on what to do.

Couples that ask for an appointment when they come to a decision like this usually want some guidance over which of the two choices is best. Each person has their own point of view on the issue at hand and very good reasons to support that decision.

The weight of “forever” or “permanency” on the decision generally makes the importance of choosing the “correct” path vital. It also confuses both parts of the couple into believing that there actually are only two choices, that one of them is necessarily better than the other and that the decision is actually irreversible. And the therapist is expected to evaluate and vote for one of the options.

After exploring the issues, it is possible to come up with a variety of possible solutions that allow the couple more flexibility and lowers the “definitive” quality of all of the choices. Many times a couple has spent so much time supporting a certain position on a matter that they have not realized that they were offered some sort of alternative solution in the process.

When faced with a life decision, do you look at other perspectives? Do you evaluate all of the possible scenarios or spend time trying to defend your own choice? Do you take into account that there are factors that cannot be controlled in the outcome? Do you tend to look  at things as permanent, when there is a possibility that they might not be?

The Productivity Problem

In the past few years, anxiety has become a main reason for going to therapy and the number of patients that consult because of it has risen steadily. Anxiety can have a lot of different sources, but a common issue that people with anxiety bring up in the first few sessions is that they worry that they are not being productive enough. When asked what that means or how they define “being productive”, the answer usually is related to reaching goals, having great achievements and doing something important in the world.

Then comes my next question ”productive according to whom?” This is usually followed by a confused look and statement about how being productive is an obvious vital element of life. How hard work and commiting to high goals is what we have to do to have a life that is worthwhile living. How 22, 27, 32, 40 is a time when productive things should be done.

Beneath these statements, there is a belief that is deeply stemmed in most cultures and that belief is that we are only valuable if we do outstanding things. That our existence must be justified. That we will be judged by how much we do on this Earth and the quality of the things we do. And all of this implies sacrifice and hard work.

It is always surprising how few people ask themselves if they are happy versus if they are being productive. I happen to think that happiness and productivity go hand in hand. If you like what you do, you are productive. Your happiness can be a great gift to the world. Nothing seems like hard work or sacrifice when you are happy. You can do more when you are happy. Anxiety about being productive actually stalls productivity.

Do you ask yourself regularly if you are happy? What does “being productive” mean to you? Could it mean something different? How much of your anxiety is about doing what you think you are supposed to be doing, instead of focusing on what makes you happy?

Should I Settle In?

Patients that have come in to my practice, have been in Chile for at least a few weeks or sometimes a few years. A frequent question that comes up at any point in time is “Should I be trying to settle in?”

Some of the moves here consist of people in a relationship, while others come for work or the experience. Many people do not know how long they will be staying and, a lot of the time, becoming accustomed to Chile seems like a big effort that will result in only having to leave eventually.

When presented with the question, I tend to explain two options. The decision is yours.

The first option is to try to settle in. If you become a part of something, then you can discover a whole new side of yourself. You can realize things about yourself that you would not otherwise. You can even come to the conclusion that living here is not for you, but you tried and learned things in the process.

Another option is to view your move as a vacation or a temporary arrangement, then you can observe culture as an outsider and have fun doing it in the process. You can also learn about a completely different way of life and incporate some of those elements in your own lifestyle. You can leave and feel that you come away with something valuable.

How do you settle in? Another frequent question. Granted, Chile is not the easiest country to fit in to. Learn the language, at least enough to move around independently. Find activities that interest you. Make friends. Learn about the history and culture.

And try to limit comparisons. Of course, this is nothing like where you are from. It is different. Not worse, not better. Just different.

Either way, whatever you choose, you can feel that coming here was worth the experience.