A Bio-Psycho-Social Approach To Looking At Your Problems

This real play is like stepping into a therapy room with Dr. Diana Hill. Diana demonstrates how to view your problems as an interconnected network of biological, sociocultural, and psychological factors. The DSM is limited when it comes to looking at the complexity of human beings. It lacks individualization, tends to medicalize your problems, overemphasizes symptom reduction, and does not guide well which direction to go. Instead, you can explore the many factors that interact to create your problems so that you can intervene more effectively. Diana walks you through how to do this yourself.

Original Music by Ben Gold at Bell and Branch

Transcript

How can you look at a problem in your life from a bio-psycho-social perspective and how can that help you develop some interventions that will help you get unstuck?

That's what we're going to explore today in this Real Play with Emily Pham on Your Life in Process.

I hope to see you at some of my summer events.

In July I'm going to be online at the ACBS World Conference presenting a workshop on WISEeffort and a workshop with Alexis Karasbachik on Infertility and Pregnancy Loss.

And in August I will be with Joseph Sirocci presenting on Process-Based Therapy through PESI and offering a full-day workshop for clinicians on ACT and Body Image and Eating Concerns through PESI.

These events are listed in the show notes and please sign up for my WISEeffort newsletter where you can stay on top of what I'm up to but also get some more tips in your inbox to practice WISEeffort in your life.

So if you were to come work with me on a problem,

One of the first things that I would do is create something called a case conceptualization.

This is really common for psychologists to create case conceptualizations but the way that I've been creating them more recently is getting out of the box of diagnoses.

The DSM is a limited approach when it comes to looking at the complexity of human beings.

A much more effective way to look at your problems is an individualized approach but an individualized approach that's based on our evidence base.

What we know from evidence-based psychology about what are the core underlying processes that many of us can get stuck in and then how they are interacting and relating to you.

Today I'm doing that with Emily Phan on this podcast.

We're taking a look at a problem that she's facing in her life and looking at it through the lens of a biopsychosocial perspective.

How all these different interacting components relate to her problem and then we intervene a little bit based on what shows up.

A lot of the interventions come from Emily herself.

That's the way that I work.

I tend to first draw on the wisdom of my client and then maybe add a few pointers in based on my experience.

It's sort of like being a rock climber on the face of a rock and if I'm their coach,

I'm on the face of my own rock.

I may have some viewpoints in to where some footholds may be,

But only they really know what it feels like to be on their rock and what their capabilities and stretches are.

So I was talking with Stephen Hayes this past week.

We're working on some videos and I'll be sharing that with you when it comes out,

But we were talking about one of the first experiences that I had with him when I was learning ACT from him and he jumped off of a phone book in a workshop.

I thought originally that he was jumping off the phone book because he was demonstrating how small a change can be,

That you don't have to make big leaps to make big changes in your life.

It starts with small changes and then building up over time,

Which is a really great behavioral principle to be thinking about if you conceptualize your own case after doing this real play with me and when you start thinking about change.

But one of the things that he said was,

No,

It wasn't just that.

It was more than that.

He said,

You know,

You can jump off a piece of paper,

You can jump off a phone book,

You can jump off a chair,

And then eventually you'll be able to jump out of a plane.

If you want to jump out of planes in life,

You got to jump.

But if you try stepping off a piece of paper,

Stepping off of a phone book,

Stepping off of a chair,

You're not going to be able to jump off that plane.

It takes some degree of acceptance and willingness to make the moves that you want to make in your life.

And that is what Emily and I explore today in her case conceptualization of her problem,

Which is she wants to be more vulnerable and open in her personal relationships.

And fear seems to be a variable that's related to that,

Although by the end of it,

She kind of figures out how to intervene with that fear in a creative way.

We're doing something called network modeling here,

And this is a very messy network model.

There's a much more protocol way to do network modeling,

And I will be demonstrating that with Joseph Sirochi.

This was more of a loose network model because I was also wanting to demonstrate some interventions along the way,

And also because I'm fairly new to network modeling.

This is still evolving and getting figured out.

So stay tuned to a future real play where I'll be demonstrating network modeling again.

So as you listen to this conversation with Emily,

I want you to listen to three things.

First,

Listen to how she is able to generate some of her own interventions.

This is the power of the leadership self that we talked about in the real play with Richard Schwartz,

Or you could call it the wise mind or the compassionate self.

A lot of times it's already in there and getting curious about your biopsychosocial network is one avenue to starting to open up for you some solutions.

Two,

Notice the interplay of the biopsychosocial factors in Emily's problem.

When you actually start to pick those apart and take a closer look at them,

Lean into them,

Get curious about them,

It becomes such a richer exploration of her.

And you have your own problems,

And maybe you've only been looking at them through one lens.

Maybe you've only been looking at them through the biological lens and neglecting psychological factors,

Or maybe you've been neglecting sociocultural factors or contextual factors.

It's important to take perspective this way when we're practicing curiosity.

And then third,

Pay attention to how Emily and I get at values for her and how those values end up being a powerful process for her in shifting her perspective and her motivation and maybe her path to doing her relationships differently.

I'll meet you on the other side to give you some guidelines for you on how you can begin to take a biopsychosocial approach to a problem of your own.

Hi.

It's been a while since I've seen you.

I know.

A few months?

Yeah.

From seeing each other every day to,

Yeah,

To not at all,

But I've been following you on Instagram.

Oh.

Well,

That's.

.

.

It's not seeing all of me,

But yeah,

Seeing a part,

Seeing the slice.

Yeah.

For sure.

You didn't see the five loads of laundry that are sitting in my hallway?

I just walked past.

I was like,

Oh,

God.

That's okay.

So I wanted to talk with you for this new segment that I'm doing,

Which is a segment called Real Play.

And it's a lot like what we did in Costa Rica when we did The Matrix and you were my,

I don't know,

Real play slash guinea pig to demonstrate that skill.

And I thought you were such a good sport for doing it and you're not my client,

So I can do it with you.

It's sort of this narrow range of how do I demonstrate these skills without being a family member or a client and who's one of those people that could do it?

And so you were one of them.

Thank you for having me.

And there's a theme to this series where I'm breaking down wise effort into these three chunks.

So one chunk is about curiosity,

Another chunk is about getting flexible,

And then the third sort of aspect of it has to do with taking wise action in your life.

And I thought you would be a good place to start to explore curiosity and demonstrate this one way in which we can practice curiosity of looking at some of our problems.

Cool.

And I saw,

Or I listened to your podcast with Issa on Real Play and so I kind of get a little bit what it's about and I thought it was great.

You're like,

I'm not going that far.

No,

No,

It's okay.

She was a friend.

Yeah,

Yeah.

No,

It's okay,

It's okay.

I'm here.

Yeah.

And I'm here to participate.

Awesome.

Why don't you start by telling us a little bit about who you are and if you have something that you feel like you want to work on in this way,

That you know how I work,

That maybe you could bring to the table to get some movement around.

Yeah.

Yeah,

Absolutely.

So I'm in Toronto.

I'm not in beautiful California like you,

Diana,

But I grew up here.

My dad is from Hong Kong and mom's from Taiwan.

I am a lawyer during my day job and specifically in commercial litigation.

It obviously involves a lot of public speaking and I didn't think that that's where I was going to be because I hate the attention and I don't really like public speaking,

But one of the things that I've learned and I am learning is to work with the fear in that moment.

I also have a dog at home.

He's a mutt.

He's a retriever,

Husky,

German shepherd,

And he's from a native reserve in Northern Manitoba and I'm very lucky to have him.

What's his name?

Henry.

Henry!

A little old man name for a young pup.

Oh,

It's so cute.

Yeah.

I used to have a retriever shepherd mix and it's such a cool combo.

They're super athletic.

I don't know if your dog is very athletic,

But mine is super athletic,

Could swim through amazing waves and then also really bonded and sweet and all of that.

Yeah.

He's a good combination.

Yeah.

He's exactly like that.

He'll jump in the air and sort of do a backflip and he's jumped into the water when it's freezing in the winter time here and it's no big deal.

Yeah.

It's super cool to see your dog be so badass.

Yeah.

He is.

You feel like it's an extension of you.

You take credit.

Yeah.

Good.

Yeah.

Good.

Well,

Henry,

I hope Henry is staying warm and cozy with you today.

And do you have,

When we were in Costa Rica,

You did a matrix with me and we're not going to do the matrix today.

I want to do something else that is exploring a problem from a biopsychosocial perspective.

It's a practice of getting curious about one of your problems in your life and all the different potential factors that are contributing to it.

And even just doing that,

It's sort of like if you were to build a house,

You'd have an architect come in and they would map out all the different parts,

Everything from the plumbing system to the foundation,

To the different rooms,

To the landscape,

Right?

And that helps the builder with the design and how you may build this unique house.

We can do that with this type of,

It's called network modeling,

Of looking at one of our problems from all these different perspectives,

From the biological perspective,

From a psychological perspective,

From a sociocultural and interpersonal perspective,

And a contextual perspective.

And one of the complaints about psychology is that we haven't done that in the past.

We've left a lot of these other parts out.

It's like we haven't even looked at the plumbing,

Right?

So I would think it'd be kind of interesting to take something maybe in your life that we could map out in this way and take a look at it in a curious way.

And it may actually help you with it because you may choose different types of interventions or approaches with something that you haven't chosen before because you have a different view in on it.

So given that,

Is there something that you would want to work on?

Yeah.

I would want to work on vulnerability.

And this point ties into both my personal life and into my work.

I had mentioned earlier from a work perspective,

One of the things that I'm learning is like working with the fear instead of against it.

And I find that fear in my personal life will prevent me from being vulnerable and more open.

So yeah,

That's the topic and what you meant.

Okay.

So vulnerability is where you want what you want more of,

What you want to be practicing.

And you see maybe the problem,

I don't know if the problem is fear,

But the problem is probably related to how you relate to fear when it shows up.

The nature of being vulnerable is that it usually will come with fear in the physical world or in the emotional world.

And then you said this shows up for you in work and in personal?

My personal life,

Especially in my close personal relationships where I'm not always vulnerable and I'm not always showing that side of myself for a number of reasons.

Okay.

If we were to,

Could we choose one,

Either your personal or your work life,

Just for the sake of simplifying it and then once we're doing this network?

So which one would you want to work with?

Dealer's choice and you're the dealer.

Well,

Which would have the biggest bang for your buck for you in your life?

If you were more vulnerable in your personal world,

Do you feel like it would open up potentially you to be more vulnerable in your work world or vice versa?

It sort of is a generalizable skill to some degree.

Yeah,

For sure.

Yeah.

Let's start with personal.

Personal?

Yeah.

Okay.

So I'm going to be just like an architect that draws out plans.

I'm going to be using a piece of paper,

Just a blank piece of paper,

And I'm going to be drawing out your network and if you have a piece of paper,

It might be helpful for you to do this.

I have.

Yes,

I do.

We're totally paperless now and I'm in the office today and so the one scrap piece of paper I have,

I'm going to write on the back.

I have this problem all the time with clients.

I'm like,

Let's write that out,

But I have no pen and we do not have pens in our house except for markers,

Like kids markers.

Pentel.

Same.

Okay.

So in the middle of this,

I'm going to say a circle in the middle,

Which is sort of the problem and putting the problem in your words or the words that you used is that I have fear that gets in the way of vulnerability in my personal life.

Is that how you would describe it or do you want to add more to that?

Yeah,

I think in line with that fear is the fear of being seen as weak,

The fear of being seen as imperfect.

Those are the two.

I think those are the two main things.

Yeah.

Okay.

So fear of being seen as weak and fear of being seen as imperfect in your personal life and gosh,

I imagine that would show up in work as an attorney.

It's not like you live and work in an environment that welcomes a lot of weakness or imperfection.

Exactly.

Exactly.

Commercial law.

Right.

Commercial litigation.

Exactly.

Exactly.

Okay.

So as in any network or any system,

There's a lot of different things that are interacting with this and one way to look at it is that there's psychological factors and psychological factors are how you relate to your feelings,

How you relate to your thoughts,

Your own inner motivation,

Your sense of self is an important one,

And then actually how you are behaving when that fear shows up.

And then there's social cultural factors,

How you're relating to others,

And then there's biological factors and then there's contextual factors,

Right?

I want to start with just the biological ones to just get a sense if there's anything biological that may be contributing to this fear.

And some of the biological factors may be things like you're not getting enough sleep,

Your diet might be off and it makes you more anxious,

You are changing medications,

You use substances that make you feel more anxious,

Like high levels of caffeine,

How are you doing with movement,

Sleep,

Exercise,

All that.

Yeah.

Yeah.

Diana,

Sleep really resonates for me and it's the big one.

I always,

I didn't used to know this,

But sometimes when I'm feeling extra anxious or stressed or I'm stuck in my head,

I immediately ask myself how much sleep I got the night before or what the quality of my sleep is.

And usually that's the key issue that drives a lot of my mood.

Yeah.

For a lot of us,

Sleep is the,

That's the time when everything gets consolidated.

Our brain gets to restore itself back to a level of being able to handle all this stuff from the next day.

And what,

When you say it's either interrupt,

Poor quality or not enough,

What's getting in the way of you getting enough sleep?

Is it you not going to bed?

Is it you just can't sleep?

You have time limitations in the morning?

Yeah.

I find it's often that I have too much on my mind before I go to bed.

It's not really the time I go to bed.

I try to go to bed around the same time every evening.

But if I've had a really busy day from a work perspective or a personal perspective and I have more the next day,

I just can't stay asleep for the full time that I'm there.

And I'll wake up multiple times a night.

And when I do wake up in the morning,

I just don't feel refreshed at all.

Okay.

Is there sort of a body,

Bodily stress state that's related to that?

Yes.

Like your body is revved?

Yes.

As well?

Yes.

Okay.

My body,

I feel like I don't have stillness in my body.

Yeah.

Okay.

So what I'm adding to our network is those two really important biological things that are related.

So you have sleep,

Which is like poor quality.

There's actually three things in here,

But I'm holding one of them.

So sleep is poor quality.

And then you also have body stress.

Right.

And I want you to put those two circles on your network.

And each one of these circles contributes to the problem,

Right?

So it contributes to the fear.

So you could draw arrows contributing to that.

But they also relate to each other.

Agreed.

Because what you said is I have this bodily stress that relates to me having a hard time sleeping.

Like I just have too much.

I'm revved and I can't go to sleep at night.

And then maybe the next day I feel more anxious and more fearful.

And then it can become a little bit of a vicious cycle,

Right?

Totally.

You have the stress on your body,

Which impacts your sleep,

Which then impacts the fear.

Yeah.

And you mentioned something else which is important because it's a good demonstration of how the biological stuff that's happening in our body relates to the psychological stuff.

Because you said,

I have too much on my mind,

Which is a psychological thing.

That's not necessarily a bodily thing.

So tell me a little bit about that,

Like the too much on your mind.

You're right.

I'm trying to clear my mind so that I don't feel the stress in my body.

But I think the more that I try to do that and try to clear my mind,

The more I feel the stress in my body.

And then you think,

Okay,

You know what?

I need this many hours of sleep.

I need to get up the next day.

These are all the things.

And you start making lists in your head,

Right,

Of all the things that you're not good at,

All the things that you need to get done tomorrow,

And then the ways that I'm going to counteract my exhaustion the next day from not sleeping.

So maybe I'll say,

You know,

Instead of doing my 20 minutes of yoga in the morning,

You know what,

I'll just cut through that and I'll sleep a little bit extra.

And it creates this vicious cycle,

As you said,

And then I also need a little bit more caffeine in the morning.

Okay,

Which is another bodily thing,

Caffeine.

Okay,

So I'm going to put all of these on our network.

And we haven't even gotten to like the deeper vulnerable psychological stuff.

We'll get there.

This is the vicious cycle that so many of us are in.

Yeah.

I don't even know where the chicken or egg is.

Was I stressed first?

Or did I create the stress by all my attempts to get rid of the stress?

Exactly.

Exactly.

We're constantly trying to problem solve in our head,

Right?

And it becomes just this little circle.

Yeah,

This little circle.

So I put on my network thoughts,

Too much on my mind in one circle,

Which is one of those psychological factors.

And then what you do when those thoughts show up,

Which is try to clear my mind,

Make lists,

Think about all the things that I'm not done with and plan for how I'm going to cut corners to get more.

And usually the things we cut corners with are the very things that we need.

Like I'll just cut out that 20-minute yoga practice tomorrow so I can deal with the stress,

Right?

Which actually is the thing that could potentially help you with the stress,

But it's not have time.

Agreed.

So you have your thoughts and then all the stuff that you're doing to try and like the thoughts that show up and the stuff that you're trying to do to manage the poor sleep and the stress.

Right.

And like you said,

It's this vicious cycle.

So we have the category of biology and then we have the category of psychology.

And in psychology includes what we do with our thoughts and our behaviors.

And the behavior is the,

You know,

Not doing the yoga and the drinking a little more caffeine,

Which then feed back into our biology.

Right.

Okay.

Let me see your network,

What it looks like.

Is it,

It can look like a complete mess,

But as long as you have it on there.

Yeah.

A bit of a mess.

There are arrows everywhere.

There's arrows everywhere.

You're related.

Okay.

Yeah.

So each of these circles are like nodes and we could even stop here.

Like we could be like,

Okay,

That's 17 minutes of our time together.

We're going to stop today.

Right.

And you would already have some clear places where you could intervene.

Right.

And you know yourself.

I mean,

You've also been to a week long act and yoga retreat.

I have.

So you have some skills.

I do.

Let's,

Let's pause here.

Cause I mean,

We haven't,

Again,

We haven't even gotten to the fear and vulnerability.

We're just working on the stress stuff,

But,

And the body stuff,

But where would be some places that you would potentially even intervene within this cycle?

What have you tried or maybe even haven't tried that you think might be helpful?

One of the things that I've tried using one of the techniques you mentioned during our week in Costa Rica together,

You know,

ACT,

Part of it is about acceptance.

And so recently I just came off a three week trial and,

You know,

Had lots of sleep issues during that period,

As you can imagine.

And when I couldn't sleep at night,

Instead of ruminating and going through this cycle of thoughts,

I would just say,

You know what,

I just,

I accept the fact that I can't sleep right now.

And it is what it is.

It's easier said than done.

The other thing that I have used one of my friends,

A surgeon and,

You know,

Super high pressure job and also sometimes can't sleep.

And she said,

One of the techniques she uses is to say that,

You know,

When she's lying in bed,

She says to herself,

You know what,

I'm just,

I'm awake,

But I'm luxuriating in this experience of being in a warm bed and awake.

And I found that that's been really comforting for me.

Oh my gosh.

Okay.

You are so good in so many ways.

So you just came up with the foundation of sleep intervention is the newer kind of cognitive behavioral approach to insomnia,

CBTI,

Which is one,

Stop trying to make yourself sleep.

Yeah.

The more you try and make yourself sleep,

The less likely you're going to sleep.

And so you are using that practice of acceptance.

Like I accept that I can't sleep right now.

That is the,

That it is what it is.

That is the reality.

I'm going to stop trying so hard to make myself sleep.

And that in itself will probably increase the probability of you sleeping,

But then you can't even think that.

I'm not saying this to make you sleep.

I'm not helping myself sleep right now.

And I will,

And I will make the suggestion that if after 20 minutes of lying in bed,

If you really just don't fall asleep,

Then get out of bed.

I mean,

You could choose.

I really like that.

I'm luxuriating in my,

My warm bed right now because I'm choosing to do something else and enjoy what I have.

And if that,

You know,

If that doesn't feel luxurious,

Because sometimes when we can't sleep enough,

Like it's been repetitive,

Not being able to sleep,

Our bed actually becomes kind of aversive.

I don't like being in my bed anymore.

It's like,

I don't know if it reminds me of not sleeping.

So you actually could remove yourself and go put yourself in a,

In a,

Like a quiet place and do something quiet.

Like if I'm not going to sleep,

What else would I do?

I'm going to read a little bit of something that I haven't been able to read or,

You know,

Right.

Whatever that act,

I could actually even do that 20 minutes of yoga that I'm not going to do tomorrow morning.

Yeah,

That's true.

Right now.

Yeah.

But those two,

That those two practices are spot on.

And what I'd like for you to do is,

Is write them and put them in boxes.

Okay.

And one box,

You said,

I accept that I can't sleep.

It is what it is.

And that to me feels like a box that could impact those thoughts.

Too much on my mind or the thoughts of make,

Instead of making lists and all the things that I haven't done.

Right.

And,

And same with the,

The other box,

Which is luxuriating in a warm bed is another place to put your attention.

Yeah.

So it's a shift of attention from worrying.

And what we know about worrying is that it also doesn't improve the chances of you,

Of the bad things not happening,

But it shifts your attention to almost also to your body.

So luxuriating in a warm bed,

You're feeling the blankets,

You're feeling the warmth,

You're,

You're enjoying what's around you.

And all of a sudden you're not in your head worrying,

You're in your body.

And the more that you're in your body,

The probably the greater chances that you'll also be able to fall asleep.

Right.

But don't do it for that reason.

Yeah.

I know.

Well,

You describing being in bed with the blanket,

It makes me feel,

It's only,

It's the afternoon right now,

But it makes me feel so cozy and want to climb into bed.

Yeah.

Yeah,

Exactly.

And we can actually activate the soothing part of our nervous system by just through that type of imagery,

Just like we can activate the sympathetic fear-based nervous system through scary imagery.

We can do the same thing with soothing,

Cozy imagery.

So I love your surgeon friend.

Surgeon?

Surgeon.

Yeah.

Yeah.

She's a craniofascial surgeon.

She does cosmetic surgery for kids.

Oh my gosh.

Cosmetics.

Yeah.

So she's,

She's got a job that it really does matter if she does a good job or not.

A hundred percent.

Yeah.

High stakes job.

Exactly.

Yeah.

That'll keep you up at night.

Yeah,

It will.

Yeah.

For sure.

And how do you,

And how do you wind yourself down?

So those are two fantastic interventions.

So put those down as squares and then you can,

You can put them,

You can put some arrows to where,

You know,

Where those squares may work on your network.

I also think it would work on the body stress.

Yeah.

Agreed.

I think it would work for all the circles I've had so far.

Okay.

Yeah.

Okay.

So we've,

We've talked a bit about,

You know,

Some of the,

The biological things that could contribute to this fear of being seen as weak and imperfect,

Which is like sleep.

The more you have problematic sleep and stress,

The more likely those feelings show up.

And then we've talked a little bit about thoughts that impact sleep in itself,

But let's talk about some of the psychological factors that actually impact this fear of being seen as weak and imperfect.

And one place I would probably want to start with you is the psychological factor that's associated with the sense of self.

Because in there you're talking about weak or imperfect and sort of like this quality about if you were to have that quality and that were to define you,

That in some way you would be bad or you'd be defined by that.

And that if you're vulnerable,

So it,

To me,

It just like,

It gives me a sense of like,

Oh,

She's,

She's basing her sense of self on this perception of how she may be judged by others.

Yes.

But tell me,

Yeah.

Tell me a little bit about if that resonates for you.

Yeah,

For sure.

So I think the sense of self and not being seen as perfect or being seen as weak started from my childhood when my parents split up and we grew up in a community where this was very unusual for two Chinese parents,

Especially,

You know,

Given their backgrounds and the social status of people around us.

And you know,

They said all sorts of things about,

You know,

Kids of single parents,

Things like,

You know,

Your kids are going to become drug addicts.

If you guys get divorced,

You know,

They're never going to make it through school.

And so at that point in time,

I was a teenager.

And I was like,

You guys for saying that about my parents and especially my mom.

So I decided that I was just going to do really well in school,

I was going to kick butt,

I was going to be the model kid that my parents could be proud of.

And I was going to change the way that people perceived my family.

So I think that that really carried on into my adulthood.

And I carried on some of the stigma and insecurity of my parents not being together into many of my personal relationships as well.

So I always feel like I had this sense that I needed to perform for love,

You know,

Even through my marriage with my ex-husband.

And it's something that I've been working on this past while.

So that's the psychological part.

Yeah,

There's so much packed in there.

And there's sociocultural.

100%.

100%.

You said that,

You know,

Parents,

The kid of single parents,

There was judgment about you.

And then you had this like rebellions of like,

You know,

F you to all those that were judging you.

But just tell me more about,

You know,

Also how being seen as weak or imperfect may relate to what it was like for you as a kid to Chinese parents.

So I grew up with two Chinese parents who were very loving and pretty open-minded,

I would say.

But at the same time,

You know,

If I would run into emotional issues,

What we were used to in our family was not letting the outside world know that.

And you know,

Even later on when I became an adult,

This is a longer story and a separate one,

But it's an example of the sociocultural element.

So when one of my really good friends committed suicide and I wanted to go to therapy,

You know,

One of my parents was like,

You know,

I really don't think you should do that.

You're in law school,

There might be a stigma to this.

And that's kind of the way that I grew up and I internalized it.

I also felt like I needed to present well for my family and I couldn't show any emotional weakness.

Yeah.

So it's also considering your family's reputation.

Exactly.

It's not just about you.

It's also about the reputation of your family and your parents.

So you're carrying that extra important load.

I mean,

It's a maybe a value system within your family as I'm responsible for my parents,

Not just me.

Exactly.

If I show a weakness.

Exactly.

And then I imagine there's like a tension between that because there might have been a part of you that wanted to go to therapy or needed that.

But then how do I navigate that without being judged,

Without looking poorly on my family?

Yeah,

Diana,

You're spot on.

I had this feeling that I should really side with my family and do what I felt they thought was right.

But at the same time,

I'm also a very deeply emotional and sensitive person and I'm also quite expressive.

And so it was this tension between these two sides and how I handle these very difficult moments in my life and in my family's life.

Okay.

Good.

Good.

So our network just got a whole lot richer beyond I can't sleep because I'm stressed.

We need like five pages now.

Yeah,

We need five pages.

You see,

I'm writing all this stuff down.

And I want to just say in this network holds your beliefs about yourself and who you are based on your early childhood experience,

Right?

Also being a kid of single parents and sort of feeling judged by others.

So I would say there may be a node there which has to do with your sense of self as like myself is also defined by what other people believe about me.

And then there's also a self,

Another aspect to yourself that myself is also defined by my parents.

So the self that is related to your parents and that interconnection that you have with them and the responsibility you feel to them.

So it could say responsibility for family in there.

And these are all self components of your psychology.

Like who am I?

Am I defined by other people's judgment of me?

Am I defined by my relationship to my parents?

And then there was also in there some behaviors that came out of those.

So another part of psychology behaviors and the behavior of performing.

Can you say more about that one?

Yeah.

You know,

The specific example I think of is,

You know,

Because my parents had separated when I was young and I didn't realize this until later on.

But I obviously carried some kind of insecurity from that and the way people perceive my family.

And I decided when I was married that I needed to have like the perfect household.

Everything need to be in place,

Like beautiful furniture,

Things a certain way,

A certain type of house,

And to project a certain type of aesthetic.

And it wasn't really about the materialism.

It was to be like,

You know what,

I still turned out okay.

And,

You know,

This idea of this concept of like this perfect family,

Which of course doesn't exist,

But for me provided some armor for the way I really felt inside about me,

The way I felt about my marriage,

Which was,

You know,

Falling apart at the time.

It was there to sort of protect me.

Yeah.

So good.

So you have in there the feeling of insecurity and then you have the perfection that is there to kind of cover up and contain that insecure part of you.

Exactly.

And that insecure part of you has its roots,

You know,

Way,

Way,

Way old roots within this early experience within your family and within your culture and how you navigated that.

You had to kind of like do the F.

U.

And I'm going to take control of this thing.

Right.

Right.

Exactly.

Yeah.

Exactly.

It was interesting because before you came on the retreat,

I don't do this with my clients,

But I do this with people coming on my retreats.

I Googled you.

I Googled you.

And of the folks that were coming on the retreat,

You were one of the ones I was most like,

Oh gosh,

I don't know how she's going to do with this.

All the profile of the attorney,

The headshot.

I mean,

Your headshot is like this.

This woman is like killing it in the professional world and the website.

And then and then you showed up and you were so warm and natural and organic and building friendships.

And I can see how that it's like that shell of perfection that is on the outside to protect the more tender.

Yeah.

Like you said,

The more emotional,

Tender,

Vulnerable self that's there.

And yeah,

I kind of like the dichotomy.

I think it's interesting.

It makes you interesting to have that dichotomy.

It's not that we need to get rid of that shell,

But I would imagine if that shell is what's dominating your experience with your friends or in the work setting,

It does lead to difficulty with connecting.

Yeah,

I agree.

I agree.

I realized a few years ago that some of my really close friends had also never seen me cry.

And so,

You know,

That that said something.

You saw a lot of tears from me when I was in Costa Rica.

So it was a warm,

Welcoming space.

Yeah.

Yeah.

That for some reason,

That part of you was able to come out more and be,

You know,

Like hair in a bun,

Kind of a mess,

You know,

Like just in like hanging out in your bathing suit,

You know,

Like all those things that I won't I won't post any of those pictures,

You know,

But it's so it's so different,

Right,

Than the very contained attorney,

Like had to had to take all of this stuff that happened for you and put it in a in a nice package so that it's contained.

Okay,

So we have the sense of self.

We also have the social cultural influences there.

I'm going to have you put some of those nodes down to help to help you and how they relate to each other.

So we would see like the insecure self,

And then the self that is there to to take care of your parents reputation,

Your family reputation.

And then we would see behaviors that are perfectionistic behaviors performing for love.

Yeah.

And then maybe feelings that are insecure.

So those would be the nodes that I would add.

So if we were to pause on some of these more psychological factors,

And there's history there and social cultural factors,

What have you learned about yourself in terms of what helps you when that insecurity shows up?

Or what helps you when you feel like I need to perform for love or when the perfectionism shows up?

And you can even use some of the things that you learned on our retreat,

You know,

Some of the practices,

But I imagine you also have your own knowings.

Yeah,

One of the things that I realized that I do when I'm feeling this way is that I hold my breath.

And I noticed that on this retreat,

Even though I wasn't doing my,

You know,

Every morning when I'm in Toronto,

I meditate.

And even though I wasn't meditating like I was in Costa Rica,

Like I would here,

I felt like when I was there,

I could just I could breathe in the mornings because of the activities we were doing.

And we were usually doing some type of yoga to start off the day.

And I found that that's been really helpful for me.

The second thing that I found that's helpful is I try to use that fear or the insecurity to my to my advantage.

That's maybe not the right way to explain it,

But I try to step into it.

And I use that I'm going to use it,

I'm going to use this in a work context,

And maybe not in a personal,

But,

You know,

Even to this day,

Before I get up and get on stage in court,

I still feel super nervous,

I can't sleep the night before.

And I used to let that fear really get to me.

And I found what was really helpful for me is in the few moments before I'm going to get up,

I visualize myself up there and I visualize myself speaking.

And I tell myself to breathe and be present.

And once I'm up there,

I use the fear as this adrenaline to like the energy just takes over the room.

And it's just the judge and the witness and me.

So good.

Yeah.

You're so you you you're such a natural of being able to find pathways to work with these very human experiences of feeling insecure or having shame around,

You know,

Aspects of ourselves.

And so the first one is the breath.

And you notice that when when the when these when insecurity shows up,

You do what most of us do,

Which is tighten up around and hold our breath because we're scared.

And how much being able to breathe and slowing down the breath and having an abundance of long,

Slow breaths helps you regulate that nervous system that that's that's scared.

Right.

And maybe be present as well.

Exactly.

And there is something about Costa Rica where you just can't help but breathe because exactly there's so many trees and there's so much it feels like so much space.

And so you don't feel congested.

You feel like there's just air moving constantly.

Exactly.

Through us,

You know,

Versus our office buildings or,

You know,

It's just different.

And and then this other part,

Which I think is a really good example of you stepping into another version of yourself with the insecurity.

So we can have a feeling and then we can have many versions of ourself that hold that feeling.

Right.

So we can have insecurity.

And then there's a version of me that shrinks away and wants to hide and makes myself small and uses words like,

Yeah,

Sort of,

Kind of.

I'm sorry,

But.

Right.

Right.

And then there's a version of ourself that feels insecure and it's like,

This is I'm putting myself on a stage like a like a musician that's getting out there and has all this energy that's it's almost like a confidence with the vulnerability.

Exactly.

And that's a super cool edge to ride.

If you can ride it,

You actually you're more likable,

Definitely people that show a little bit of vulnerability with putting themselves into big spaces are very what the research shows is they're very likable.

But it also gives you feels makes you feel empowered.

Like I just you know,

The visualization of that version of you before you go on,

Get out there and you could use that same visualization before you go into a relationship,

Right.

Or even now,

Like I'm sensing that part of you is kind of maybe here.

Yeah.

Doing this.

Yeah.

No,

No,

No,

Absolutely.

And I was going to say,

You know,

One of the things that we talked about in Costa Rica that feeds into what I was just explaining is you talked about,

You know,

The fact that this is not about feeling better.

It's about feeling better,

Which means accepting how we are feeling and not pushing that away.

And I found that that concept has been really helpful to me,

You know,

Both in moments like this where I have to perform and then when I have to do scary things in interpersonal relationships.

Great.

It's about feeling better,

Getting better at feeling right.

Yeah.

Yeah.

So let's put some of those boxes in.

Okay.

And those will be boxes that intervene and help you with the insecure self helps you with the like perform like you're using performance for love instead of using performance for love.

You're you're loving through your performance,

You know,

You're putting yourself out there first and then and then this other like this like fierce version of you that that's brave,

Like the brave you,

Right?

That's a different self that's showing up,

Right?

So I hear breathing.

What would you want to call that version of you that's like brave that shows up in the court or visually visualize her?

I think a braver like courage.

That's the word that sort of comes to mind or like,

Yeah,

Or like working with the fear.

But that's many words.

Yeah.

It's like Henry in the in those ways.

Yes,

Yes.

Totally.

Jumping like that Henry version of you that's like,

I'm just going to be get out there and be strong.

Yeah.

Exactly.

Okay.

And then getting better at feeling.

This is me getting better at feeling the bigger the feeling,

The more I have an opportunity to get better at feeling.

Yes.

Yes.

Absolutely.

Absolutely.

So that opening to feeling those will be some of your boxes of interventions.

All right.

And there's lots of other pieces we're not going to get to all of your all of the network here.

But maybe there's two other pieces I want to explore for you.

One is motivation.

And so motivation is another psychological component within ourselves that drives us to do these hard things like the work that you do.

But in friendships,

Why would you want to be more vulnerable in your friendships?

Why does it matter to you?

Because I want more intimacy in my life.

I want more authenticity,

Not just out of myself,

But out of other people.

And I find that if I can be vulnerable and I can be authentic,

Despite people thinking that I just have this really tough and intense exterior,

As you saw from my headshot,

That gives other people space as well to be vulnerable and to share with me.

And that feels truly like a gift when people can do that with me.

Can you tell me about a time and experience where you've had that feeling of intimacy and this exchange of authenticity where they get to have it and you get to have it too?

Yeah.

So I recently I was speaking with one of my friends who I found out had been sexually abused when she was young.

And I sort of knew that that had happened,

But she didn't come out and write out,

Tell me.

But I know that that led to so many things and decisions in her life that she felt were unhealthy.

And that was sort of the root cause.

So I shared some things in my life that I had done during a time when I had gone through trauma myself.

And I am thinking of in particular,

Like two suicides that I went through and all the things I did to numb out my emotions during that time and not to feel things.

And so I shared that with her before asking her what had happened with her.

And I think that that gave her the space to tell me not only about the sexual abuse,

But all the things that she did afterwards that she felt so much shame over that hopefully she felt a little bit less shame and I felt less shame about the stuff that I've done because we're human.

We shared this like common experience in some ways together.

Yeah.

Yeah.

Such an example of how you being willing to open up was a gift to her to open up.

And then you start to feel safer with the stuff that feels really unsafe when you are just alone with it.

Exactly.

Exactly.

So being alone with memories of sexual abuse or being alone with memories of someone you cared about committing suicide is like,

Those are dark places to go to.

So you being willing to do that,

Which is showing the imperfections or what some would consider weakness and others that are maybe those that value authenticity and bravery.

I just see that as incredibly strong to not just gloss over something or say like,

Yeah,

I get it and change the subject,

But actually to go into it.

And you did it in a very skillful way to where you didn't just ask her to start opening up.

Right.

You opened up first.

Right.

Well,

We did this activity when we were in Costa Rica.

You might remember where one of us acted as the therapist,

Just listening to what the other person was saying.

The other person was,

I guess,

Our patient.

And we didn't have the opportunity to reciprocate that.

The person just gets to be the therapist and listen,

And the patient just gets to talk.

And that experience of just being able to hear somebody else's pain and hear somebody else's story is so powerful.

Yeah.

Well,

I remember that because when I did that exercise,

I didn't switch sides.

The person that shared the story to their perceived therapist then didn't get the chance to switch and be the therapist.

And those that shared the story felt this feeling like,

Wait,

No,

I got so much help from my therapist.

It's not fair to my therapist.

And were you the therapist in that example or the client?

No,

I was the therapist.

You were the therapist.

Yeah.

And what all the therapists said,

Quote therapists,

They're just general people that were acting as therapists.

What they all said was,

No,

That was so helpful for me to be able to be the receiver of your story.

Exactly.

Like it was so moving.

And I feel like I got so much out of it.

Exactly.

Which is my experience all the time,

Obviously,

As a therapist.

But we don't get that.

We don't understand that.

Right.

That just receiving.

Yes.

Is a gift.

Yes.

Without trying to fixing.

And when we were at this retreat,

We bore witness to so many people's stories.

And we weren't trying to solve their problems or make them feel better.

And it was just bearing witness.

And that was so powerful.

So I will say,

That's a motivation for you.

That's a value of yours.

That's one of the things that you took away and you were touched and moved by.

There's so many other things.

There's so many things to remember about what happened there.

Right.

But that's the one that you're like,

Oh,

That thread.

And that's what was also happening with my friend.

And when you have a sense of,

OK,

That is sometimes our motivations are also just remembering what it felt like to be in that pair dialogue with the person that you shared with.

Who was your partner?

Rebecca.

Rebecca.

OK.

Yeah.

So Rebecca,

She's another.

Awesome.

So she's a doctor.

Yeah.

You know.

Another powerhouse.

Yeah.

Exactly.

Yeah.

Yeah.

So these two powerhouse women,

You know,

In this very vulnerable state and just being there.

And an attorney not fixing a doctor.

Right.

Exactly.

Exactly.

Go figure.

We want to fix everything.

So good.

Yeah.

So to bear witness.

And we can think about your values as being and the sort of that being the motivation that is the I would say,

Well,

That can help you with your insecurity and that can help you with your body stress and that can help you with,

You know,

When you get caught up in this part of you that feels torn between,

You know,

I should I should respect my parents and family and not go to therapy.

And then I really need to go to therapy.

Right.

And I need to be able to bear witness to for others and for myself.

And part of that is the values that will motivate me to be vulnerable.

Yeah.

Even when it's uncomfortable.

Yeah.

Because I see and have felt in my life the experience of bearing witness.

Right.

And the power of it.

Right.

Thank you.

No,

That was that's also a gift because I didn't realize that this is one of my values.

I realized this is something that's important to me,

But I'd never framed it as a value.

So I'm going to take that away and think about it.

Yeah.

Yeah.

Not to give you your values,

But I've just I was noticing it.

Yeah.

As a potential value.

Yeah.

You take it away.

I see the fits.

You try it on for you.

Thank you.

OK.

We didn't get to everything here.

So there are other aspects of your network that I would be interested in is just sort of like context,

Contextual things like who are who are the people that you're trying to be friends with and in what context are you building this vulnerability?

Right.

So you may you may have a greater chance of having vulnerable,

Intimate relationships,

Being able to share and cry with a friend.

If you're doing something like going for a hike or hanging out at each other's house,

Then you would maybe at a bar or at like a event where you have to be more of the,

You know,

Perfect self.

Right.

And so there's all sorts of contextual factors that influence your ability to be vulnerable.

And do you feel like you have enough of those going on in your life,

Like spaces to be?

Yeah.

So it's interesting.

I didn't realize this until you just mentioned this,

But after Costa Rica,

I have been having difficult conversations with people while we're on walks instead of going to a bar for drinks.

And it was a really unconscious thing.

I wasn't sure why.

But now that you've said it,

I think it's I don't have to perform in that moment.

Right.

For a waiter,

I don't have to look at a certain way at a certain restaurant.

And I can just be in that moment with like nature around me that somehow makes me feel safer than if I'm at a loud bar,

You know,

Talking to someone over drinks.

Totally.

If that context of going for a walk with a friend versus,

You know,

Other contexts,

It does make it makes a big difference.

And our environment just influences so much of what what version of us feels like they can show up.

Yeah.

For different reasons.

Yeah.

Right.

So that that's another thing for you to think about.

There's a bit of a map here of all and we haven't gotten to all of it,

But a start of things that are influencing the fear that gets in the way of being vulnerable.

Right.

In your relationships.

Right.

And we didn't even get to unpacking some of these thoughts,

Like what to do,

How to diffuse thoughts and all the other things.

Right.

But we have some boxes here that you came up with that are good ones.

I can accept this.

It is what it is.

Can I luxuriate and savor whatever moment I'm in if I'm in my bed,

Working with your breath,

Allowing yourself to breathe,

Allowing yourself to feel what you're feeling and and then this this brave self,

Like this courageous Henry self,

Whatever you want,

Whatever you want to call it.

I love it.

Embodying your dog.

I love dog energy.

Yes.

I love that.

And how to work with that perfectionism with with remembering what your what your values really are,

Which have to do do more with bearing witness than being the perfect witness.

Yeah,

Absolutely.

Absolutely.

So as we close,

Any thoughts on just thinking about it this way,

Networking it this way,

What it was like for you?

Not that we solved anything,

But just explored this landscape.

So two things come to mind.

I think that the fact that,

Again,

We haven't solved,

We didn't solve anything per se here,

But the fact that we explored this and I'm having this open discussion with you about this somehow is lifted this weight inside of me and I just feel a little bit lighter for this moment.

And that's like quite beautiful.

And I want to savor that afterwards.

The second part of it is that I don't think I drew the link between,

You know,

Biological things like the sleep,

For example,

All the way to,

You know,

Performance and perfectionism.

I mean,

It makes sense that they're related,

But to see them like visually on a map like this and to see how some of the habits that I have now help me to work with those situations.

Yeah,

It's powerful.

I need to think about that.

It is a good example of sometimes just stepping back and looking at how all these different things are related also makes you feel a little bit less like,

No wonder I haven't been able to figure this out.

It's not that simple.

No,

I know it's not that simple.

I find that relieving when we see how complicated we really are and that there's so many different factors that are contributing to this struggle that I have.

And it's so old.

Usually it's so old and it's not even,

It's like maybe even started before I was born.

And maybe there's one piece that I could target and I actually know some things that I've tried that have worked and maybe I could keep on practicing those things to target this piece and it could start to just shift the network a little bit and open it up.

Yeah,

I love the idea of sharing this with a friend or someone who I want to develop more intimacy with.

I'm a very visual learner as well.

And so it's like almost a fun little game that we get to play together,

But to deepen our relationship.

Yeah.

Network a problem.

Yeah.

Well,

I will at the end of this,

After we're done,

I'm going to walk people through kind of what we did.

I'll give a little bit more concrete how they could try it at home.

So it was fun for you to just jump in and do this with me.

This is the first time I've done it with somebody live.

So it was a good challenge for me as well.

And I appreciate how much just you brought of yourself.

You were so open and vulnerable and practicing everything that you want to practice with your friends.

So you're doing it here.

Thank you.

No,

Thank you for having me.

And I think you've always,

You know,

I've met you in person and I'm obviously seeing you again and you've always made me feel really comfortable and that I'm in this space that and you're holding space for me.

And so that's the way I was able to do that today.

Great.

Thank you,

Emily.

Okay.

Back to your busy life in Toronto.

Thank you.

I'm up to a firm summer party.

So it's a different.

Okay.

You don't have to get your suit back on.

Okay.

Exactly.

Good.

Well,

I'm glad you're done with your trial too.

Thank you.

Thank you so much.

Nice to see you,

Diana.

First,

I want to say thank you to Emily for doing that with me.

She is so courageous already for putting herself out there and being so open and vulnerable.

She's already practicing the very skill that she wants to practice in her friendships right here on this podcast,

Which is amazing.

And if you want to take a biopsychosocial perspective on one of your problems,

Here's some tips that you could try out this week.

And again,

This is just the first part of network modeling.

There's a second part where we go into the relationships between all of these parts,

All of these interacting parts and which relationships are the strongest.

And if you were to remove this one part,

How would it affect your problem?

We'll talk more about that in the future.

But I first want to just wrap our heads around a biopsychosocial perspective.

So what you can do is get out a piece of paper and choose a problem that you want to work on.

It can be something like I can't fall asleep or I'm anxious or I'm tired,

Or you have a conflict with your coworker,

Maybe you have an unwanted feeling like sadness or anger and put that problem in a circle at the center of the page.

Then we're going to start to brainstorm the different elements that relate to this problem.

So for example,

With Emily,

We first explored biological elements.

Would your problem improve if you changed your level of exercise,

Your diet or nutrition,

Your sleep patterns,

Your medications,

Your pain or your response to pain,

Your bodily stress,

Even your fatigue?

Write down how some biological factors may be contributing to your problem.

Just brainstorm on your page.

You can circle them.

You can even put some arrows in if you want to relate them to each other and to the problem.

In the example with Emily,

We talked about sleep as her biological factor,

And it really helped us be able to look at,

Okay,

This is a place like a tangible place that she could intervene in.

It probably would improve her problem if she was able to get a better night's sleep.

Then you can look at the psychological elements and the psychological elements have to do with the six core processes that we've been talking about all season,

All year,

Since the inception of your life in process.

How is your problem related to your emotions,

How you feel and how you respond to these feelings?

For example,

With Emily,

Predominant feeling that she talked about is fear.

When fear shows up,

She either shrinks away from the fear and doesn't become vulnerable,

Or she is actually quite courageous with the fear,

Actually uses the fear energy to get her up on the stage.

How do emotions relate to your problem?

What about your thoughts?

Do you have sticky thoughts,

Beliefs about yourself,

Beliefs about others?

How about motivation?

Do you have a sense of values or do you lack values in relationship to your problem?

What about your sense of self?

We've talked a lot about the sense of self with Emily in terms of how she identifies herself based on her parents,

Based on other people's judgments of her,

This perfectionistic self that she's created.

And then your attention,

Are you able to stay present in the moment or is your mind all over the place in the future,

In the past when it comes to this problem?

And then finally,

What are you doing?

Are there any behaviors that you are engaging in?

Emily talked about canceling her yoga session in the morning,

That's a behavior,

Increasing her caffeine use,

That's a behavior that then relates to these other problems,

Right?

She drinks more caffeine,

Then she might be more anxious,

She also may interrupt her sleep even more and it becomes a vicious cycle.

So those are the psychological elements,

Your emotions,

Your thinking,

Your motivation,

Your sense of self,

Your behaviors and your attention.

And then we have the social cultural elements.

Would the problem improve if you resolved some conflicts in your life,

If you expressed your feelings to someone,

If you felt less disconnected from your cultural community or you better used your cultural strengths?

If you gave someone feedback,

These are the ways in which your relationships with other people and your culture are impacting your problem.

So you can bring some of those on your case conceptualization.

And then finally,

There's contextual elements,

How the problem is related to your environment.

So maybe are you in a toxic work environment or even Emily just talked about the difference of being in Costa Rica and being able to breathe versus maybe being in an office setting,

Going for a walk with a friend versus going to a bar or a restaurant with a friend.

Those contexts influence her problem.

Once you have these different brainstorms out on your paper,

You can start to look at how they relate to each other and just even holding the paper up and holding it back a little bit and looking at this network in some ways is very humanizing.

It's like,

Oh man,

This thing is complex.

There are a lot of interacting parts,

It's a system and these interacting parts together are greater.

The sum of these parts,

The whole is greater than each individual part on its own.

They influence and interact with each other.

And you can also start to look at where would I get the most bang for my buck in terms of interventions.

If I intervened here,

Would it disrupt the system?

Would it change all these other parts to it?

When you do a more formalized network modeling and you look at the relationships between these parts,

That can be very much the next step of this,

Of looking at how these parts are related and which ones have the strongest relationships.

So taking a look at your network,

What you can do is pick a few places to intervene.

And just as Emily did,

You can brainstorm some options of interventions that you may want to try out.

This is the process of evolution,

Which is variation,

Selection,

Retention.

So variation,

Try some new things out,

Select the ones that work and then retain them,

Keep on doing them.

And this is also what we're doing here,

Which is getting curious.

This first step of wise effort,

Getting curious so that you can become more flexible and take wise action in your life.

All right,

I'll see you next week.

Thanks for listening to Your Life in Process.

And for those of you that are more Life in Process members,

If you made it this long to the end of the show,

I'm going to have a handout for you in your membership that outlines this procedure in your daily practice.

Thank you so much for listening to this episode of Your Life in Process.

When you enter Your Life in Process,

When you become psychologically flexible,

You become free.

Please join me as a member at yourlifeprocess.

Com.

And if you like this episode or think it would be helpful to somebody,

Please leave a review over at podchaser.

Com or call me at 805-457-2776,

Email me at podcast at yourlifeinprocess.

Com.

I want to thank my team,

Craig,

Ashley Hyatt,

Elaine Shmelkin,

And thank you to Ben Gold at Bell and Branch for his original music.

This podcast is for informational and entertainment purposes only,

And it's not meant to be a substitute for mental health treatment.