Questions and Answers

Questions on Stress Symptoms: Anxiety

Questions on Personality

Questions on Intimacy

Questions on Self

Questions on Achievement

Questions on the Lifetrack Graphic Program

Questions on Further Information

Questions on Stress Symptoms: Anxiety [Top]

Q: What is stress?

A: Stress can manifest itself in the form of distressing and preoccupying signals, such as anxiety, anger, physical symptoms, depression, and even psychosis. These signals arise when our capacity to cope is exceeded. Our existing personality-the way we think, feel, and act-is being overwhelmed by the challenges we face in life.

Q: What is anxiety, and why do we become anxious?

A: Anxiety can be experienced as thoughts, feelings, and actions that signal nervousness, tension, worry, and fear. It is the first line of defense (or warning signal) when our past experience and current ability to cope (our personality) is exceeded by the challenges we face in our sense of self, a close relationship, or our work.

Q: Why do I get anxious and irritable in situations where others might not?

A: Getting nervous, anxious, and irritable is a normal and necessary warning signal to alert us that we are facing challenges exceeding our past experience and current ability to cope. It is not objective, external events alone that create stress, but one's subjective response to those events. Work on your subjective response to life's circumstances.

Q: I just got the promotion I have wanted for years. Instead of feeling elated, I'm stressed out of my mind. Why don't I feel good when I should?

A: Although negative emotions commonly cause an increase in stress, positive experiences can also push us to our psychological limits. Getting a long-desired promotion, being accepted to the school of one's choice, landing a new job, or persuading the woman or man of your dreams to finally take notice can provoke anxiety, anger, physical symptoms, depression, and sometimes even psychosis. The reason one may react negatively to positive experiences is fear. You are afraid of the very things you most desire. Instead of being able to enjoy well-deserved success while it lasts, perhaps you are expecting and preparing to lose it.

Questions on Personality [Top]

Q: What is personality?

A: Personality is the way we think, feel, and act in the three key spheres of life: self, intimacy, and achievement.

Q: What is the self sphere?

A: Self is the way we think and feel about and act toward ourselves.

Q: What is the intimacy sphere?

A: Intimacy is how close we are to our partners in our most important, close, one-on-one relationship, such as that with a spouse or significant other. For children, parents represent an important relationship that is critical to their growth and development.

Q: What is the achievement sphere?

A: Achievement involves our activities that are productive and creative, those that make us feel connected to the world at large-studies, work, career, sport, hobbies, and so forth. Achievement gives us a sense of satisfaction and a sense of meaning in our lives.

Q: Should I try to build my sense of self, intimacy, and achievement simultaneously? This seems like a rather tall order. My work schedule requires long hours. During vacations, I try to make up my time away from home to my family. Occasionally, I find time for myself, but it's rare.

A: Short-term tradeoffs among aspirations for self, intimacy, and achievement are not only natural, but often necessary to maintain and balance internal health and success. Although such short-term flexibility is essential to well-being, a consistent denial of human aspirations over long periods of time can result in great vulnerability to stress, imbalance, and even insanity. Conversely, a steady attention to each of the three spheres over one's life span can result in an increased ability to live life fully, with resilience to overcome inevitable setbacks and maintain psychological health.

Q: I have heard of the work of Carl Rogers on personality and have admired it considerably. How is your approach similar or different?

A: Like the humanist Carl Rogers, the positive mental health Lifetrack model was inspired, developed, and tested in daily clinical practice with demanding patients. It evolved from the need to help demanding patients with hectic lives improve their overall psychological adjustment. Patients inspired the model of positive mental health, put it to the test, and challenged it daily. Much like Rogers approach, Lifetrack therapy recognizes that the relationship with the therapist is an essential means to engage someone in change. Lifetrack, however, goes beyond this recognition to state that a close interdependent relationship, such as that with a partner, is even more critical to fundamental change and long-term well-being. Hence, rather than make the therapist the object of the close relationship in therapy, the Lifetrack approach helps the patient to become significantly closer to a person who can stay in his or her life long after therapy has ended.

Q: I know of Maslow's hierarchy of needs. Are the three spheres an explanation of psychological needs? What is the difference between your work and that of Maslow?

A: Maslow's hierarchy of human needs does not allow for tradeoffs. It mixes physical and psychological needs. According to Lifetrack, the need for self, intimacy, and achievement can be creatively met in myriad ways. In the short run, tradeoffs among these psychological needs are a sign of flexibility and health. The ability to make tradeoffs, however, does not imply that these needs are merely desires, not critical elements of a healthy life. Over time, consistent frustration in any one of these needs can result in distress and breakdown.

Another important difference from Maslow is that the model of positive mental health provides a means to understand the same individual at different points in the life cycle, whether in dire distress or optimal health. This differs with Maslow's studies of self-actualization, which focus on historical figures such as Lincoln, Jefferson, Thoreau, Einstein, and others as ideal candidates. Although Maslow contributed much to the field by balancing the darker side of the human psyche with an understanding of love, well-being, and exuberance, some say he fell short of integrating the two halves; the positive and the negative. In this sense, the positive mental health approach represents a middle ground, integrating the mind (or personality) both in distress and in well-being.

Q: Are you a psychoanalyst? How does your approach differ from psychoanalysis?

A: The positive mental health approach differs significantly from psychoanalytic theory in that its focus is not on the diseased mind, but on the healthy mind. Successful therapy is defined not in the absence of disease or neurosis, but in the presence of health.

Although my training in psychiatry taught me how to reduce or contain symptoms diagnosed as diseases or mental disorders, it has not helped me understand health to the same degree. When I realized that "successful psychological adjustment" was not necessarily much better understood or practiced by traditional mental health experts than by ordinary people who have never heard of sophisticated psychological theories, I stopped being a passive observer of patients divulging problem after problem. Instead, speaking more than 80 percent of the time in dynamic therapy sessions, I challenged what I was taught and sought new insights; I put each idea to a daily test. I spent most sessions analyzing, interpreting, explaining, and finally persuading patients as to how they must think, feel, and act for them to break out of the confines of their existing personalities. The process includes application of visual models of Lifetrack concepts, as well as daily graphic tracking of patients' subjective self-rating.

I quickly found that people kick, scream, and yell all the way to well-being! It is only through persuasion, humor, perseverance, and a concerted effort that some individuals, according to their own self-rating and account, achieve and surpass a previous best level of adjustment. This active approach to therapy differs both in substance and style to the classical psychoanalytic approach, which focuses on neurosis and bringing the unconscious to the fore through the method of free association.

Careful listening to patients' difficult pasts is effectively finished during the first hour of the first session; during the second hour, the patients are presented with the therapists' analysis of their problem. I lay out the goal, method, and process of therapy; the expected course of therapy; and the required time and cost of therapy, which typically lasts from 3 to 6 months.

Q: I have heard of preventive mental health, but not of positive mental health. Why the new term?

A: Positive mental health is different from preventive mental health, which entails attending to risk factors, in that it does not suggest that all disorders are preventable or curable by early intervention. Rather, a positive mental health approach uses crisis as an opportunity for fundamental change. The objective is not to directly decrease the symptoms of disease, but to actively increase the positive factors in an individual's life beyond a previous best level of adjustment. When this is achieved, symptoms often disappear, and a new pattern of coping emerges.

Q: What do you think of the Oedipus complex and other Freudian concepts?

A: Although the Lifetrack positive mental health approach eschews the Oedipus complex and the emphasis on sexuality found in psychoanalysis (intimacy is only one of the three spheres, not the only sphere in mental health), it does recognize the existence of the conscious, preconscious, and unconscious. The central goal of therapy, however, is not to bring the unconscious to the conscious, but to change the way an individual thinks, feels, and acts about areas in his or her life that can contribute to positive health.

This is not a passive process. Nowhere is it assumed that understanding conflicts in oneself can free the individual and create health. Naturally, understanding the self is part of the process, but the individual must go farther. Rather than dwelling on a difficult past, the emphasis in Lifetrack is on helping the individual accept the past and to think, feel, and act in ways that can improve the ability to fulfill core human psychological needs in the present.

Q: What is the difference between your therapeutic approach and that of behaviorists who emphasize personality change by focusing on changing actions?

A: Unlike Skinner, Watson, and other behaviorists who emphasize behavioral elements that bring about desired change, the Lifetrack approach puts equal weight on cognition, emotion, and action. Individuals, when rating themselves on the Lifetrack scale, are encouraged to consciously improve how they think, feel, and act about critical areas in their lives that contribute to psychological health, often overcoming their emotional resistance.

Q: How is your approach different from Henry A. Murray's large list of more than 20 motives or needs?

A: Because the three-sphere model seeks to determine the essence of, rather than great detail about, human personality, it is more succinct than Murray's 1938 lengthy list of more than 20 motives or needs. The three spheres are helpful to patients and lay people precisely because they remain conceptually broad enough to encompass all critical psychological events, yet simple enough to be remembered. At the same time, the tripod model has been further broken down into three dimensions or nine elements for each sphere (see Definitions of Terms). This allows the three spheres to be better understood by individuals who wish to improve in each sphere and provides a conceptual means to cluster essential elements of each sphere to show how individual elements and spheres overlap and interact.

Q: What are the similarities between Lifetrack theory and organismic or systems theory that views personality as an open system of interacting parts?

A: Unlike strands of organismic theory, which assumes a constant equilibrium among parts, the parts of personality in the Lifetrack model influence and are influenced by the environment. A sense of self is not created in a vacuum. There is no assumption that human beings are good and are perverted by the environment. A balanced personality organization is not the natural state of the organism, nor is disorganization always a sign of pathology. Crisis and disorganization can be painful but are sometimes necessary to help the individual challenge and change the way he or she thinks, feels, and acts in key areas of life. In this sense disequilibrium, however painful, can become an opportunity.

Q: What do you think of medications such as Prozac or of the Diagnostic and Statistical Manual of Mental Disorders (DSM) classifications?

A: Although pharmacological research has given the medical field increasingly effective and safer medications such as Prozac, the disease model has failed to prove that specific chemical changes in the brain are the sole cause or the cure for all mental illnesses.

Experts in psychopharmacological therapy admit that only 8 to 15% of the depressed population actually receives treatment, and only 30% of those who received pharmacological therapy under proper professional supervision actually achieve remission. It is also reported that some 30 to 60% of the general population receiving care from general physicians receives antidepressants such as Prozac. If these two statistics are accurate, it means that a great majority of the general population should or may receive antidepressants, and only 30% of them could expect remission, leaving 70% to continue to take ineffective, and potentially dangerous, medications at great expense under inadequate pharmacological supervision or follow-up.

The DSM is a classification for diseases and disorders that is helpful for describing patients' symptom presentations, for the disbursement of medication, and for insurance claim and reimbursement purposes. Today, this science based on the disease concept is outliving its usefulness-not because it is wrong, but because it is too narrow a worldview. Mental maladjustments and suffering by so many is indeed a serious problem deserving great sympathy and care comparable to all other physical illnesses. However, the disease concept has its limitations and inhibits advance in our understanding of the problem we face and constrains our effort to provide potentially more effective ways of helping the suffering population. Most of all, the disease concept does not attempt to do what all natural sciences must:
effectively explain, predict, and measure experiences.

Natural science has already gone through such a change in paradigm over the last century, having been liberated from the Newtonian worldview that had dominated science for 350 years. Relativity, quantum mechanics, and Bell's theorem have provided the world with a far more inclusive and useful paradigm that made possible rapid advancement of science. Psychiatric science must undergo a similar transition after 150 years of domination by the "disease model."

The Lifetrack model is one such attempt. Naturally, all models are to be continuously challenged, tested, and replaced by more useful models. In case of psychiatric problem, the most, if not the only, qualified observer must do such testing, and that is the patient who is suffering.

Questions on Intimacy [Top]

Q: Why do we end up fighting after having had wonderful time together? On the way home from fun weekend trips or after a nice evening dining out in town, we find ourselves arguing over nothing, spoiling everything.

A: Increased intimacy provokes defensive reactions, such as anxiety, anger, physical symptoms, depression, and psychosis in "defensive" individuals, who are threatened by escalating closeness. To become closer to another human being requires that you and your partner overcome these defensive reactions to increased intimacy. Next time you are riding home and become hostile after a good night, remind yourself that it is your defenses that are acting up. Take a moment of silence or laugh at your own defenses. Recognize that your irritability is your normal reaction to increased intimacy. It is a good stress! Now act in ways to further enhance your relationship, rather than sabotaging it.

Q: When I want to become closer to a man, I seem to do everything wrong. I am difficult, I purposely try to discourage a potential boyfriend and tell him that I am already with someone else. I really do want to have a relationship. What is going on?

A: That people typically fear most what they desperately need to be happy is neither surprising nor unusual. Behind it lies a mechanism of defense used by the mind to protect itself from potential harm and ensure its "self-preservation." When a person experiences closeness, that person experiences the accompanying "fear" that it may not last. This fear of eventual loss, rejection, or betrayal is so powerful that it mobilizes the mind to use its best resources to prevent or protect itself from such potential disappointment and loss. Your challenge is not to avoid your fear, but to become closer in spite of it. To do so, you will need to overcome your fear of intimacy.

Questions on Self [Top]

Q: Isn't there a safe haven for the "self" that is sheltered from the ups and downs of achievements and intimate relations? A home where one can just "be?"

A: The ability of individuals to keep a sense of peace apart from what occurs around them does exist. This is a part of the self, however, that has to be developed and constantly nurtured. Those who meditate or take time out to reflect during a busy day may be feeding this part of the self. To create a retreat from a busy and sometimes even chaotic environment can empower a person to return to the same environment refreshed, invigorated, and ready for action.

Questions on Achievement [Top]

Q: No matter what I accomplish, I do not seem to satisfy my need to do more or to be better. I did my job well but quit because I felt unfulfilled. I went and joined a humanitarian organization but still feel that I am not amounting to much. I am now thinking of starting my own firm. What do you think?

A: The meaning people find in what they do, from the moment they wake up to the moment they go to sleep, plays a role in how they feel about themselves. A person may gain more satisfaction from playing a mean game of tennis than from writing a best-seller. An unrecognized artisan, who finds what he does meaningful and rewarding, may reap greater rewards than the recipient of a prize who is never happy with whatever she accomplishes. To feel good about yourself depends not only on your objective job or work environment but on the subjective meaning you attribute to your work. Rather than continuously changing jobs, I would suggest that you first understand how achievement is an indirect quest to be admired, respected, and loved for doing something difficult and meaningful with your life.

Questions on the Lifetrack Graphic Program [Top]

Q: I am confused about the difference between the Lifetrack theory and the method of tracking. What is the difference?

A: The contribution of Lifetrack is first to define psychological spheres that contribute to well-being and distress and second to develop a means to help patients measure, quantify, track, and improve the subjective experience of health over time. They are interrelated, but separate. You can learn about the insights gained from the model over the years and try to apply them to your life intuitively. You can also use the tracking method as a tool to make health part of your daily lifestyle. The tracking does not provide the totality of the experience, but is a tool to trigger insights and move beyond a previous best level of experience. The tool helps you to ask relevant questions of yourself regarding your capacity and willingness to build your health on a daily basis.

Q: How can I put numbers on how sexually excited I am or on how much I accept my spouse without wanting to change her?

A: Patients in Lifetrack therapy do this all the time on a 10-point scale, where 0 is the minimum and 10 is the initial maximum. Having people artificially assign a number to their thoughts, feelings, and actions reinforces the idea that the subjective is controllable. That a person depends on his or her spouse or significant other at only a 5 on a 10-point scale means that the individual could learn to do better.

In Lifetrack sessions, an individual is actively coached on how to improve in each of the parameters. Although you might presently depend on your significant other at a level of 3, how might you strive to make your 3 a 4? How about a 5? Because improvement is the objective and not the absolute value, the self-rating exercise is not simply an act of passive accounting. Rather, it is an active process in which an individual must reflect on how he or she can think, feel, and act so as to improve daily scores in each of the positive parameters that help to contribute to positive health. When rating oneself, the person is encouraged to ask the question, "How can I think, feel, and act to make this score go even higher?" This concentrated effort accounts for the rapid rate of growth in a relatively short period of time by those who use the approach.

Q: I am a physicist and see some similarities between the study of the mind and physics. What I also see is that your method of tracking is influencing the experience of health itself. Can you comment?

A: The inner state of mind affects what it is one sees and experiences. To put it in terms of physics, the observed object is not separate from the observer. When the mind focuses on one thing, it does so by selectively ignoring another. When the mind understands something, it has adopted one perspective exclusive of others. As you have hinted with your comment, depending on what we decide to observe and measure, we may be creating what we look for and find. Hence, if individuals observe and precisely measure diseases and disorders, they may create them where they might not have otherwise existed. Conversely, if individuals choose to observe and measure positive mental health or well-being, they may be able to create these where it may not have otherwise existed.

Naturally, part of being happy is being conscious of it. In this sense, it is clear that the observer may well influence the experience of life by the intention or act of assessing it according to the Lifetrack model. This is intentional. Daily self-rating attempts to change not only the objectively measurable life experiences but the "unconscious measuring rod" or the subjective perception of experience. The scale should serve to help individuals discern that they are getting much happier, rather than believing that their level of happiness is "constant." Taking such a psychological leap is more than just symbolic. It empowers you through incremental thinking; In short, the observer may be "creating" what he or she observes simply by choosing to observe it.

Q: I enjoy the simple self-rating exercise and find that anyone who can count to 10 can do it. However, I can't fully capture the richness or complexity of my mind in words, let alone digits! So why bother?

A: I agree with you. The subjective experience of happiness, well-being, depression, and the like cannot be fully described in words or digits. Health can only be experienced by each individual. This raises an inevitable question: If the "reality" of psychological phenomena can only be experienced and not fully described, how can we track it?

The physicist Finkelstein wrote similarly about how "experience" in the exact science of physics cannot be fully communicated to others. Einstein, too, gave us an analogy regarding a physicist ever wanting to capture reality, but never being able to see under a watch's face and discover just what it is that makes it tick. Finkelstein argued that despite the fact that one cannot fully communicate experience to others, if we can show others how to make the experience happen and how to measure it, then we can help others to experience it. This is precisely what has been done in the Lifetrack self-rating program. Use it as a tool for building health, and do not confuse the tool with the experience of health itself.

Q: Why do you allow your patients to rate their health, rather than administering a personality test or having a panel of doctors do it? I question the validity of patients' self-rating. They are not objective in their assessment.

A: In medicine, the doctor decides if the patient is ill or well. It is not left up to the patient's subjective opinion. If a patient is tested and found to have AIDS, that patient is sick even if in the early stages of the disease he or she is not suffering from any symptoms. The patient's feeling healthy does not discard the objective reality of the presence of a potentially fatal disease. In physical medicine, an objective approach is far more reliable than a patient's subjective perception of his or her state of health.

What holds true for the body, however, may not necessarily hold true for the mind. If someone is miserable, it does not really matter that a whole panel of psychiatrists "objectively" decides according to some statistical norm (normality defined as a statistical average) that the patient has an ideal or well-adjusted life. If in one's mind life is hell, he or she will continue to feel miserable unless his or her perception of it changes. The reverse is equally true. If someone is dying with a terminal illness but feels at peace, then it doesn't matter that a panel of doctors "objectively" decides this fellow is really miserable but doesn't know it. Whatever the "objective" panel concludes will make little difference to a happy individual.

Naturally, there are limits to using subjective experience as a yardstick to well-being. A positive mental health approach does not rely solely on an individual's internal perception of well-being. In therapy, outside parties-the therapist and the individual's partner (if there is one)-are constantly following a patient's subjective response to events. When the patient's perceptions of events become distorted as in an acute psychotic condition, his or her own understanding of well-being becomes meaningless. It is at these times that subjective rating does not make sense. Individuals who have difficulty in introspection may also do less well in Lifetrack therapy.

Q: Is happiness or distress measured in the same way by everyone?

A: Experiences of psychological distress or well-being (such as "anxiety," peace," "depression," or "happiness") are essentially subjective and can only be observed and reported by the person who is experiencing them. What makes one person happy might make another miserable and vice-versa. Furthermore, happiness to one person may not be exactly the same thing as happiness to another. It may even be different for the same person at a different time. Nevertheless, because the experience of well-being or distress is a subjective internal phenomena, the best expert to measure it is still oneself.

Q: I am an up-and-down type of person. The mood you catch me in when I start to rate myself makes me doubt the validity of my self-rating. Should I rate myself anyway? Who am I trying to fool?

A: Psychological experience occurs in spikes of thoughts, feelings, and actions. As you have experienced yourself, happiness and depression are not steady states but can change from one moment to the next. For this reason, the Lifetrack total adjustment sheet (each self-rating exercise) is really a snapshot of moments. Even with a simple 10-point scale, assessments may be different if you perform the exercise only a few minutes later (depending on what happened in the meantime) or what you might have happened to think about when you were self-rating yourself.

Despite this fundamentally subjective and changeable nature of self-assessment, in the experience of Lifetrack therapy, repetitive self-rating according to the same fixed model yields highly valuable information. Although memory is short, one can reliably observe if one is happier or more depressed than the day before.

To use an analogy, you can imagine that each of your individual self-ratings is much like a droplet in your psychological experience. These droplets, when viewed individually or in isolation, may not tell us much. They are really a collection of "snapshots" that are arbitrarily pulled together. Nevertheless, for lack of a better way to capture the dynamically changing states of the mind, this may be a good beginning. Most important, my patients have discovered that when you use the same model consistently over time, the droplets accumulate, creating patterns that take the shape of a fountain. Although we can individually see the droplets and patients can attempt to describe their experience at one given point in time, it is only when we see the fountain that we capture personality. In this sense, you can think of your overall psychological state as a fountain, which keeps a certain shape, but consists of constantly changing and discontinuous droplets.

Q: You say the scale is from 0 to 10, but then later you correct yourself and say you can go beyond 10. Why doesn't one's best stay constant at a 10?

A: In modern physics, the speed of light in a vacuum is known to be constant at approximately 186,282 miles per second, regardless of the direction and speed of movement of the observer measuring it. The reason for this is that the tool used to measure the speed of light changes its length depending on the observer's relative speed of motion. When the observer is in motion a high rate of speed, the tool shrinks according to the observer's speed, thereby explaining the reading on the scale as always exactly the same: 186,283 miles per second. In a similar way, the tool used to measure one's subjective psychological experience seems to change its length in such a way that the reading is always the same for most individuals. "One's best" is always one's highest limit. The term, much like the speed of light, is thought of as a constant, the highest attainable limit at any given point in time.

When one translates the term best into a number on a 0- to 10-point scale, a problem arises. A brilliant scientist who became my patient pointed out the predicament to me many years ago. As the patient exceeded in certain elements his previous best adjustment, he consistently rated himself at a 10 (the maximum score). Insisting that his 10 today was much higher than the 10 of last week, he felt that his scores were no longer representative of his true experience.

It was at this time that I realized that internal psychological adjustment has no limits. The scale would have to be open-ended to reflect that reality. The 0- to 10-scale expands as one's experience surpasses a previous best. When an individual exceeded a past optimal experience, the measuring tool grows to enable the measurement of higher levels of adjustment that were previously thought unimaginable (the patient could rate an 11, 15, and so on). Past maximums could in this way be challenged and replaced by a new maximum.

Questions on Further Information [Top]

Q: Where can I find more information on your approach?

A: The Download section of this site lists articles, books, and other material for download as they become available.



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