Tales from the Clinic

James, 40

James is married with three children. He’s a successful businessman and, although he works hard, he enjoys a good lifestyle. So it might surprise you to learn that James came to the clinic because he was suffering from anxiety. It’s easy to forget that what we see on the surface is often very different to what’s going on inside.

James explained how much he worried. He would worry about his wife going off with someone else; about his children getting injured; he would worry about the health of his parents; about his business and the people working for him. And he would worry about himself too. In fact, he frequently visited the doctor and used the internet to try and determine what disease he might have at any given time.

He said people were always telling him how lucky he was, what an amazing life he had, so how could he explain that he was in a constant state of anxiety. Likewise, how could he explain that having everything so good only made him more nervous, because he had that much more to lose. He said that just thinking about the anxiety made him anxious. He would then start to feel guilty, as though he was stupid for feeling that way and would worry that he might be losing his mind.

The idea of meditation occurred to James after he saw something about it on television. He said that although it seemed a little “out there,” he was willing to give anything a go. Needless to say, he came to the clinic with many of the usual preconceptions about meditation, assuming that it was all about trying to stop thoughts and clear the mind of any unpleasant feelings. But he also came with an open mind and a willingness to embrace something new. In fact so much so that soon he was looking for any opportunity to apply the techniques. He applied mindfulness to his exercises at the gym, to eating his lunch, and even just sitting with the baby. He also quickly built up a daily practice of about twenty minutes.

Although enthusiasm doesn’t always define the result, in James’s case it seemed to make a big difference. Over time I watched as he became increasingly relaxed about the way he felt. We worked on a number of techniques, some of them generic and some specific to anxiety. Most of the focus was on how James related to his anxious thoughts. He had always seen them as a “problem,” something to “get rid of” and he’d built up so much resistance to the thoughts, that he was battling them pretty much the entire day. It’s a common reaction, but by resisting these feelings James was not only creating tension, but also exacerbating the situation by treating the thoughts as something tangible.

So it came as quite a surprise to James when I asked him to meditate less on the anxiety itself, which when left alone has a tendency to just come and go in its own time anyway, and instead focus on his resistance to the anxiety. After a little while he started to notice how his obsession with trying to control the anxiety was actually driving the anxiety itself. As he became increasingly aware of this tendency, so the situation started to unravel a little.

This didn’t immediately stop the feeling of anxiety, but it did change the way he related to it. Slowly, he gave up struggling to get rid of the thoughts and allowed the feelings of anxiety to flow a little more. During those few months I noticed that James started to find some humor in it all and not take himself or his thoughts too seriously. In fact he even started to share a few of these thoughts with other people. To his surprise his wife responded with relief, saying she’d always assumed that he was so “sorted” and that she was the “crazy” one. Knowing that he experienced these feelings too somehow took the pressure off a bit. He even made a couple of jokes about his anxiety with his friends in the pub.

I bumped into James recently. As expected, his enthusiasm for the meditation had kept him going and he was still sitting every morning. He said that although he still felt worried in certain situations, it didn’t bother him in the same way. He no longer identified so strongly with the feeling of anxiety. Most importantly, he said he was no longer fearful of worry, which meant he didn’t need to expend huge amounts of time and energy in trying to get rid of the feeling. The irony of it all, he said laughing, was that ever since he’s stopped fighting the feeling, it didn’t seem to come and visit quite so often.

Rachel, 29

Rachel came to the clinic because she had started having difficulty in sleeping. She’d seen her GP who had prescribed sleeping pills that Rachel was reluctant to take.

We discussed what might be causing the problem. Rachel thought it might be to do with being under a lot of pressure at work. She’d also moved in with her boyfriend and the fact she was working so much was causing arguments. He wasn’t unsympathetic, but he felt she had her priorities wrong.

Rachel referred to her problem as “insomnia.” I asked if she ever slept well and she said that sometimes she slept very well. This seemed to rule out insomnia, which tends to be both consistent and chronic. I asked if she could remember the first time it had happened. She said there’d been a particularly difficult day at work, about six months earlier, when she’d been preparing for an important presentation the next day and hadn’t got home until midnight. By the time she got back her boyfriend was asleep, which she said made her feel guilty and a little lonely.

She said she remembered feeling very anxious as she lay in bed, with thoughts whizzing around in her mind. She was conscious of needing to look good the next day and to perform at her best, but the more she thought about it, the more wide awake she felt. In fact she found that the anxiety soon turned into frustration. First she got angry with her boss, then she got angry with her boyfriend, then she got angry with herself.

As it happens, the presentation went well the next day and the company won the contract, although Rachel said that she felt awful and didn’t feel as though she’d contributed as well as she might have. What scared her the most, though, was that “it” might happen again. By the time she got home she had already planned a strategy for getting to sleep. She was going to have a bath and go to bed very, very early. But even though she was tired, her body wasn’t used to going to sleep that early, so again she lay awake for ages. She started to panic that “it” was happening all over again and that she was in for another sleepless night. And so it went on. Of course, sometimes she would fall asleep straight away, but a pattern had developed where she was becoming increasingly anxious about not sleeping, which itself was causing her not to sleep.

After reassuring Rachel that sleeping difficulties are very common I introduced her to the basic approach to meditation and got her doing ten minutes every day. Although she thought it a bit strange that I was asking her to meditate in the morning when it was at night that she was having the problems, I explained that this wasn’t necessarily how the mind worked and that it was more important that she had a stable daily practice.

I also asked her to look at her “sleep hygiene.” This is how you prepare yourself for sleep. I asked her to make sure she only used the bedroom for sleep, as well as for being with her boyfriend of course. This helps strengthen the association between going to bed and going to sleep. I asked her to avoid taking naps during the day and explained how important it was to develop a regular time for sleep, going to bed and getting up at pretty much the same time each day—even at weekends to begin with. This may sound strict, but for the body and mind to learn new habits, they need to be repeated many times. I also asked her to avoid watching any stimulating television late at night, or playing computer games as both tend to leave the mind feeling a bit speedy. We discussed food too and the importance of eating at least a couple of hours before going to bed, allowing the body time to digest everything. Finally, we talked about the importance of buying an old-fashioned alarm clock, so that her mobile phone could live in another room overnight and she would not be tempted to look at e-mails.

In the first week Rachel got very excited as she’d slept well for a number of nights in a row. But the gremlins returned in the second week and she became impatient with her progress. We discussed the approach again and the attitude that needs to be applied in order to see the best results, and by the third week she was starting to see genuine progress.

We continued to meet for a couple of months, slowly working through the techniques until we reached those specific to sleeping (you can refer back here). Now and then she would have a bad night, but by and large she was feeling more confident. Perhaps the biggest change was Rachel’s perspective toward sleep. It no longer mattered that much. She said that looking back she couldn’t understand how she’d taken it all so seriously. She said that she now recognizes that her sleep won’t always be perfect, but that’s okay, she’s happy to ride out the wave. And it’s this change that has made it a truly sustainable approach.

Pam, 51

Pam was referred to the clinic by her doctor. She’d been on antidepressants for over three years and had tried various strategies to overcome the way she felt. She was still holding down a full-time job and, other than her GP and human resources manager at work, nobody knew about her depression. She described the depression as just “sitting there,” making everything look dark and pointless.

Pam had grown-up children who lived in other parts of the country and she had been divorced for ten years. Part of the reason for coming to see me was that she wanted to reduce her medication. With her doctor’s support, she was planning to very slowly reduce the dosage. It was estimated this might take about a year. That may sound like a long time, but when people suddenly stop the long-term use of antidepressants, the results can be quite serious, so it’s important to do it with your doctor’s consent and in a very gentle way. The other advantage of this approach is that studies have consistently shown that relapse is far less likely if the withdrawal is gradual. Pam had read in the papers that meditation was supposed to be very good for treating depression, and was keen to give it a try.

At the heart of Pam’s depression was the feeling that nothing went right for her and that everything was “her fault.” In fact, it was remarkable the way in which she would reinforce these ideas. This sense of identity had become so strong that this was the only way she was able to see herself. But as long as she was continuing to engage with these thoughts, to nurture them even, there was little chance of her being free from the feeling of depression.

We spent a long time talking about how it was possible to step back from thoughts, to create a little more space. We talked about not needing to identify with the thoughts so much, that they were not who she was, but simply thoughts that had been colored by the feelings of depression. And we talked about the analogy of the blue sky. When someone feels depressed, the idea that there is an underlying sense of happiness can seem laughable. The clouds have received so much attention and been given so much importance that they’ve become thick and dark in color. For many people in this position it’s difficult to remember a time when there might have been some blue sky, never mind the possibility of there actually being some now. But the analogy is important, because as long as you’re searching for happiness or headspace outside of yourself, it will only ever lead to a temporary end to depression. What’s more, it will intensify the feeling that what you’re currently experiencing is somehow “wrong.”

It wasn’t an easy process for Pam but slowly the clouds did begin to part and she was reminded of what the blue sky felt like. The depression had become a strong habit so the clouds would return at first. But because it was a habit, it meant that it could be unlearned and the more Pam saw these patches of blue sky, the more she realized that the depression was not something permanent. She couldn’t ignore these moments of calm and happiness that were creeping into her life, no matter how fleeting. At the same time, with the help of her doctor, she reduced her medication until she was ready to give it up altogether. At six months there’d been some reluctance to give up the medication. She felt it was part of who she was and worried who she was going to be if she was not that any more. In many ways it was about letting go of that identity. But by the time a year came around she was more than ready to stop. She added it felt a bit like saying goodbye to an old friend, but a friend she was very happy to see move on.

It was Pam’s willingness to understand the feeling, and make friends with it, that ultimately enabled her to let go of it. What’s more, she’d done it herself, taking time out each day to sit with her mind, no matter how she was feeling. Pam now keeps in touch by e-mail and is doing well. She still sometimes worries if she goes more than a few days or so feeling unhappy, fearing that the depression might be returning, but she says she’s learned that as long as she remains aware and remembers that they are just thoughts, she knows that she can never be harmed by them again.

Clare, 27

Sometimes people come to the clinic because they’re looking to add something to their lives or improve a particular aspect. It might be a professional athlete looking for that competitive edge, or an artist or writer trying to access their creative potential. When Clare came to the clinic, it was with the intention of “tapping into her creative reserves,” as she liked to refer to it. She believed that creativity was something that was always there, but that she couldn’t access it because of her busy mind. This view is not so different from the blue sky analogy; it’s not that we need to “create” creativity, but, rather, find a way to allow it to come to the surface.

Clare seemed to do a lot of different things. She composes music and plays an instrument, but writes too and has even published a book. She also paints, draws, and creates sculptures. She’s an artist, in every sense of the word, and she’s clearly good at what she does. But with so many different things going on at once she could never settle to one idea long enough for it to develop fully. As a result, her home and studio was full of half-finished verses, compositions and pieces of art.

Clare’s biggest challenge, when practicing the Take10 process, was noticing when the mind had drifted off—and it drifted off a lot. Clare would struggle simply to follow her breath up to a count of two or three. It’s a little bit like links in a chain: a thought arises and if it’s seen clearly, within the light of awareness, it doesn’t have anywhere to go, it loses momentum and the focus remains with the object of meditation. But if that first thought appears so interesting that all awareness is lost, a second thought is created, and then a third and a fourth. It might be that there are so many links in the chain that five minutes will pass before you even notice that the mind has wandered off. But by repeating the exercise each day, the length of the chain gradually gets shorter. Your mind may still have a tendency to wander, but when it does, you’ll see it happening a bit sooner and you can avoid getting caught up with the story.

Not only did Clare struggle with maintaining her focus, she also had difficulty remembering to take the ten minutes out of her day. She said that she really wanted to do it, but other things just seemed to get in the way. Some things do require urgent attention, but in most cases I’d guess that there’s not much in life that can’t wait for ten minutes. As a way of helping Clare, I suggested she put her meditation in her diary for each day. It was a simple way of saying “this is just as important as any other part of your daily routine.” I also asked her to write down each time she was going to miss a session—just a short sentence to say why she wasn’t going to do it. This isn’t a retrospective to be done at the end of the day, it’s about writing down, there and then, what it is you are about to do that can’t wait ten minutes. Clare found this second exercise particularly useful. In fact, she said that any time she went to write an excuse in the book, it just looked so feeble that she went and did her ten minutes anyway.

I also asked Clare to choose a couple of activities in the day that she did on a regular basis, which she could use as further prompts to be mindful. For example, drinking a glass of juice in the morning, brushing her teeth, or preparing herself at her desk for work. The idea was not to do the activity while focusing on the breath, but rather using the activity as a support to be present and in the moment. If she was brushing her teeth then the focus was on the physical sensation of the toothbrush in the mouth, of the taste of the toothpaste, the smell of the toothpaste, and even the sound of the toothbrush moving backward and forward. And if the mind wandered off, in that moment she realized it had wandered, simply to return the focus to the physical senses. She enjoyed doing this and added a new activity each week. By the end of ten weeks, she had short bursts of mindfulness dotted throughout the day. The accumulative effect of this, together with the ten minutes of meditation each day, cannot be underestimated. For Clare, those moments were a time to “regroup,” to check whether she was spinning off into other ideas, and bring herself back to what she was working on at the time.

John, 45

John was at the clinic for one reason only: his wife had said that if he didn’t do something to control his anger she was leaving. John did not have a physically violent relationship, with either his wife or his children, but there were elements of verbal aggression and bullying at home. In fact, John found himself getting irate with perfect strangers too. He would barge past people in line at the store, drive like a madman, and get upset when the smallest things didn’t go his way. His blood pressure was high and he regularly felt a tightness in his chest.

John knew his behavior was irrational, but said that it was as if a red mist would descend from nowhere. He had grown up in a household where emotions had neither been discussed nor expressed. He said that losing his job seemed to be the trigger for it all. It had put additional stress on the family, and John hated the fact he had nothing to do and that he’d seemingly lost his purpose in life.

I suggested that John gave the meditation two weeks and that if he’d not seen any benefit at all, then he would speak to his wife and discuss other options. I showed John how to do the ten minute exercise and spoke briefly about the kind of attitude that worked best.

When John came back to the clinic the following week, he said that far from calming him down, the meditation had actually made him more angry. He said that when he sat to do the exercise, all he could feel was anger, and that every single thought seemed to reflect that feeling. He felt angry at his old boss for making him redundant, but most of all he felt angry at himself. He was angry that he couldn’t control the thoughts and that the thoughts resulted in him being unkind to the people he loved. Most of all he was angry that he wasn’t the person he thought he was, or the person he wanted to be. I explained to John that the meditation would not have made things worse, but it may well have given him greater awareness and insight into just how angry he was feeling. But I also explained how reacting to the anger with more anger, while understandable and instinctive, was not the most helpful response.

I asked John how he reacted to his eldest daughter when she got angry. He said that in those situations, when she was really upset, all he wanted to do was put his arms around her. He said that if she let him he would just hold her. He knew from experience that there was nothing he could say that would make her feel better, it was just a case of being there to reassure her. I asked him to take a moment to think how it might feel if he approached his own anger in this way, to just allow it to be, without judgment or criticism. It was at this point that John started to cry. Although it was evidently uncomfortable and even embarrassing for him, it was quite uncontrollable. He said he hadn’t realized how hard he was on himself, how he constantly beat himself up about the way he was feeling.

So John and I made a deal that his course of meditation wasn’t going to be about getting rid of the anger, but instead meeting the anger with kindness and understanding. His task was to notice every time he got angry with himself, and in that moment of realizing, rather than getting angry at himself for having got angry, to allow that feeling to have a bit of space. And if he felt himself spinning out of control, to remind himself how he would respond to that anger if it were his daughter’s. John agreed to this, and he even started to sit and meditate twice a day while he was out of work. He said that he found the exercise challenging, and would often get caught up in the anger again, but said that when he remembered to remember, the feeling was as if everything suddenly became a bit softer.

We worked through a number of different techniques over the months, each specific to John’s character, but that simple yet challenging task of meeting anger with kindness remained at the heart of them all. I’m happy to say that John is still very much together with his wife and he now has a job too. It’s not that a miracle has occurred and that he never gets angry these days, but he says that life feels more comfortable now, and if he does get angry, he has a greater sense of perspective about it and is better able to deal with it.

Amy, 24

Amy is a single mum with a young daughter. She came to the clinic after speaking to her GP about various health concerns. She was underweight, had stopped menstruating, and was experiencing a small amount of hair loss. She was a determined woman, but seemed to carry the weight of the world on her shoulders. She’d struggled bringing up her daughter on her own and, although she was keen to be in a relationship, she didn’t think anyone would really be interested in a single mum. Amy was intensely conscious of her body. She exercised at least once a day, ate a diet that was woefully inadequate, both in content and nutrition, and clearly had an unhealthy relationship with how she viewed herself.

I noticed Amy had sore-looking hands. I thought it might be eczema, but when I asked her she said that when she got stressed she had a tendency to wash her hands a lot and they got quite raw with the scrubbing. I asked her how often she did this. She said she would do it every time she touched something in public. She said that she knew it wasn’t great, but that she only did it when she got stressed. She said the bigger problem was why her hair was falling out and why her periods had stopped so suddenly. So having agreed that she would also visit her GP, we agreed to meet once a week at the clinic.

In many ways, Amy’s tendency to be very disciplined was useful when starting to meditate and she rarely missed a session. But sitting down to do it is one thing, applying the mind in the right way is quite another and Amy was heavily critical of herself and found it difficult to sit and observe her thoughts without passing judgment. She said most of the thoughts seemed to be about the exercise itself, almost as though there was a running commentary on how it was going. Amy had slipped into a pattern of thinking about thinking, which doesn’t make for a very restful mind. She also seemed to be “correcting” herself the whole time, trying to create the perfect state of mind she imagined meditation to be.

If you’ve never tried meditation before it may sound strange that people would still approach it in this way, despite being told that it’s counterproductive. But habitual patterns of mind can be very strong and sometimes even though we’re told to do things a different way, we just can’t help ourselves. That’s the interesting thing with meditation. It’s a reflection of the way in which you relate to the world around you. So Amy’s experience of meditation simply mirrored her attitude to life. Despite this approach, she still made some important insights into why she was living the way she was. She became more aware of her lack of self-worth and her tendency to compare herself physically to the young girls she taught at school, despite the fact that she was over ten years older. She also became more aware of the strong thought patterns that encouraged her to act in a way that was often obsessive in nature. We worked mostly with techniques that encouraged a sense of kindness and compassion toward herself. These techniques have the same essential elements of Take10 at their core, but are further developed to best suit the personality and character traits of the individual.

Amy has now been meditating for over three years. The insights that she had early on have continued to develop and she has made some remarkable changes to the way she feels about herself. She is still underweight, but no longer dangerously so. She still exercises every day, but says it’s now more for enjoyment than punishment and her periods have started again. Amy says that while she recognizes obvious changes such as living a more healthy lifestyle and having a more balanced outlook on life, it’s actually the way she feels about herself that has changed the most. She says she feels as though she’s found something within herself that reminds her that she’s okay, no matter how she might feel on the outside—so that even when she slips back into old ways of thinking, she somehow feels okay with that.

Tom, 37

Tom came to the clinic describing himself as “a professional addict.” Over the past fifteen years he had been addicted to alcohol, drugs, cigarettes, sex, gambling and food. Sometimes it was just the one addiction, and at other times it was several at once. He’d been in and out of rehab a few times, and when he came to the clinic he belonged to so many different support groups that he had just one night free each week to simply relax or meet up with what he called his “non-addict” friends.

Now it’s important to say that if you feel as though you or others are at risk as a result of your addictive behavior you should always consult a doctor before following an approach such as mindfulness. Tom had seen his doctor on a number of occasions, but he felt as though he’d tried everything and yet was still falling back into the same old patterns of addictive behavior.

Tom was single and had no children, although he said he desperately wanted a family. This was complicated by the fact that he’d come to the conclusion he was probably gay. He’d been involved in various relationships over the years, but none had lasted—more often than not because of his insatiable appetite for something new. Tom was always chasing something, and as long as he was involved in doing something, he felt okay. But as soon as he stopped, he felt on edge. He had built up an array of distractions that he could dive into. There were those that were socially acceptable, such as eating and drinking, and then there were those that he hid.

Tom had been through so much therapy over the years that he had come to think he knew it all, and was no longer so receptive to new ideas. His feelings sounded as if they had been analyzed, pulled apart and put back together in the form of a psychiatric evaluation. It’s not just with therapy that this can happen. It can happen with meditation and mindfulness too, where the ideas are simply applied at an intellectual level, but don’t actually become part of one’s being. That said, it’s much harder to do with meditation, because in the silence of sitting, there really is nowhere to hide. Some of the treatment he’d had was invaluable and the support groups continued to be a great source of comfort and security to him, but he felt let down by others.

This was a good opportunity for me to remind Tom that I couldn’t promise him results, but I could tell him about the research being done into mindfulness and addiction, and I could speak from experience and tell him what other people had got out of the exercises. I explained that the success of the process would depend on his willingness to follow the program, his discipline to do it each day, and a commitment to keeping an open mind. Tom agreed and left the clinic feeling very optimistic, having been led through the ten-minute exercise that was to be his homework for the week. To his surprise, he’d found it easier than he expected, which in turn gave him a huge amount of encouragement. Meditation can seem an alien concept for people who’ve not done it before, so it’s understandable if they worry it’s going to be impossible to do. But once you’ve actually tried it, and seen for yourself that you can do it, it’s not such a big deal, it’s just sitting down and taking ten minutes out to unwind, to appreciate the silence. Even if your mind is all over the place at first, being able to sit there for ten minutes gives you a belief and inner confidence that you can do it every time.

For Tom, this approach was very different to anything he’d tried in the past. He’d been used to having therapy every week for years, and he said that the “work” was usually done during that session each week. Sometimes he would be given things to think about during the week, but mostly it was about turning up and talking through issues from childhood. He said he felt the responsibility for “sorting him out” was very much with the therapist. With this in mind, I pointed out that I was not a therapist, and that the responsibility would be with him this time. This idea seemed to scare Tom a little, the implications being that if he was responsible, then he would also be to blame if it didn’t go well. No matter how much I explained that there was no blame in meditation, he didn’t seem convinced.

While it would be inappropriate to say that Tom became addicted to meditation, he went at it with an enthusiasm and discipline that I’ve rarely seen before. Had the dependency on a substance simply been replaced by a dependency on the feeling he experienced in meditation? Possibly, although it appeared to be much more than that. And besides, if he was going to be dependent on something in life, it’s hard to imagine anything more beneficial than meditation. To tackle the issue of dependency, we also discussed the possibility of him coming every other week, rather than every week, and then just once a month. These were big steps for Tom. It meant him taking responsibility for the health of his own body and mind, rather than blaming someone else if it didn’t go well. He still gets in touch if he hits a tricky spot or needs some guidance, but mostly he’s content to sit with whatever it is and see how it plays out, in both his mind and his life. He still attends some of the support groups, but says he feels as though he can now be there to help support others, rather than going there just to be supported himself.