 Welcome! My name is Steven Philip Katz. I'm a licensed marriage and family therapist and you've just turned on shrink wrap Hawaii on a great day because my guest today is Dr. Sarah Sarkis. Welcome to the show. Thanks for having me. Sarah is a licensed psychologist here in Honolulu and I usually start off by telling, asking people, how did you get here? To Hawaii. Yeah. I got to Hawaii seven, six years ago, six and a half years ago, but I had been coming for years. So I have first cousins that were born and raised here. And I went to undergrad with them and one of them is a close friend of mine and we were roommates and at spring break she said, you should come home with me. I think you'd really like Hawaii. So I did freshman year and then I started coming every year thereafter until I moved. Wow. For at least a month. I wrote my dissertation up here on the North Shore. Really? Yes, in the summertime. Did you write a dissertation on surfing? No. But I had, you know, peace and quiet away from academics. Uh-huh. Yeah. And you came here from? Massachusetts where I was born and raised. What in your family made you become a psychologist? Oh, that's a very special show. It's a very special show. For a very different topic. But I, you know, I am the last of six. Uh-huh. So I sort of always was observing and part of a big crowd and always very, I guess, precocious, like a lot of questions. And just as I got through school more and more, I mean, I thought I would do other things. I thought I might be a writer. I thought I might be a journalist. But, you know, at the wise age of 23, I decided this is what I would do. And where did you start doing that? Doing, which part? Psychology. Oh, I got my master. Well, I, first I had my undergrad at Georgetown. Uh-huh. And I did a undergrad degree in psych and English. Then I worked for nine months in like a children's, a pediatric ward inside of a big privately funded, inpatient school and hospital for really severely traumatized children. And decided I didn't want to work with children. And then went to BC for my masters and then straight in to get my doctorate at George Washington. Wow. And that was an analytic program, the George Washington program. Analytic as in Freudian? Yeah. Well, we, the main theory that they were sort of a big fan of was Brenner. Uh-huh. But I did my dissertation looking at a Winnecott object relation. Uh-huh. Yeah. Does that still, is that still part of your work? Yes, very much. I don't do analytic work nor am I trained to do analytic work. But my case formulation, my brain naturally formulates. And I, as I learned more, I believe it always did. I just didn't know that's how I thought. I didn't know that there was a name for what I thought. But I definitely formulate people's trajectory using many sort of analytic style conceptualizations. And then as I've matured, I've taken on lots of other lenses that are really, really helpful. Because then you're sitting with patients and you realize like, I gotta, I mean, something's got to be helpful. So you start picking up lots of other things that are practically helpful and helpful with, you know, different presentations that analysis might not be helpful with like panic attacks. There's very practical things you can do. So with that kind of stuff, you do more of cognitive behavioral stuff? Yeah. Well, I do like the mindfulness stuff. Ah. So then when I was in my internship training, I had the good fortune of being just geographically close to a guy named John Cabot-Zinn. So I started to get pretty, and I was like doing yoga myself with that very Namaste, all that stuff. So I started to get into that world of not the spiritual side of it for me, but the central nervous system regulation. And how powerful that is to not control your thoughts, but, you know, really observe them. Start to observe how you think and feel from a very different lens than just being wrapped up in it. So that brings me to what I was just, before we came in, I was doing some little preparation, which I was telling you I seldom do. Yeah. I feel honored. I should do a little homework. And I read your great little blog called The Petted Room. Oh, yes. That's just the name you make. Oh, Petted Room. Very Boston. And you talked about this whole idea of the observing ego. Yes. And getting some distance from your own thoughts. Yes. And observing your thoughts. And you mentioned this thing about anxiety and panic attacks. And I was thinking about a client. So I do a lot of couples work. Yeah, yeah. And so the issue, one of the issues presenting is the guy's got a stressful job. His boss makes him crazy. He comes home. And I don't know, he doesn't usually have full blown panic attacks. The kind where you can't breathe. But he's really anxious. And he's angry. And he goes stomping around the house. He can't sleep. He wakes up at three o'clock in the morning. Wakes up everybody. He's mumbling to his wife. It's like, I can't stand it here. I want to go back to New York. Oh, interesting. And he knows. When he calms down, he goes, yeah, I do that. He goes, yeah, I know. I shouldn't do that. And so what do you do with a guy like that? Well, I mean, there's a lot you can do. What I would do is in the sessions, I would start to just model that kind of observational lens so that he can eventually, it takes time. I note in that same blog this notion of the baseball, the rule of... I love that, the 300. Yes. So my husband, I have to really attribute that to my husband because... He's a baseball? He's a huge... Red Sox? Yes. He's a Massachusetts sports guy. Oh, that's insane. It's very... Diagnostic. It is. It's diagnostic, exactly. So he would try to get me into these... watching these sports. And this was his way of getting me into this, that he thought I would find it particularly fascinating that to be a top hitter, you only have to make contact with the ball 30% of the time, which in any other arena is failing. Right. Right. Oh, I got 30% on my test. I did. Great. I would use that over the years with my patients because it sort of mitigates us from being so hard on ourself. Uh-huh. But, yeah, I would start to just practice that observing ego stamps, just that you're just observing how you feel that you don't actually have to engage every single thought or physical sensation. What does that mean? Not to... So, like, the guy... I'm going to be the guy. Yeah. And I'm going... I like my boss. And you can't... You know, he fired this guy. Yeah. I'm quitting. And we're going back to New York. Yes. I can't stand it anymore. Yes. Right. In the moment, you probably can't do much because the central nervous system train has left the station. So you sort of have to ride the train to the next stop. And afterward, you can really walk him through. Like, I would try to slow him down. Like, what was it that you were feeling when you woke at 3 o'clock in the morning? Angry. Yes. So tell me how the angry felt. And you walk him through. And then eventually, you're going to get to see it in the office. And then you're going to get to really be helpful because you're going to be able to model through your own actions. Like, that we're going to... You're all right. We're going to... You get the client to sort of imitate what you're doing. Yes. Yeah. Modeling, which we now know rules the roost. Like, basically, I mean, you have a child or several. There you go. I got one. Well, they're 30, but... But you know that they basically... Do what you do. They do what you do. Not what you say. They don't do what we say. Right. And that's comforting and horrifying. Right. So we have some choice over which side of that coin we want to be face-up. You know, which side of the modeling paradigm. But when the train's leaving the station, he doesn't feel like he has a choice, right? Not right now, he doesn't. Yeah. But eventually through the process of this observing ego and mindfulness, like we chatted about John Kabat-Zinn, that's the philosophy that MBSR is the style that I ascribe to. Which is amazing because you also talked about the mind-body connection and the pain relief that people get. Yes. Yes. Yes, exactly. And so with a guy like that, and I can relate to that kind of like fiery temperament, I jive with that. But eventually if he observes his thoughts and then carves out time daily when he is not heated to take five minutes in the morning and five minutes at night to just be in a state of restful awakeness. You're not trying to go to bed. You're trying to be awake, but very restful and just breathing normal and observing your thoughts. Eventually this muscle, like all muscles, increases and there will be a day where he will come in and he will say, I felt white-hot mad, but I didn't lose my mind last night. I didn't blow a gasket. I just observed it and I tolerated it. It's basically increasing frustration tolerance. It's increasing the capacity for frustration tolerance. So does that really mean feeling the feelings but not acting on it? Yes. Yes, it is not trying to think positively. This is not Scientology. And this is not clearing your thoughts. Right. It's letting you... Not trying to avoid the thought. No. No, we don't want any... Generally speaking, we don't want to encourage avoidance. Right, because that has the opposite effect anyway. Exactly. Don't think about elephants. Exactly. Now all we're going to do is think about it. So eventually with practice, like all things, by the way, he didn't come into this style of coping with anger overnight. No, no. He's not going to undo it overnight. It's going to take him some time. What does he feel after the episodes? I think he feels shame. Yeah. And regret. And shame weds him to that pattern, by the way. How does it do that? Because it makes us so... like we don't even want to look at it or think about it or reflect on it. Ah, so then it's not going to change. Yes. Yes. It thrives in secret. Part of it is that, you know, it's a couple's relationship also, right? Yes. Because it pisses her off. Yes. And is she settled in Hawaii? She wants to be here, yes. Yes, so that will cause strife as well. Oh, that's a big conflict. Yes. But when I asked him the question, so was it better in New York? No. Because wherever you go, there we are. I read that book too. Yes. That's our favorite person. Yeah, he admitted, no. Yeah, no. But, you know, he had this whole mantra of, yeah, but there's all these things to do there. Yeah, but then he never did the way he was there. And the other thing that caught me about your padded room thing, like the title of it was something about, it's not about doing, it's about being. Yeah. It's not in the doing, it's in the being. Yeah. Because when people say like they'll have certain insights or we'll sort of reach this space in the therapy where we have like some aha moments or something. Yeah. And they'll be like, yeah, but now what? And there's always like this pressure. Let me stop you right there. Yeah. Now we have to go to a break. Okay. All right, that's what. We'll be right back after this word from somebody. Aloha. I'm Carl Campania. I hope you please visit us this summer. It's a wonderful summer. It's actually a cooler summer than we're used to. But I hope that you come back and visit us and watch our show Education Movers, Shakers and Reformers here on Think Tech Hawaii. It's at noon every Wednesday. See you then. Aloha, Kako. I'm Marcia Joyner. And I'm inviting you to navigate the journey. We are discussing the end of life options. And we would really love to have you every Wednesday morning at 11 a.m. right here. Aloha. My name is Josh Green. I serve a senator from the Big Island on the Kona side. And I'm also an emergency room physician. My program here on Think Tech is called Health Care in Hawaii. I'll have guests that should be interesting to you twice a month. We'll talk about issues that range from mental health care to drug addiction to our health care system and any challenges that we face here in Hawaii. We hope you'll join us. Again, thanks for supporting Think Tech. Welcome back to Shrink Wrap. I'm still with Sarah Sarkis. And we're talking about being versus doing. Yes. And you were saying that you had this aha moment. Sometimes. Sometimes. Yes. And then what? People generally want, you know... And then they say now what? Yeah, they say like, hey, but we have all this insight, but what do I do? And so I don't know about you, but I always feel pressure when that question's asked. Yeah, yeah, yeah. Because I'm always like, yeah, what do we do? Yeah, but she's still in India. And now what? Yeah. And like, what do we really do? So I was telling a colleague who lives in Massachusetts about this, and she said this great line to me. And then I wrote this blog, which is, well, it's not in the doing, it's in the being. So now I use that regularly in those moments. I say, we're doing it. We're here together. You're tolerating your feelings. You're addressing things that had previously thrived in the secrecy of shame. And... Like this guy's anger. Anger, or his... Really, it's his acting out. Right, right. Stopping around the house. And then people falsely attribute it to being anger. It's anger is not the problem. It's the response to anger that creates the shame. It's his stomping. Yes, exactly. So that's always my response, is that this is the doing. So I gave him very sort of behavioral advice. I said, go stomp outside. Yeah, yes, sure. And I'm wondering if that will do it for him. You know what I mean? Yeah. Because that's all his wife and his kids. They just want to sleep. Yeah, they don't want to be woken. It's true. But is the disruptiveness part of what he needs? So like... Oh, for attention. I don't know. It's sort of... I treat it all an experiment, right? Yeah, yes. So like, let's see what happens if you go stomping around. He's just like, it's four in the morning. It's Hawaii, it's safe. Well, if you think about... Like I always try to think about things developmentally as well. So like if you kind of examine his behavior from a developmental trajectory, you can kind of get a sense of maybe where he started to snuggle into this behavioral pattern. Two, three? Yeah, maybe a little older because like you can really... At like eight or nine, you can really snuggle into a fight, you know? So developmentally, you can sort of start to understand where he's at. And I always think it's as a clinician, it's always best to try to help people better regulate their emotions. So yes, if your only choice is either wake your family up at 3 a.m. or go outside, go outside. But that's interpersonal. But the interpersonal journey is about getting to a space where you can increase your tolerance of that feeling even though it's so uncomfortable. You can just sit with it. And you just sit with it. You don't have to like it. You just have to do it. Yeah, and that gets me to the same problem when you talk about asking people to meditate. Yeah. And they say, I can't do it. Yeah. And I always think they say they can't do it because they have the wrong idea of what it is. Yes, totally. Right? They think they're supposed to stop their thoughts. Yes. And I tell them, it's bunk. Nobody stops their thoughts. Yes. They just come. Nobody can think of nothing for more than about a second. Right. You just observe them. Right. It's fine. Yeah. The only way I could stop my thoughts is when they say, OK, now focus on your thoughts. Yeah. I don't have a thought. Yeah. You're like, coming up empty. It's like the opposite of the other thing. Yes. That's why I try to make it like five minutes. And I try to increase it eventually that they're doing 20 minutes in the morning and 20 minutes at night. I admire that John Kabb is in. It's just like 45 minutes every day. Yeah. Right. But I always used to fall asleep. Yeah. Especially when he did the lying down one. Yeah. Like in the workshop, I was out in 10 minutes. Yeah. You're like, I hope it is more. I did roll me over. But I just try to make it really digestible, really manageable. And I just, you know, when people are like, so what am I supposed to do? Are you going to like give me anything to do? I'm like, sure. Take five minutes morning and night and meditate. Or I don't use the word meditate. I say, be mindful. Just be mindful. And they're like, okay. Do they do it? Yeah. After all, you know, there's a courting period where you have to sort of convince them. Yeah. And you know, you usually get to an intersection where the discomfort of what they're experiencing emotionally outweighs the nuisance of sitting still. And so then they're ready. Right. They've got to sort of hit their own bottom. Yeah. Which reminds me, do you ever use that stuff with addicts? Yes. Yes. Yeah. I mean, it's enormously helpful with everybody. I do it with my kid at nighttime, every night for 10 minutes. He'll do it. He's eight. You said he's eight. Yeah. I mean, it's when he's going to bed. He's got no choice. It's like, I'm either going to shut the light off and leave the room or we can sit here and do this together. Or you'll do it with him. Yeah. Yeah. I'm going to get him through for him because he's so young. It's too abstract to just say, observe your mind. Right. He's like, what? But I do guided imagery. Oh. Or I do progressive relaxation. Or I do just sort of... Like your toes and then up your body. Yes, exactly. Or I just kind of do a very generic, like I say one phrase sort of repeatedly, quiet your body, quiet your mind and notice the relationship between the two. And I say that over and over to him. So that he begins a process of, you know, being able to regulate within reason his central nervous system and realize that he is... he can be at the driver's seat if he wants to be. You know what? You just made me think of something that I haven't thought of in 60 years. Do you tell? When I was a little kid, you know, I hated to go to sleep. And when my mom put me to sleep, there was a ritual. And I think that's part of it. Yes. I mean, I love rituals. I love rituals too. Right? Love me a good ritual. Yeah. And so, you know, and part of it was God bless Mommy, Daddy, Uncle and, you know, everybody in the whole world. Yes. And it was very reassuring. And it gave me something to focus on. Yes. And in a way, it was like almost like what you're talking about. Totally. You know? Yes. And now what I do, you know, people talk about counting sheep. I don't count sheep. I count breaths. Yes. Because I find it very hard just to focus on my breath. Yeah. I need a lot of other ritualistic kind of things. Yes. Like, oh, I'm going to try to count 200 breaths. Uh-huh. The only time I get up to 200, if I'm really going through some period of... Wired. Yes. Right? And counting is good because you can tell when you lose the focus. Uh-huh. You know, you get up to eight. Yes. And you go, oh. And you drift off, or you're, yes. And it's nice. And then, you know, to be non-judgmental about it, oh, okay, I left off at eight. Yeah. I could do nine. Yes. Exactly. Yes. That's exactly it. And it is that principle of ritual, or habit, or regulation, if you wanted to talk about it from a biologic standpoint, things that have... they have a pattern and a system to them. Right. And that... Like, for me, I think the first thing that I got into that was like that was running. Yes. Me too, in college. You know, I run every morning. Yeah. I, you know, I do my little shtick. Yes. I run. I stretch. I meditate. Yes. And it... What it took was getting away from the question, am I going to run? Totally. Because, I mean, it's very freeing. Yes. To know that I'm going to run. Yes. And sometimes it's hard to get out of bed, so I have coffee first. Yes. Because I love coffee. Me too. You know, I don't... It's another ritual. It's another ritual, right? And it's something that I love. Yes. So I'm lying in bed thinking, oh, it's kind of chilly. I don't want to get out of bed. Yeah. I say, oh, but I can have coffee. Yes. I know. Yes. And then it's... One thing triggers the next, right? So you go to have the coffee. You go to the bathroom. Yes. Exactly. And then you're ready. And then, you know... And in Hawaii, what do you need? You know, I need my swimsuit. Yeah. And that's really it. Yes. Because I go to the beach. Yes. And I'm there. Yes. And I take the dog. Yes. Because the dog likes it too. And he or she needs a run as well. And she's ready. Yes. Yeah. And so, like, that whole period, which for me, I feel guilty sometimes, because I'll take two hours with this thing. Yeah. And... But it's... I don't care what happens after that. Yeah. Because I feel so good. Yeah. And isn't it interesting that we feel guilty to, like, do something... That's just for me? Yeah. And that's promoting well... It's promoting balance. Right. And it's actually, I tell myself, well, I do this for my clients. Yes. I know. And then you're going to sit all day. Yeah. I know. I check my pedometer at the end of the day, and sometimes it's 50 steps. And it's just like, wow, I'm going to die from deep vein thrombosis in this chair one day. Oh, that's not a joke. I know. Well, you got to get up in between. That's true. Yes. You know, my first client I ever had here in Hawaii, we did it walking the beach. Oh, wow. And I think I got to get back to that. How did you get around HIPAA? What's that? That's how you got around. No, no. HIPAA is not a problem because it's windy. Okay. You can't hear more than three feet away. All right. I would love that. And, you know, they don't know who I am. I'd go hiking. They don't know who he is, right? Yeah. We're just two guys talking, right? I lost him. I think he got better right away. Yeah, he didn't need you. You need him in the office. So I'm going to teach for myself. Century isolation. That's really funny. It was very effective. Yeah, it was. You cured him. He realized what he needed was fresh air and exercise. Right. And really, the basics, like you go back to the basics. It's like, you're going to get enough sleep. We're going to regulate your central nervous system. You're going to minimize alcohol and minimize caffeine. And you're going to eat decently and come to therapy. And the rest of it sort of, you know. And then eventually, the last part. I just say to people, yeah, eventually, you know, with like a consistent sense of working with somebody who is present and capable, things work themselves out. Like the human body really does want to reach a place of homeostasis. So that's fascinating. What you just said is that basically to do your job well, finish that sentence for me. I mean, it doesn't sound like there's a lot you have to do. Yeah. I mean, I have to do what I tell my patients to do. I have to sleep. I have to exercise. I have to eat good food. I have to be present. I have to be capable of being present, which for me also involves moving my body once a day at least. You know, you have to have a degree. You can't be like reckless. And there's certain tools like we are sort of picking up throughout our time. But, you know, otherwise really, to me, the relationship does a lot of the work. That's what every study shows. Yes. It does a lot of the work. It's the sense of being connected. And if you can deeply connect with your patients, you know, usually they'll stick around and they'll keep coming back. And it's really rewarding. Like we were saying before we started, it's such a good gig. Oh, I love it. Yeah. Because I think that I'm curious. I mean, when I was driving a cab in New York, I used to ask everybody in the back, so what do you do for it? Totally. Are you happy? Yes. I didn't know, but I was practicing. Yes. Yes. Are you happy? Yes. You know? Yes. I mean, if you could summarize your job in a sentence, what is your job? Oh, I don't know. That's a really hard question. Sometimes I say I'm a professional secret keeper because we just carry these stories, you know, when we carry them and they're intimate. They're intimate relationships. We're out of time. You'll have to come back. Okay. Gladly. Thank you. Thank you so much. Tune in next time for, what's the name of this? Shrink rap. Bye-bye. We're done. We're done. Thank you.