 Welcome to Shrink Rap Hawaii. I am Steven Philip Katz, a practicing marriage and family therapist at Hunley. Every two weeks I chat with other professionals whose lives are dedicated to helping others. Today is my delight to welcome back Dr. Sarah Sarkis. We are going to explore the goals of therapy and ask the question, is happiness just another cage? Welcome back Dr. Sarkis. Thanks for having me. Good to be back. What do you mean by that? Well, what I mean is that when we ask our patients questions like how are you, we compel them to put themselves on a continuum. I'm fine, or I'm not fine, or I'm good. How many? Exactly. And it sort of artificially forces the person to put themselves on a scale of good or bad. And so whatever you answer, it just becomes a cage. And there's this expression that good is just another cage. Meaning then you have to maintain good. Because if you're not good, then you're bad. So that is what I meant by that. Is it better to ask how are you feeling today? Sure. And I don't necessarily, there's probably really skilled therapists that open with how are you. So, you know, everybody's got their own jive that they have to come to. But for my particular style, it's been more beneficial to ask a question that allows them to ponder that we're all of it. We're good, we're not great, we have areas where we're really confident. We have areas where we feel really insecure and that that's not pathologic. That's the human condition. To feel all these things. Yes. And I think that part of our role as humans, just trying to figure it out, but in our profession as therapists is to convey to our patients that emotional dexterity, the ability to sort of fluidly move through different emotional states without necessarily judging whether or not it's good or bad, you know, kind of eases the human condition. Because then you're not like, oh I feel sad, I'm depressed. Now there is real, as you know, there's real clinical depression. But in my opinion, a lot of it is just sort of jargon that people pick up. Like, oh why are you here to see me today? Because I'm depressed. And then when they really start elaborating what's going on, it's like, well dad just died and boyfriend broke up with them and the dog ran away and you're like, oh you're not depressed, you're having congruent reactions to difficult situations in life. You feel sad, that's a very normal emotion. So isn't that just another word for depressed, sad? No. To me, depression is like a syndrome. Sad, greed. You mean like the VSM-5? Yeah, exactly, exactly. Pathology. It's a pathology. We want to be in their interior world of emotions and then determine whether or not it seems, I'm even reluctant to use the word pathologic, but it's our job in that assessment period to sort of figure out, is this more than just grieving? I mean situational. Yes, exactly. The trait qualities versus state. Right. And so some of it is normalizing what people experience. So if I come in and I say, you know, suddenly I just find my side, I just find tears rolling down my eyes and I don't know why. Does that mean I'm sad? Well, we would have to explore that. We would have to find out where the tears are generated from and that would really be the starting point with which you could try to engage the person around their interior world. So the goal isn't necessarily to cheer somebody up? No. Not necessarily. Right. It sounded like the grim reaper. But no. I mean... No, but that's what you're talking about emotionally, dexterity. Yes. And also what you talked about in other writing that you did about being able to be uncomfortable. Yes. Yes. You have to... I think there's a part of the human condition that requires us to tolerate sitting in uncomfortable interpersonal dynamics and interpersonal dynamics. So that is one of, I think, one of the goals we can model in the interpersonal dynamic with a patient and that we can also carve the space out within the therapeutic room. So in the therapeutic relationship, would it be appropriate for me as therapist to say, you know, I'm feeling really sad. Something you said is making me feel really sad. Would that be appropriate? Well, I don't know if I would can say whether or not I think it would be appropriate because it would be dependent on so many different things including the relationship. But I would say this that I think anytime we can genuinely reflect the empathic experience we're having of the patient, I think there's healing value in that. Because humans that feel connected, genuinely connected, don't suffer as much. And we know that from the research with geriatric patients and how, you know, when a spouse of like 50 years dies often the other spouse dies fairly quickly after that or, you know, now we know through like the research with like therapeutic animals and sense of community that we're a mammal that thrives with connection. It's the only way we survive. So if you can make empathic statements that are accurate, your patient is going to feel connected. They might not feel better. But if we can, I think that part of what we do is we bear witness. So you're not fixing their problems. They're not broken. They're just going through life but you bear witness. You share the emotional experience and that in and of itself is healing. Yeah. Paradoxically, if somebody just feels heard, you know, so many times I feel like I'm not doing anything or I'll repeat back, I'll parrot back what the client said. So what I hear you say is you're feeling a lot of pain and they'll go, yes, that's it. Like I'm a psychic. It just said to me, I'm in a lot of pain. And I said, you're in a lot of pain. How did you know? You know, because I listened. And we really are sort of in the business of listening in a unique way that doesn't happen in the regular world. Right. You know, kind of through no fault of the regular world. It just is the way it is. Well, like, you know, if you're my spouse and you come home and you say, you know, I had a terrible day, my boss told me I'm a jerk, then, you know, the wrong move for me to make would be, well, just tell her she's an idiot. Yeah. Yes. Trying to fix it. Yes. Right. Especially as a male, which gets into the gender patterns of how our brain works. It's just neurology. Somebody told me that's called mansplaining. Oh, my God. That's so funny. Yeah. Yeah. Guys want to fix things. Yes. Yeah. Yeah, it's tinkering. Right. Yeah. It's on the car. See, I know that I can't do that on the car. Yeah. Right. So I don't, I think, you know, You've saved yourself a lot of hardship. Yeah. I just say, wow, that must feel terrible. Yeah. Then they go, don't give me that therapy crap at home. Yeah. Oh, I hear that all the time. Don't handle it. Yeah. Yes. So, but why is it different? Like if I'm sitting on a tack or is that there's that funny routine I saw somewhere and somebody has like a nail in their head and they're talking to, you know, their husband, the husband keeps trying to tell her she's got a nail in her head. Don't try to fix it. Just listen to me. She's like, no, literally. You have a nail in your head. Yes. Yeah. So I mean, well, why is it different? Right. Like if I'm sitting- Because you're not married to the person, which is by the way like- No, but if you were the therapist, you would still tell the person they got a nail in their head. Yes. Right? And you alleviate the pain, take the nail out. I wish it was like that emotionally, like- Ah. You know what I'm saying? Yes. Like, oh, wow, I got a leg cramp. Oh, well, walk around a little bit and go away. Mm-hmm. Oh, I feel terribly sad. Oh, do this. Well, there are tactical things you can do. Yeah. So you're still male. You really just want to fix it. No. But there are tactical things- No, I'm just curious why it doesn't work the same way. Yes. Because it's emotions. And they're very different. You know, when we- I guess when we rose above instinct, you know, we like- You think we rose above instinct? Only moderately. Yeah. But, you know, we're one notch up. But yeah, I mean, it is different. Yeah. But I do think speaking to that urge, because we are people who like to help, you know, we want to be helpful. I've been trying to liberate myself from that for years. But they- Oh, yeah, last time we said we were going to go into why did you choose this profession? Oh, yeah. But so the- there are those tactical things you can do when somebody's in acute pain, right? Right. We offer sort of suggestions and takeaways. And to me, that's like- that's our equivalent of saying like, well, yeah, you got a nail in your forehead, you know? Yeah. Yeah. So we were talking before about the- what I call the typical dynamic of the woman who is very passionate and the guy who's totally out of touch with his feelings. And that's a very common combination that I run into doing couples counseling, right? Yeah. And it's so hard for both of them, right? Because the guy just wants to run away if it's the guy. Yeah. Right? It's not always that way. Yeah. Right? We can speak in generality. Okay. Liberate. I'm a passionate one. Yeah. It's like, why can't you just like be here with me? Talk to me. Yes. Well, how do you feel? How do you feel? That's what we're always asking. How do you feel? Yeah. How do you feel? And the guy's like, I don't know. Yeah. Yeah. What do you do with that? Well, it would depend on the particular man and as you understood why he sort of disintegrated from himself because beyond the generalities that our society does sort of tend to ask men, boys, at an earlier age to, you know, separate their feelings out. But each person has their own little interior narrative, right? Right. And once you understood that, you as the therapist, you could connect to that. And you could draw the man's awareness to that, whatever it, you know, whatever it was, what series of things that were unique to his environment. Even like in his childhood. Dynamics growing up, childhood, loss, grief, whatever it was, right? And with that, that's insight is when you start to understand that your past contributes significantly to who you are now. And so you draw awareness to that and then each time it happens, oh, there's that thing again that happens for you. And slowly my experience has been like as a human and a therapist that people reconnect with themselves. He'll find his way. You mean get in touch with his feelings? Yes. His expression is. It's not to make him look more like her. Right. Right. But make him look more like him. We'll come right back. We have to take a break. We'll be back with Dr. Sarah Sarkis. Don't go away. Aloha, Kako. I'm Marcia Joyner inviting you to navigate the journey with us. We are here every Wednesday morning at 11 a.m. and we really want you to be with us where we look at the options and choices of end of life care. Aloha. Hi, I'm Chris Lethem with The Economy and You and I'd like to invite you each week to come watch my show each Wednesday at 3 p.m. I've got the Beagle Sisters here with a healthy tip. We encourage you to enjoy the food you eat this holiday season and keep it local and healthy. Yeah. Rainbow. Yeah. Rainbow. And if you need any produce, come to the red bar on the north shore. Aloha. This is Akina with the Weekly Ehana Kako. Let's work together program on the ThinkTac Hawaii Broadcast Network Mondays at 2 o'clock p.m. Movers and shakers and great ideas. Join us. We'll see you then. Aloha. Welcome back. I'm still Steve Katz and this is still Dr. Sarah Sarkis. And you just asked me an interesting question. We were talking about couples. Yes. We were talking about different subjects and you said, how do you sustain connection for a long time? Yes. Right? Which is, you know, the, oh, it's the cliche, the empty nesters. Yes. And now they got to look at each other. Yes. And it's like panic. It's like, who are you? Who are you? What have I done? Yeah. Yeah. Yes. It happened. Where do you start? Frequently. With that couple? Yeah. Well, it would depend on what stories they, you know, came in with. I like to go golfing and she wants to go to see chick flicks. And you know, if I ask, if I, we want to go on a date, and then she's got to tell me like which way to get there and how I made a wrong turn in all this stuff. And it, and we never even get to the movies. We get mad. We get into the fight. We go home. Yeah. That's just noise to keep them from having to actually connect. Right? You just sort of sit with it and wade through it. And some relationships are not salvageable. Right. By the way, some relationships sometimes you uncover that what had unified them was the kids. For good or ill, they stayed together for the kids. So, you know, I don't go in with any, first of all, I should say couples is not like my complete jive. Right. I see them. I work with them. I enjoy them. But you really live in that world. No, but you're right. I don't have an agenda either. Yeah, you go in. It's not up to me to decide if they should stay together or break up. Exactly. Yeah. So, you go in just sort of ready to explore. Yeah. And, you know, I would think in those first few weeks you ask a lot of questions like to her, you'd say, what did you hear him say? Right, because they don't hear each other. Because you're literally trying to understand how their brain works. Yeah. How do they process each other verbally, physically? How are they interpreting the other person's sort of intent? Oh, it's so hard. Because they're busy making up an answer. They're not listening. Yes. Right? And you should play that game where they have to repeat what the other person said and they can't do it. They can't do it. Or they do it like I love when patients say to me, they'll be like, I thought about something that you said this week. I'm like, oh, what did I say? Because I'm always so interested to see. What they heard. In the game of telephone, what did they hear that I said? No. And you get the full spectrum of answers, which reveals so much data. And I always say to patients, we're just collecting data. These are just data points. And we're going to plot it. Or I use the metaphor of a puzzle. It's like, we're going to turn all the pieces over. Then we're going to build the borders. And then we're going to start really figuring out the interior. But all of it's just data. Like, oh, that's how she processes information. Or you realize, oh, OK, so she processed that piece of information fairly well. It's funny when you first said that, when you said something you said, I thought about something you said last week, right? At first I thought you were playing the wife saying to the husband, and like as the husband, I was getting defensive. Oh no, here we go. Yeah, like bring it on. Bring it on or where's the door? Yes, exactly. Where's my escape hatch? Yeah, yeah. And the escape hatch for a lot of men is what we were talking about earlier, is that there's a strong capacity to press pause on your emotional experience of something while it's happening. And in a certain environment like a hunter, that is an incredible gift. There's other environments professionally and all kinds of environments where the capacity to feel your emotions second, but be absorbing things at a very practical level first, really served men so well. And so it's like most emotional traits. It's a coin, and so on one side of the coin, it's a superpower. And if you flip that same coin over, it's your greatest liability. And everybody has these traits. And one of the goals of therapy I always say is to give people, give us a little bit more leverage over which side of the coin is face up. The superpower or the vulnerability. To choose. To choose, to be aware of when it is happening and sort of mitigate. So why do you go choose? You don't think it's really a choice? I think it becomes possible for it to be a choice. But that takes a long process that isn't just cognitive. Right. It's an interior experience first. And then we gain the capacity to sort of make the choice like, oh yeah, I'm doing that again. There I am doing it. I just pressed the emotional pause button. Let me try to tap back yet. Or like you said before, I think you said this off the air, that with some people you want to try to regulate the emotions. Yes, modulation. You want to be able to pause like some people can. Like the woman with the passion. Right. And passion is a really good word to use because it's a perfect example of how passion can be something that's really captivating and draws you in. Right. But if the environment is right and you flip that same coin over, it can become unpredictable. Right. And so with somebody that's trying to modulate or regulate passion, they would have the opposite process than the person that's trying to learn how to stay present. Right. Stay emotionally present. Yes, exactly. Yeah. And two people often are drawn together who are the opposite ends of the spectrum because it's when it's good, it's like, oh, this person is so well grounded. He's not going to go crazy. And then he bores you to death later. You flip the same coin over and you're like, he's a bore. He's a bore or he's dishonest. He's emotionally dishonest. Yeah. He can't get in touch with his feelings. Yes. Yes. I have a whole blog on this, this part of connection and sort of how we're drawn to chemistry. It's on my blog, but I look at it through the lens of like looking at this scene in Star Wars that I love. But it's this exact premise that like in the early days of lust at this unconscious level, we're drawn to people. Right. And we don't really know why, but it's like, it's intoxicating. Oh, it's a right. And then years north of the lust, the coin flips over and you start to see the unconscious subtext of why we were drawn to certain people like the guy that you dated or the woman that you dated and you just thought she was just so fun and she was like laid back and she loved to have a good time. And then decades later you realize, oh, she was an alcoholic and you have an alcoholic parent and you swore you'd never go down that path. Right. That's sort of the very quintessential... How did this happen? Exactly. And this is exactly how. Because we fit together like sort of lock and key. Right. It's like one of my favorite lines from Rocky where like Paulie proposes to Adrienne and Paulie's like, whoa, why you like my sister? And he's like, I don't know, she's got gaps. I got gaps. Together we fill gaps. And that's that premise of like, we just fit together and it's years in that you're like, oh, that was the fine print on the contract and I didn't read it. Right. But then the goal of therapy hopefully will be to understand that and embrace the other person knowing them better, knowing them more fully and understanding both sides of the coin. Yeah, I don't know if I would necessarily completely agree with that that's the goal of therapy. It might be the goal of the couple. But for me as the therapist, the goal is to create a space where each person can sort of over time be their most authentic self and be present. Right. And then you can look at each other as the couple and you can decide whether or not this is something you are still in love with or that's workable. And so I just try to, for my own space because good is just another cage. So sometimes couples staying together is just another, it's just them enduring it. So I try to stay equidistant. Do you have a judgment about that? What do you mean? If they're just enduring it. Not if they're both coming to that from a place of empowerment. If they both are like, you know, this works and we're not madly in love but we work well together, we enjoy traveling. Whatever the fine print on the paper. It's good enough. If that's what they come to, they don't have to, the world doesn't need to reflect my values. It needs to reflect authentically their values. But it's really hard not letting your values get in the way. It's something where you have to be really mindful. And you know, there are certain things that you can't help but have your opinions in a way. But you know, we do our best to make it about their journey and them figuring themselves out. So we touched on a little bit. You said, well maybe this will just tickle it open today. I asked you a question about the whole beauty question. And I said, you know, I meet all these women in my practice that you know, I look at, they're beautiful. You're beautiful, they're beautiful, and they don't think they're beautiful. What is that about? That is like, we would have to have like a five hour summit. We should do that. We should. We should get a panel of, you should or no show, get a panel of people and we really should engage more in a dialogue around what is happening. That A, we'd have to define beauty. Right. And what's happening for women that... They all can. They all point to each other and say, yes, she's beautiful, I'm not. Usually if you go back into their story and you really start to hear the messages and the modeling that they had. As kids. And their family of origin, their community of origin. You're going to have a pretty clear understanding of why that is the way it is. And on top of... But it's rampant. I know, because I was going to say, on top of that we live in a global society that really does put a currency on beauty. Right. We got to go. It's been a delight, and as I said it would be, and a pleasure to have Dr. Sarah Sarkis on the show again. And what are you doing for the next, you know, every other Tuesday? No, thank you so much. Thanks. Thanks for having me.