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Cognitive Behavioral Therapy
The "One-Two" Method
Sometimes, saying "you'll be fine" isn't reassuring.
Posted September 13, 2017
The short, thin runner stands just outside the medical tent, tears etching slowly down her face. Her two companions, another woman runner and a man, talk with her in earnest. The triage nurse, speaking to me, gestures to this trio and says, “She didn’t finish the race—she’s upset.” As a member of the Toronto Marathon Psyching Team, I take that as my cue to see how I can help.
I walk over, introduce myself, and ask about the race. Janet (as I’ll call her) says: “I feel terrible that I couldn’t finish the race. I should have been able to. Pat (her companion) did. This is so humiliating. I can’t even call myself a runner. I did Boston in 4 hours—and now this! I’m a quitter. What kind of example am I setting for my kids?!”
I begin assessing the situation. First, the facts: For many racers, today has been a good day in terms of weather—a very important feature for a marathon race. But this woman competed in a marathon three weeks ago. Has she had the appropriate time to recover? And not just any marathon: the Boston Marathon, the mecca for distance runners. Equally significant, she completed the Boston Marathon in blistering heat—a race many runners decided to pass under the circumstance. Those who did complete it were markedly slower than anticipated.
To even run the Boston Marathon, one needs to qualify—so clearly, this woman is a skilled and trained runner. I have no doubt about that reality. Yet she is questioning her identity, her personality, her human connections.
Pat, her friend, does a great job of reassuring her and being reasonable, pointing out Janet’s strengths, reminding her of the conditions in Boston, commenting on how far and well she ran today. This kind of cognitive re-framing is often excellent; it forms the backbone of cognitive-behavioral methods.
But Janet is having none of it. For me to pile on additional reassurances at this moment will only alienate her and leave her feeling further isolated and not understood.
I commend Pat on her helpful intent. At the same time, I suggest what Janet may need from us right now is simply to have her feelings heard. I spend some time listening to Janet’s repeated thoughts and comments, empathizing with her distress and reflecting back to her on what she is describing. I emphasize that this is how she is feeling right now, discouraged and despairing.
Gradually, Janet’s tears dry up; she begins standing a bit straighter. It is only now that some of Pat’s logic can penetrate. Janet can begin to appreciate and celebrate the grueling work that she’s put mind and body through over the past few months. She can understand that she reached—and probably overextended—her physical tolerance. She can take away some lessons from this experience, for herself and her children.
Now that Janet is in a more level state, I ask: “Supposing Pat had done Boston but hadn’t been able to complete this race. What would you be saying to her?”
“That she had courage.” I agree. I give both women pieces of “finishing line ribbon,” suggesting that they can pay attention to that sense of courage whenever they touch the ribbon.
I think of this process as a “one-two” method. When someone is distressed, just being logical with them can, as with Janet, leave them feeling misunderstood and alone with their feelings. Feelings are feelings. They often need to be acknowledged. If that is all that you do, though, it’s possible that the sense of being overwhelmed will become an even more emotionally wrought state. So it’s important too, to shift from feelings (Stage One) to thoughts or actions (Stage Two). Interestingly, oftentimes when people feel fully heard, they themselves make that switch naturally.
This One-Two method isn’t reserved for elite athletes. It’s an excellent method for parents to employ with upset children. For us to employ with ourselves. And with our friends.
Now, a story a little closer to home: A good friend of mine recently underwent a major surgery. Since we live some distance apart, instead of visiting with her in person, I’ve pledged to “visit” with her every couple of days. Mostly, our conversations have revolved around what one would expect post-major-surgery: her gradual physical recovery.
But a few days ago, she was clearly alarmed. After some minor changes in the surgical site, she made an appointment with a surgeon friend—someone she likes and respects. He was not concerned, but since the surgeon who had actually operated on her was in the building, he called the second surgeon in.
“Hmmm, strange,” said the second surgeon. (Note to surgeons: Be careful what you say out loud in the presence of patients.) He left. The first surgeon, seeing my friend’s alarm, said, “Don’t worry. If he was concerned, he would have let you know. He’s going to see you in a week.”
My friend went home, but she’s been in a state of worry ever since. What did her physician mean by the word “strange”?! As she talks with me, agitated, voice higher pitched, she knows she’s not being rational—but there it is, all the same. I could remind her of everything that she knows—but this isn’t the moment. Instead, I listen to her agitated recital. I hear her out. I empathize with her feelings. And sure enough, gradually, she calms down. She reminds herself of what she knows. She reminds herself that for right now, there isn’t anything that she can do, that she really is OK…and that right now is a matter of time, of waiting out the situation. So we begin talking about ways she can distract herself to help the time pass with a little more ease.
Thank you for reading my blogs. With this one, I expect that I’ll hit the 100,000 reader mark!
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