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Tuesday, 10 May 2011

The Time Horizon

In a hockey game, it’s important to know where to look.  If you focus on the end of your stick, or on your sweetheart in the stands, you won’t score many goals.  

Similarly, in much of life it matters a great deal where you place your attention.  In my clinical practice, many of the problems people have are influenced by the time horizon they use.  If it matches the needs of the situation they tend to do better than if there is a mismatch.

Imagine a physician completing her residency and studying for final examinations four weeks away.  If she focuses relentlessly on her future after the examination – the consequences of failure, whether she really wants to practice in the area she has chosen – this will impair her ability to prepare during these few weeks remaining.  

At this point she has invested years of her life in the field she has chosen.  This is not the time to begin trying to decide whether she really wants to be a surgeon.  The impulse to abandon ship is likely to be so contaminated by her desire to avoid the stress of the exam that it cannot be trusted.  Once the examination is over, she can make the decision whether to practice as a surgeon or not:  passing the exam does not commit her to any course of action.  Much of the work of therapy, then, is to decatastrophize failure (her life will not be destroyed no matter what happens) and then to pull in the time horizon to the task of the moment:  her preparations.

Sometimes clients have a time horizon that is too close.  People who are extremely anxious sometimes try to cope by refusing to think about the future, doing everything they can simply to get through the day.  When they allow thoughts of the future to come up, they worry about bad outcomes – failure, bankruptcy, illness, loss, death.  

The task of therapy is often to help the person remain in the mindful present for much of the time, but to begin contemplating where they would like to be in a month, in a year, in five years.  Then we can work backward from this vision to identify the steps they may need to take in order to make that future a reality.

Here’s an example.  Many young people suffer from a crisis of confidence about their abilities.  After graduating from high school, they continue to live with their parents and find it too stressful to think of furthering their education or finding employment or even meeting new friends.  Their time horizon creeps inward.  

They might ask themselves “What do I feel like doing today?”   The answer is easy.  If the mission is to feel as relaxed and happy as possible today, the best thing to do is to stay at home, perhaps watch television, and avoid the potential humiliations of the outside world.   And indeed, if this was their last day on earth, these might be reasonable options.  But it isn’t.

If a confidante can help them to relax enough to lower their defenses against the fearful future, they can readily see that continuing to choose comfort in the short run makes them more uncomfortable in the long run.  By extending the time horizon for short periods we can explore a vision of a future that might be more fulfilling.  Then we can map our way back to find the first few steps of the path.

Individuals who experience chronic pain can be similar.  If the question is “How can I best control my pain right now?” the answer is usually quite easy.  Take pain medication, avoid movement, and perhaps have another hot bath.  All of these are entirely reasonable and appropriate things to do, but for most pain conditions they tend not to help the person become more mobile.  

Instead, we need to ask “How can I best reduce my pain two months from now?”  The answers will be quite different.  Gradual increases in activity, scheduled (rather than as-needed) medication, and mobility exercises will typically increase short term discomfort but produce greater benefits in the long run.  Our goal should not be to disregard short-term pain relief, nor to challenge ourselves to the point that discomfort is intolerable, but to supplement the present-oriented coping strategies with strategies for the future as well.  

In short, if we are feeling stuck or uncomfortable in our lives, the time horizon we are using is one place to look.  Sometimes we cast our eyes too far ahead, and need to focus on the here and now.  Sometimes we need to supplement a focus on the present with a careful consideration of the future.  When in doubt, shift the horizon and see what happens.

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