Q: I am confused about the difference between the Lifetrack theory and the method of tracking. What is the difference?

A: The contribution of Lifetrack is first to define psychological spheres that contribute to well-being and distress and second to develop a means to help patients measure, quantify, track, and improve the subjective experience of health over time. They are interrelated, but separate. You can learn about the insights gained from the model over the years and try to apply them to your life intuitively. You can also use the tracking method as a tool to make health part of your daily lifestyle. The tracking does not provide the totality of the experience, but is a tool to trigger insights and move beyond a previous best level of experience. The tool helps you to ask relevant questions of yourself regarding your capacity and willingness to build your health on a daily basis.

Q: How can I put numbers on how sexually excited I am or on how much I accept my spouse without wanting to change her?

A: Patients in Lifetrack therapy do this all the time on a 10-point scale, where 0 is the minimum and 10 is the initial maximum. Having people artificially assign a number to their thoughts, feelings, and actions reinforces the idea that the subjective is controllable. That a person depends on his or her spouse or significant other at only a 5 on a 10-point scale means that the individual could learn to do better. 

In Lifetrack sessions, an individual is actively coached on how to improve in each of the parameters. Although you might presently depend on your significant other at a level of 3, how might you strive to make your 3 a 4? How about a 5? Because improvement is the objective and not the absolute value, the self-rating exercise is not simply an act of passive accounting. Rather, it is an active process in which an individual must reflect on how he or she can think, feel, and act so as to improve daily scores in each of the positive parameters that help to contribute to positive health. When rating oneself, the person is encouraged to ask the question, "How can I think, feel, and act to make this score go even higher?" This concentrated effort accounts for the rapid rate of growth in a relatively short period of time by those who use the approach.

Q: I am a physicist and see some similarities between the study of the mind and physics. What I also see is that your method of tracking is influencing the experience of health itself. Can you comment?

A: The inner state of mind affects what it is one sees and experiences. To put it in terms of physics, the observed object is not separate from the observer. When the mind focuses on one thing, it does so by selectively ignoring another. When the mind understands something, it has adopted one perspective exclusive of others. As you have hinted with your comment, depending on what we decide to observe and measure, we may be creating what we look for and find. Hence, if individuals observe and precisely measure diseases and disorders, they may create them where they might not have otherwise existed. Conversely, if individuals choose to observe and measure positive mental health or well-being, they may be able to create these where it may not have otherwise existed.

Naturally, part of being happy is being conscious of it. In this sense, it is clear that the observer may well influence the experience of life by the intention or act of assessing it according to the Lifetrack model. This is intentional. Daily self-rating attempts to change not only the objectively measurable life experiences but the "unconscious measuring rod" or the subjective perception of experience. The scale should serve to help individuals discern that they are getting much happier, rather than believing that their level of happiness is "constant." Taking such a psychological leap is more than just symbolic. It empowers you through incremental thinking; In short, the observer may be "creating" what he or she observes simply by choosing to observe it.

Q: I enjoy the simple self-rating exercise and find that anyone who can count to 10 can do it. However, I can't fully capture the richness or complexity of my mind in words, let alone digits! So why bother?

A: I agree with you. The subjective experience of happiness, well-being, depression, and the like cannot be fully described in words or digits. Health can only be experienced by each individual. This raises an inevitable question: If the "reality" of psychological phenomena can only be experienced and not fully described, how can we track it?

The physicist Finkelstein wrote similarly about how "experience" in the exact science of physics cannot be fully communicated to others. Einstein, too, gave us an analogy regarding a physicist ever wanting to capture reality, but never being able to see under a watch's face and discover just what it is that makes it tick. Finkelstein argued that despite the fact that one cannot fully communicate experience to others, if we can show others how to make the experience happen and how to measure it, then we can help others to experience it. This is precisely what has been done in the Lifetrack self-rating program. Use it as a tool for building health, and do not confuse the tool with the experience of health itself.

Q: Why do you allow your patients to rate their health, rather than administering a personality test or having a panel of doctors do it? I question the validity of patients' self-rating. They are not objective in their assessment.

A: In medicine, the doctor decides if the patient is ill or well. It is not left up to the patient's subjective opinion. If a patient is tested and found to have AIDS, that patient is sick even if in the early stages of the disease he or she is not suffering from any symptoms. The patient's feeling healthy does not discard the objective reality of the presence of a potentially fatal disease. In physical medicine, an objective approach is far more reliable than a patient's subjective perception of his or her state of health.

What holds true for the body, however, may not necessarily hold true for the mind. If someone is miserable, it does not really matter that a whole panel of psychiatrists "objectively" decides according to some statistical norm (normality defined as a statistical average) that the patient has an ideal or well-adjusted life. If in one's mind life is hell, he or she will continue to feel miserable unless his or her perception of it changes. The reverse is equally true. If someone is dying with a terminal illness but feels at peace, then it doesn't matter that a panel of doctors "objectively" decides this fellow is really miserable but doesn't know it. Whatever the "objective" panel concludes will make little difference to a happy individual.

Naturally, there are limits to using subjective experience as a yardstick to well-being. A positive mental health approach does not rely solely on an individual's internal perception of well-being. In therapy, outside parties-the therapist and the individual's partner (if there is one)-are constantly following a patient's subjective response to events. When the patient's perceptions of events become distorted as in an acute psychotic condition, his or her own understanding of well-being becomes meaningless. It is at these times that subjective rating does not make sense. Individuals who have difficulty in introspection may also do less well in Lifetrack therapy.

Q: Is happiness or distress measured in the same way by everyone?

A: Experiences of psychological distress or well-being (such as "anxiety," peace," "depression," or "happiness") are essentially subjective and can only be observed and reported by the person who is experiencing them. What makes one person happy might make another miserable and vice-versa. Furthermore, happiness to one person may not be exactly the same thing as happiness to another. It may even be different for the same person at a different time. Nevertheless, because the experience of well-being or distress is a subjective internal phenomena, the best expert to measure it is still oneself.

Q: I am an up-and-down type of person. The mood you catch me in when I start to rate myself makes me doubt the validity of my self-rating. Should I rate myself anyway? Who am I trying to fool?

A: Psychological experience occurs in spikes of thoughts, feelings, and actions. As you have experienced yourself, happiness and depression are not steady states but can change from one moment to the next. For this reason, the Lifetrack total adjustment sheet (each self-rating exercise) is really a snapshot of moments. Even with a simple 10-point scale, assessments may be different if you perform the exercise only a few minutes later (depending on what happened in the meantime) or what you might have happened to think about when you were self-rating yourself. 

Despite this fundamentally subjective and changeable nature of self-assessment, in the experience of Lifetrack therapy, repetitive self-rating according to the same fixed model yields highly valuable information. Although memory is short, one can reliably observe if one is happier or more depressed than the day before. 

To use an analogy, you can imagine that each of your individual self-ratings is much like a droplet in your psychological experience. These droplets, when viewed individually or in isolation, may not tell us much. They are really a collection of "snapshots" that are arbitrarily pulled together. Nevertheless, for lack of a better way to capture the dynamically changing states of the mind, this may be a good beginning. Most important, my patients have discovered that when you use the same model consistently over time, the droplets accumulate, creating patterns that take the shape of a fountain. Although we can individually see the droplets and patients can attempt to describe their experience at one given point in time, it is only when we see the fountain that we capture personality. In this sense, you can think of your overall psychological state as a fountain, which keeps a certain shape, but consists of constantly changing and discontinuous droplets. 

Q: You say the scale is from 0 to 10, but then later you correct yourself and say you can go beyond 10. Why doesn't one's best stay constant at a 10?

A: In modern physics, the speed of light in a vacuum is known to be constant at approximately 186,282 miles per second, regardless of the direction and speed of movement of the observer measuring it. The reason for this is that the tool used to measure the speed of light changes its length depending on the observer's relative speed of motion. When the observer is in motion a high rate of speed, the tool shrinks according to the observer's speed, thereby explaining the reading on the scale as always exactly the same: 186,283 miles per second. In a similar way, the tool used to measure one's subjective psychological experience seems to change its length in such a way that the reading is always the same for most individuals. "One's best" is always one's highest limit. The term, much like the speed of light, is thought of as a constant, the highest attainable limit at any given point in time.

When one translates the term best into a number on a 0- to 10-point scale, a problem arises. A brilliant scientist who became my patient pointed out the predicament to me many years ago. As the patient exceeded in certain elements his previous best adjustment, he consistently rated himself at a 10 (the maximum score). Insisting that his 10 today was much higher than the 10 of last week, he felt that his scores were no longer representative of his true experience. 

It was at this time that I realized that internal psychological adjustment has no limits. The scale would have to be open-ended to reflect that reality. The 0- to 10-scale expands as one's experience surpasses a previous best. When an individual exceeded a past optimal experience, the measuring tool grows to enable the measurement of higher levels of adjustment that were previously thought unimaginable (the patient could rate an 11, 15, and so on). Past maximums could in this way be challenged and replaced by a new maximum.