Click here to contact Michael and/or see his GoodTherapy.org Profile

I am thinking that a good place to start with my initial article on Holistic Psychotherapy is to define this term or label. Just what does “Holistic Psychotherapy” mean?

Let’s begin with psychotherapy. The word is derived from two Greek words: psyche which refers to the soul or the spirit and therapeia which means to care for or to cure. So, quite literally, psychotherapy is an endeavor that involves caring for the soul with the ultimate aim of alleviating suffering. Of course, within this definition, many different theoretical and applied approaches to psychotherapy have been developed such as psychodynamic, cognitive-behavioral, humanistic, etc. In the end, all of these approaches can be said to have the same goal involving relief from pain of the psyche with psyche in more modern terms referring to the workings of the mind.

As for the word “holistic”, we can also first examine the word’s etymological roots to attain a definition. Holistic relates to the word holism, which in Greek is holos meaning the total or entirety, and a fundamental aspect of this definition is that the whole of a given system is greater than the sum of its parts. Applying this to a person’s health, a holistic perspective posits that symptoms or dysfunction can only be comprehended by examining all aspects of the person (physiologically; psychologically; spiritually; socio-culturally; environmentally; etc.) and by appreciating ways in which these aspects work in a synergistic fashion. This is in contrast to a more reductionist perspective of health which focuses on understanding problems by looking for the malfunctioning part or parts that are producing the symptom.

So, when we bring these two words together Holistic Psychotherapy can then be defined as an approach to caring for the psyche that involves a focus on comprehending the synergistic relationship of the multiple aspects of a person’s existence. Doesn’t seem so radical, does it? From this definition, a psychotherapist with just about any kind of approach to care could be operating holistically. What’s more, I find that this is increasingly true for most psychotherapists regardless of theoretical orientation.

So, then why does it seem that the term Holistic Psychotherapy has such an avant garde connotation? I would suggest that there are at least two primary reasons. First, reductionism (the opposite of holism) provides the basis for the natural sciences, and the natural sciences continue to hold significant sway over truth making in our culture. In other words, making sense of the ways things work in our culture, particularly in medicine, continues to be the domain of the natural sciences, and holistic or systemic perspectives remain peripheral in that domain. And second, Holistic Psychotherapy for better or for worse (and directly related to its place outside of the mainstream of the natural sciences) has become firmly aligned with alternative or complementary health care. The combination of these two factors, I believe, has resulted in holistic health care in general becoming the place where any and all alternatives reside to more reductionist approaches to health care.

So, as I reach the end of this article, I believe that I have arrived at a point where many people, health care practitioners and laypeople alike, wind up with regard to holistic health care. The basic idea of approaching health holistically just makes good sense. Most everyone can relate to a basic experience such as knowing that being in certain environments produces different degrees of stress and that the impact of that stress has an impact both psychologically and physiologically. From that point though, where do you go? Many become uncomfortable and/or confused with the options in the world of holistic health care, including holistic psychotherapy, and finding guidance in this regard can be challenging.

A primary goal for the articles that I will be writing will be to provide insight into the possibilities with regard to approaching psychotherapy holistically so that you, the consumer, can make more educated choices. Next up: are all alternative approaches to psychotherapy necessarily holistic?

©Copyright 2010 by Michael N. Schneider, Psy.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Michael and/or see his GoodTherapy.org Profile

Click here to contact Christopher and/or see his GoodTherapy.org Profile

In my first IPNB article two months ago, I went into detail about the significance of starting the therapy with our advertising and our first phone contact, email, or voicemail. Our intentions need to be clear and of the upmost integrity as these greatly influence the client even if they do not attend a session. Our kindness and helpfulness also beneficially impact ourselves.

“Mutual empathy occurs when two people relate to each other in a context of interest in the other, emotional availability and responsiveness, cognitive appreciation of the wholeness of the other, the intent is to understand… Growth occurs because as I stretch to match or understand your experience, something new is acknowledged or grows in me” (p. 89, The Stone Center).

Although this may only be a message or a brief conversation, it is important for us as therapists to understand its significance. Many client’s are seeking therapy because they are desperate. Maybe their marriage is falling apart, their child is suicidal, they are so depressed or anxious they cannot function at their work or within their family. Some form of emotional pain, loneliness, or fear are present, and kindness and intent to understand and help is extremely beneficial.

“Mrs. Jones, I can hear how terrifying this situation is for you and your family. I can only imagine how painful it must be to see your daughter lying in that hospital bed not knowing if she will come out of her coma. Some people, myself included, believe that the comatose patient can sense and know that people are around them, so all the love and caring the family can feel and convey to her with your presence is helpful to her. I appreciate your call to me and please continue to call me for support as you need it… and no matter what happens with her, I will be available to your family to help you through the grieving, recovery, or prevention of future suicide attempts.”

Here, I address her loneliness, her fear, and the power of her love and presence for her daughter. Also, I am giving her support and letting her know she will will not be alone in the future no matter what happens. And we will work to prevent this from happening again–lots of reassurance. Consider how much more beneficial this would be than the client hearing, “Yes, this sounds very difficult. Why don’t you call me when you are ready for an appointment.”

The power of IPNB is amazing in that just me writing this and you reading it changes our brains. We can feel the caring and reassurance that is in the speakers words and we can feel the relief of the client as she lets in the caring and reassurance. It is especially important to identify the power of the love and caring the family has for the daughter. No matter what transpires here, once the family or the daughter come into the office for therapy that needs to be a point of focus. “As I sit hear now I remember how I felt when I talked to Mrs. Jones on the phone during the comatose period. I could feel the love, concern, and caring in that hospital room, and I can feel it now… and I can now feel this appreciation for the family and how much you gave to your daughter… and this probably helped her pull through this and allows her to sit with us here today… Please take a moment to experience what you feel in your body right now as you hear this from me and reflect on where you have been these last weeks.”

The more we can feel these emotions as either giver, receiver, or observer, the more we will be able to benefit others and participate in the experience.

©Copyright 2010 by Christopher Diggins, MA, LMHC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Christopher and/or see his GoodTherapy.org Profile

Click here to contact Bill and/or see his GoodTherapy.org Profile

I have been incorporating psychodrama into my therapy sessions for the past 21 years. I utilize it primarily in group sessions but there are some helpful applications in individual sessions as well. Psychodrama can be defined as follows: a method of group psychotherapy in which participants take roles in improvisational dramatizations of emotionally charged life situations. The extemporized dramatization is designed to afford catharsis and social relearning for one or more of the participants from whose life history the plot is abstracted.

The following is a general overview of the general purpose and typical structure of psychodrama. In this powerful therapeutic technique, clients more or less spontaneously dramatize their personal trauma before an audience of fellow group members and their therapist(s). Some of the group members are chosen to participate in the dramatization. The lead therapist functions in the role of director, and encourages and supports participants to project as much as possible into their roles. He or she also occasionally modifies the parts of the players. The subject matter of the drama is typically an emotionally charged traumatic event common to the group participants or more specifically from the client’s life experiences.

The desired goal of psychodrama is to help the client gain some emotional release and control over existential anxiety that is provoked in similar situations or triggers in their present life. They also learn new healthier ways to respond to their emotional triggers in the future. Sometimes the therapist will have an auxiliary character switch roles with the protagonist, so that the participant(s) may observe and react to themselves as others see them. All dramatizations are followed by discussion between participants and therapists.

First Stages of Group Process

I will now unpack some of what has been presented. In clinical vernacular, psychodrama can be conceptualized as a process of externalizing the internalized processes of the primary participant. One person is thus chosen to share their traumatic event(s) with the group. It is important for the therapist to consider possible time frames for the ensuing work. Because closure is so imperative when doing deeper psychodynamic work, it is important to error in the direction of having time left over rather than running out of time. This is one of the reasons that my groups typically are scheduled to run for three hours. In working with trauma victims I also personally commit to staying over if and when someone’s process is not complete.

Once chosen to do work, the client then provides information to their group about who the primary people were that were involved in the dynamics of the trauma in their lives. The client is then asked to intuitively choose people to play the various roles that are discussed. Group members can then agree or choose not to play the requested role. Most group members will agree to attempt the role assigned, as they realize the potential opportunity to help the participant heal and get free from their past trauma. Occasionally a requested role closely resembles a similar event in the group member’s past and they are not comfortable in playing that particular role at the present time. Since groups are carefully screened in advance and most have been working groups for a period of time, it is understood by all group members that they are empowered to speak up about their needs in regard to whether they play the role or not. Since most things that happen in therapy are to some extent a projection of inner dynamics, it becomes noteworthy as to who is asked to participate. I will elaborate more on that next month.

(Next Month: Beyond the Introduction)

©Copyright 2010 by Bill Mason, MA, LPCC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Bill and/or see his GoodTherapy.org Profile

Click here to contact Susan and/or see her GoodTherapy.org Profile

Frustration. Most parents are very familiar with this emotional state! For some parents, frustration is an occasional and fleeting emotion. Some parents, however, live in a chronic state of frustration. Frustration is the feeling that you experience when there is a discrepancy between how you think things should be and how they actually are. Many parents suffer from a case of the “should’s”. For example, you think your baby should sleep happily in her crib, but she cries every time you try to put her down. Or you think your toddler isn’t showing any interest in using the potty and you think he should be potty trained by now. Or your school age child is shy and you think she should be more outgoing and make more friends.

Often parents experience a feeling that they label as anger when underneath that anger is really frustration and sometimes unacknowledged losses. As children move from developmental stage to developmental stage parents experience loss, children do too. Lots of losses; loss of sleep, loss of their “baby” who is growing up, loss of the envisioned child the parents expected, loss of parental availability when a sibling is born or a parent returns to the workplace.

Acceptance. Accepting things for what they are. Simple concept, not easy to do! There are several tools for you to choose from to deal with frustration. Tools for resolving feelings of frustration include; prayer (to a God who is accepting and forgiving) meditation (calming your mind so that you can accept and forgive), talking with friends and loved ones (who are accepting and forgiving). Do you seem a theme here? Acceptance and forgiveness is the remedy for the problem of frustration. Having realistic expectations is also helpful in dealing with frustration. This is remedied by talking with experienced parents, who can reassure that these things pass and are normal or reading books about child development, or talking with a family counselor.

Many parents have unrealistic expectations about parenting and child development. This is indeed frustrating when your experiences don’t match up to your expectations. Listen to your inner dialogue as you go about your day. You may be so consumed with feeling that you haven’t noticed the thoughts running through your head that are contributing to those feelings. You may notice thoughts like “she should know better”, “I can’t believe he is doing that”, “I’ve told her a million times not to do that”. Or you may even be saying those things out loud. Notice those thoughts non-judgmentally and accept them and then notice and accept the reality. For example, I’ve told her a million times to put away her toys before she gets out new toys and she just won’t listen. Then you might tell yourself something like this: She is playing with her toys and isn’t putting away as she goes, I forgive her and going to teach her how to clean up as she goes. I will model putting things away and encourage her. That may be enough to teach her. If that isn’t sufficient, I will also tell her when she doesn’t put something away, I am going to put it away and she won’t be able to play with it for the rest of the day as a logical consequence. Simply being told this probably won’t be sufficient for learning and I very well may have to follow through with this. After she has experienced the consequence, she will probably learn to pick up. Also take time to talk with your parenting partner about these things and listen to each other, support each other, and encourage each other.

The answer to frustrating behavior by a child isn’t punishment. Take time to think before you act; so that you can respond, rather than simply react. Think about what is happening. Think. Pray. Meditate. Sometimes a parent realizes that the situation calls for acceptance and no change is needed. Sometimes a parent realizes while they need to accept the problem for what it is, they also need to take action to promote change and growth. As a Marital & Family Therapist, this is the first step I take in doing a family assessment. Many times a family comes to counseling with a problem, or a problem child, and the parents want the child “fixed”. I need to assess the family carefully to see what is happening in the family system. Sometimes change is needed and I help parents help their child and we have a goal of what we are trying to help the child learn, sometimes the change is helping the parents with acceptance and forgiveness and the child doesn’t need to change a bit. Sometimes, it’s a little bit of both. Sometimes there is a marital problem that needs to be addressed.

In the autistic community there is a tension between interventions to teach children with autism desired behaviors and knowing when and what to accept and not try to change. Some individuals with autism have spoken out and said, “stop trying to fix us and accept us for who we are”. Parents often need to stop and think and look at the big picture and see if they are helping or hindering. Is the child benefiting? What do they need? For a young child, what would they say, if they could? When is enough, enough? Many parents will tell you how helpful a certain intervention was for their child and how their child and their whole family benefited from it and in other cases, parents will tell you they tried various interventions without benefiting and after experiencing a lot of frustration they deciding to stop intervening.

Acknowledge and grieve losses. Telling yourself and/or a trusted person, that you miss the person you were before you had kids, or that you are tired, or that you love your child but they aren’t what you expected; is healing. Denying feelings of grief and loss won’t make them go away. To deal with grief, you need to go through it, not around it.

Freely apologize and ask for forgiveness. Over time, this is the best way for your child to learn to do the same, by following your example. Forgive yourself for being tired, impatient, frustrated, angry, and imperfect. Forgive your child for the same.

©Copyright 2010 by Susan Martinez, MA, LMFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Susan and/or see her GoodTherapy.org Profile

Click here to contact Francesca and/or see her GoodTherapy.org Profile

Why did I choose Voice Dialogue as the cornerstone of my counseling and coaching practice?

1. Voice Dialogue is a brilliantly constructed method that allows me to draw on all of who I am. All the skills, insight, knowledge, and wisdom I have gleaned from a lifetime of personal and professional growth express through me as I facilitate a Voice Dialogue session.

2. Voice Dialogue makes sense. Co-created by psychologists Drs. Hal and Sidra Stone, Voice Dialogue is based on 40 years of study, clinical experience, and mapping of the human psyche (our inner world). It is founded on the premise that humans are not a single entity. Rather, they are made up of an organization of numerous and distinct structures called Inner Selves, sub-personalities, parts, or energy patterns. Each is born with a purpose, has its own beliefs about us and reality, and carries certain characteristics and behaviors. We develop and identify with our Primary Selves, while we bury or repress equal and opposite Disowned Selves. For much of our lives the Primary Selves are who we think we are. They are making our choices and driving our psychological car. By the very nature of life there comes a time where this imbalance creates problems and makes us blind to many new options or choices. Until we have choice, we are not free.

3. Voice Dialogue is a well thought out, structured process by which we enter into direct communication with the client’s Inner Selves or sub-personalities. This careful step-by-step process makes Voice Dialogue the safest and most respectful tool for accessing the depths of the psyche that I have encountered. We never intrude into a person’s inner world without the permission of the existing ego structure. This means that if I have a dialogue with a Disowned Self (an aspect that is in the Unconscious or Shadow), the more conscious or Primary Selves have opened the gate to that territory voluntarily. This collaborative, inclusive approach brings astounding self-knowledge, and results in lasting healing and growth from the inside-out.

4. Voice Dialogue guides the client toward a larger, more objective perspective, called the Aware Ego Process that finds the gold in every sub-personality. This is a very expansive view that welcomes and includes even the most polarized and repressed aspects. Clients learn to incorporate the essence from opposite Inner Selves in response to life’s inevitable adversities; and to live, create, and communicate from much more of the totality of their being. The Aware Ego becomes a master of paradox (the ability to “sweat the tension of the opposites”), which is a foundation for living a more conscious life.

5. Voice Dialogue works. In addition to learning about each Inner Self’s history, purpose, opinions, and behaviors; clients become aware that each has a distinct kinesthetic or energetic feel to it. One of the great gifts of the Aware Ego is its growing ability to conduct, or dial up and down, the energies of the Selves. The Aware Ego Process is like a Conductor of the whole inner orchestra. As the client masters conducting, managing, and moderating the Inner Selves, almost unlimited options and choices become available. The client lives more from conscious choice than from automatic reactions and habits.

6. Voice Dialogue is a flexible method. It supports the resolution of a full spectrum of presenting psycho-spiritual concerns: depression, bi-polar disorder, OCD, healing childhood trauma, recovery form destructive relationships and/or groups, processing loss and grief, sexual identity, blocks to creativity and aliveness, all kinds of relationship issues, eating disorders, lack of meaning or purpose, spiritual crisis or emergence, etc. Voice Dialogue profoundly supports the life-long process of conscious evolution.

7. Voice Dialogue empowers clients to be self-responsible. It gives them the skills to love, nurture and heal their wounded, traumatized Inner Child. As this happens, this vulnerable, sensitive, and essential part of the psyche no longer needs to reach out to get its needs met by another person. In turn, this generates relationships between equal adult partners that are more alive and spontaneous; and maintain connection, passion, and appropriate boundaries. “They learn to love each other without losing themselves.”*

8. Voice Dialogue is a fascinating, unpredictable, engaging process for both facilitator and client. As a counselor and coach my days are filled with intensely meaningful, enlivening, and life-changing work with my clients. I can honestly say, “I have never been bored, ever.” My practice expanded tremendously as I incorporated Voice Dialogue into the mix. Word of Mouth spread quickly as clients reported their successes.

Voice Dialogue moves clients through the most profound healing of life’s traumas, and takes them beyond these barriers to growth. The process brings the facilitator and the client into a collaborative, safe crucible that guides the client through their complex, captivating inner landscape. With new skills to manage and conduct these characters in life, clients begin to achieve “extreme psychological, emotional, physical, and spiritual well-being.” With the help of Voice Dialogue they have the tools and self-knowledge to resiliently and effectively respond to conflicts and problems; while achieving their potential, and creating their dreams.

For an excellent description of Voice Dialogue see Mary Disharoon’s article, Multiplicity: Change is Easier When You Think of Your “I” as a “We”. You can also learn more by visiting my GoodTherapy.org profile and website.

References:

*Stone, Hal and Sidra, Partnering: a New Kind of Relationship, New World Library, Novato CA, 2000, cover

©Copyright 2010 by Francesca Starr, MA, LPC, BCPC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Francesca and/or see her GoodTherapy.org Profile

Click here to contact Paul and/or see his GoodTherapy.org Profile

In my experience with psychotherapy with the elderly client in family settings, I’ve found that the ability to facilitate a sustaining positive outcome after long-standing family dysfunction involves two main factors: 1) the client’s emotional constitution (i.e. their ability to accept the fact that maladaptive behavior exists) and 2) the client’s willingness to take the emotional risk of making amends. A third factor is the adult child’s ability to understand the parent’s life journey.

In the course of my work with a 96-year-old woman, “Lilly”, who had recently lost her third husband and her older daughter (aged 70) within six months of each other, it had become clear that I had the task of not only helping her through her bereavement, but also of trying to repair sixty-plus years of undischarged feelings of shame, embarrassment and guilt. These feelings had resulted from the years of routine abuse – mostly emotional but periodically physical – that she had inflicted on her younger 66-year-old-daughter, “Dina”. (The actual names of mother and daughter have been changed.)

Dina had contacted me to serve as almost a stand-in “hand-holder” for her legally blind mother, to relieve Dina of the weekly barrage of complaints she received from her mom about the caregivers obtained from a variety of homecare agencies. Lilly later admitted to me, jokingly, that she had caused her daughter’s ulcers.

My weekly home visits with Lilly soon revealed her hunger for emotionally reconnecting with her surviving daughter, as well as her poignant re-awakened feelings of abandonment and emotional deprivation from her own painful childhood. At first, Dina reported that Lilly did not want to talk about her past, that it was too painful and I should stick to discussions of the present. However, I gently prodded Lilly, as I saw that she was resilient enough to face her past. It was possible to actually do psychotherapy with this sharp 96-year-old, rather than just supportive counseling.

In reviewing Lilly’s difficult past with her, I began to draw a parallel to Dina’s emotional deprivation. It was this growing understanding that motivated Lilly to have the courage to risk her daughter’s impatience and anger and forthrightly approach her about their long-standing rift.

During and after the period in which we had stabilized Lilly’s homecare situation, Dina and I had exchanged e-mails. I could see that her extreme anger towards her mother for the years of abuse had blocked any understanding of the subtext of her mother’s nagging about home attendants and other routine matters. Lilly’s complaints and various requests reinforced Dina’s impatience with her. Anger at mom – particularly at taking her stepfather’s side when it came to Dina’s choices of careers and friends — prevented her from clearly seeing Lilly’s own fears of her strict Austrian–born husband leaving her if she took her daughter’s side. In further understanding her mom’s horrendous childhood, failed marriages, and disappointments, Dina gradually began to look at their relationship differently. She came to understand how Lilly’s own emotional deprivation as a child and her yearning for greater closeness with Dina led to her pattern of constant complaining.

After Lilly’s initial expression of remorse to her daughter, Dina felt relieved but that it was still “sixty years too late”. She sent me an email about this and when I responded I helped Dina understand the immense pain that her mother felt. Dina then was able to see Lilly’s apology as “extraordinary”. She wrote, “If she was brave enough to face herself and give me what she owed me, I felt I could take the plunge too”. She told her mother that “the past was in the past” and described a long embrace with her. “It was touching and difficult but also easy”.

When mother and daughter both realized the similarities of the emotional betrayals that they had each suffered, a significant amount of misperception was dissipated and both were willing and able to give each other the gift of a new beginning. It was a great achievement for these two strong-willed women.

Of course these issues were not completely resolved, but an important breakthrough was achieved a few months before Lilly’s passing at 98. At any stage in one’s life, when an individual reaches a point of understanding of their own motivations and life patterns as well as their loved one’s, a true bond of caring and reassurance can be re-established. Dina wrote me, “I can’t get my life back, but I’ve always been amazed at the fine job I’ve made of it, given what I started with”. Dina had forgiven herself for her own feelings of shame and inadequacy that she had felt as a victim.

The bond that was re-established between Lilly and Dina made Lilly’s final months and battle with cancer a little easier for both of them. Dina invited me to a memorial service that she held for her mother several weeks after her death. When she eulogized her mother she spoke about their reconciliation and how much that had brought some peace of mind to her own life.

But what about adult children who are not as fortunate as Dina was to reach an understanding with her mother and receive the apology that she had always needed? We can only do our best to understand our own parents’ painful lives, allow ourselves the time and space to mourn both what we lost and never had, then forgive ourselves and know that we did the best we could for our parents and ourselves under very difficult circumstances.

©Copyright 2010 by Paul Cohen, LCSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Paul and/or see his GoodTherapy.org Profile

Click here to contact Jeffrey and/or see his GoodTherapy.org Profile

Do you have difficulty getting out of bed? Have you lost your appetite or perhaps you’re eating more than usual? Have others noticed that you’re somehow different, somehow not as up or happy as you usually are? Have your coworkers or boss noticed that you have been missing more work lately or coming in late?

If this sounds familiar, you could be suffering from depression. Depression is a word that is often thrown around without much care being given to what it actually means. It seems that if you’re sad, then you’re depressed. The word depression is sometimes even substituted for sadness. And while sadness is part of depression, that’s only part of it.

Depression is a life changing, and at times, life threatening condition. According to the DSM-IV (Diagnostic Statistic Manual-the book therapists use for diagnosis) depression consists of having certain feelings, behaviors, and thoughts. They include, but are not limited to: a depressed mood; loss of interest or pleasure in things you used to like and enjoy; diminished interest in all or almost all activities; significant weight loss when not dieting or, conversely, significant increase in appetite; insomnia; fatigue or loss of energy; feelings of worthlessness or guilt; loss of concentration, and recurrent thoughts of death. These things need to be present all day, everyday or nearly every day in order to be considered clinical depression.

The good news is that depression is treatable. It does not have to define you. Most people who suffer from depression are able to live the life they want by taking certain steps that have been proven to work. What I have found in providing therapy is that most people don’t take the steps that can help. But if you are willing to do the work you can start to feel better and start to enjoy life again.

Here are five tools that have been proven to work for those who suffer from depression. I have seen them work for the people with whom I work and they can work for you.

1) Think Good Thoughts

This is perhaps the hardest of all the steps you can take. Arguably the worst part of depression is not the sadness, but the negative self-talk and thoughts that you have due to the depression.

The most basic way to manage these thoughts is to confront the negative thoughts and replace them with good thoughts. However, this doesn’t mean it’s easy. It’s not. This is the idea behind one of the most successful forms of therapy for depression – cognitive-behavioral therapy. The idea here is that our thoughts control our emotions and behaviors and if we change our thoughts, we change our feelings and actions, i.e. what we feel, say, and do.

When I work with those who suffer from severe depression changing their thoughts is the hardest thing for them to do. One way I have found that works for people is to acknowledge all the thoughts they have and dismiss the negative ones. The idea is to say to yourself that you are having negative thoughts and then to let them go. It’s natural to have negative thoughts when you’re feeling depressed. The key is to remember that they are just thoughts and not you. You are separate from your thoughts. You can change the way you think.

2) Exercise

Research has shown that daily activity helps us to feel better about not only ourselves, but also those around us. The exercise you choose to do doesn’t need to be vigorous or long, just something that gets you moving. However, when you’re depressed you may find it difficult to motivate yourself to exercise. This is common.

So what should you do? Get up. Go for a walk. Do yoga. Go swimming. Walk up and down the stairs a few times. Do anything that gets you active and your body moving.

Exercise has been proven to create endorphins. Endorphins are chemicals that are released when we are active and they contribute to feeling better. The release of endorphins helps us to feel more relaxed, less depressed, and helps us to have a better outlook on life.

When I work with patients in the hospital I encourage them to pace the halls or ride the stationary bike. The movement and motion helps the body create endorphins and the mind to think about something else. It’s another way to help yourself to mental health.

3) Create a Happiness Journal

It’s common to loose track of those things about which you are happy. When I work with people who suffer from chronic depression, I ask when was the last time they were happy or enjoyed doing something. The answer nine times out of ten is that they can’t remember. Their brain has blocked the way to think good thoughts and is focusing only on the negative.

One way to combat this is to write down those times when you were happy, when you enjoyed doing something, or when you felt good about yourself. This is important as it will help remind you that there is hope; hope to feel like that again. It will also help remind you that there are events, people, and places you like; things you may have forgotten about.

4) Eat Well

When you are experiencing depression it’s common to either want to eat all day or not at all. And if you choose to eat, chances are that you will want to eat junk food. Why is this? Simply because of the sugar high you will get.

In a study out of Britain, researchers found that people eating whole foods, such as fruits and vegetables, were 26% less likely to be depressed. Conversely, the same study, published in the British Journal of Psychiatry, found that people who eat processed foods, such as those with refined sugars or fast food, were 58% more likely to suffer from depression.

Wanting to eat foods high in sugar, or comfort foods, is normal if you are suffering from depression. But remember, while it’s normal, it’s not helpful. There are a number of reasons for this. The first is that sugar only gives us a short boost of energy. It is similar to any drug that lifts our energy and mood for a short time. However, our body will only feel good until it has processed the sugar and then the crash that will happen may even leave you feeling worse then before.

5) Therapy

And then there’s therapy. The simple act of talking about your issues, feelings, thoughts, and ideas can have amazing affects on both your mind and body. Research has shown that talk therapy is among the most important steps someone who is suffering from depression can take.

I have found working with those who suffer from depression that it is common to want to be left alone; to want to hide out in a safe place and just watch the world go by. The problem is that since you are also probably suffering from negative self-esteem, negative self-talk, and feelings of being alone and isolated, what will most likely happen is that you will not be able to make the changes necessary to start to feel better.

However, therapy can help provide a safe place to talk; a safe place to discuss your issues without fear of retaliation, ridicule, or judgment.

Conclusion:

There is no one answer on how to deal with depression. My experience in providing therapy has shown me that the act of doing something, anything, creates better results then doing nothing. If you want to start to live a life that has less pain and depression, then now is the time to act. The fact that you’re reading this means you have taken the first step in seeking help and that’s something you can feel good about.

©Copyright 2010 by Jeffrey Raich, LICSW, MSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jeffrey and/or see his GoodTherapy.org Profile

Click here to contact Lindsey and/or see her GoodTherapy.org Profile

Solution-focused therapy is a new type of therapy to many people, including psychology professionals. It is considered a form of brief therapy, much like Cognitive-Behavioral therapy, though it doesn’t necessarily have to be practiced in the short-term. I consider these kinds of therapies to be “strength-based” as opposed to “insight-oriented.”

What are some of the benefits of choosing a strength-based therapy?

1. Focusing on your strengths always produces the best return on your investment.

It’s true that most clients don’t come to therapy wanting to improve something they are already good at. However, a solution-focused therapist will work hard to identify the client’s strengths in order to help the client use these strengths in areas where they do want to improve.

Imagine your life as a pie chart, with each slice of pie a different size. At any given time, some section of the pie is going to be off or not functioning at it’s best. That’s normal; we have a lot of pie on our plate! A client who is problem-focused is looking only at this once slice of the pie. A solution-focused therapist is going to help the client fix that slice by balancing strengths that are part of the rest of the pie.

For example, a couple might come to therapy complaining generally of having “communication issues,” but upon further questions from a solution-focused therapist, it might turn out that these issues only arise during a specific topic, or under certain circumstances. The couple might have excellent communication skills and just have not figured out how to apply them to their problem area.

2. People are always trying to right themselves.

While you might know a constant complainer who we secretly think does a pretty good job at self-sabotaging, remember that they don’t see their life this way. A solution-focused therapist doesn’t, either. When a client and therapist can tap into the right system to solve problems, the client’s constant efforts to right themselves will eventually work.

A solution-focused therapist works hard to believe the best in the client and to act as a coach and facilitator towards the client’s goals.

3. Thoughts are our best predictors of happiness.

Why does research show cognitive therapy to be as effective as some medication for mental illness? Because we know that there is a direct link between the thoughts you think and the feelings you feel. When practiced over time, a healthy and productive thoughts produce effective long term results.

If a client has negative ideas about himself, his future, or the world around him, then he is likely to be depressed. Instead of dwelling in these negative thoughts, a solution-focused therapist is interested in learning about when these thoughts are not present. Is there any part of the day when the client is not experiencing the problem that has brought them to therapy? Why is this?

Solution-focused therapy focuses on the present and the future. It is concerned with today’s problems and tomorrow’s concerns. The kind of therapy I do is also non-pathologizing therapy. This means that I don’t view my clients as being deficient or sick in some way. I don’t diagnose clients (unless insurance requires it) and I don’t let them diagnose themselves either.

It’s not that insight-oriented therapy is the opposite, but it is more interested in one’s past, one’s history of repetitive patterns and relationships, and gives much more weight to subconscious drives, behaviors, and issues.

While both therapies have their places in the world of mental health, my experience has found strength-based therapy to be more effective for the type of clients that I see. My clients are not interested in making therapy a hobby that lasts for years and years. In the coming months, I’ll be writing about how solution-focused therapy is used to help a variety of couples issues and common disorders like anxiety and depression. I welcome your comments and look forward to learning from you as well!

©Copyright 2010 by Lindsey Antin, M.A., MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Lindsey and/or see her GoodTherapy.org Profile

Click here to contact Linda and/or see her GoodTherapy.org Profile

“Hold fast to the Great Form within
And let the world pass as it may
Then the changes of life will not bring pain
But contentment, joy and well being”
Tao Te Ching, Verse 35

My client walks in and begins crying; covering her face, she is looking down, searching for some thing, some words to identify her experience. She speaks in anxious circles, words revealing nothing but the space that she cannot find comforting. She admits that her life is “dominated by thoughts” and that she is constantly mining for a jewel that will explain what is going on. As she seeks to find meaning, to understand, I feel her pain and suffering, but am also aware that I do not want to add to her experience with probing questions that would distract her. And I don’t wish to take away from her experience by offering soothing words that would only serve to temporarily mute her inner noise. Instead, I just sit with what is revealing itself, with what is arising in the present moment. In this being together, it is understood that nothing needs to change, that there is no pressure to interpret or to understand.

She squirms while watching me as we sit in this process of not adding to or taking away from her experience. She reports as she sits looking down, “It’s like I wake up and am in this body, and I wonder, ‘Is anything there if I’m not obsessing?’” She elaborates, “I’m looking for a mental formula that proves I exist, but I can’t find it!” She is genuinely curious about her experience of confusion. In this act of being present to one another (without an agenda that something needs to be different) there is a sense of completion despite her conflict, her anxiety, and her questions regarding what signifies an experience of being alive. This sense of completion arises from not needing to change or to maintain a condition. Just like in meditation, we view our thoughts, our emotions, and our sensations as passing conditions and don’t need to do anything about them.

The two main benefits of meditation are the attainment of another way of perceiving and relating to reality and more enjoyment in life in general. These benefits are cultivated by quieting the mind through concentration and insight practice. Sitting quietly, we place all of our attention on watching the breath go in and out. A few seconds later, we notice our leg feels stiff, our nose is running, there is a pain in our forehead. We are wondering what’s for dinner. We notice we’ve been thinking with a sense of dread that there may be a problem in our relationship. As soon as we see we are distracted, we gently pull our attention back to the breath. There is no attempt to explore or understand any of the experience that distracted us. Instead of analyzing any “thing,” that arose, we work with the structure of the mind itself by strengthening its ability to not attach to the passing phenomena of experience with any emotional reactivity. The ability to learn how to rest and to feel at home in our body is cultivated in the practice of meditation. This practice is an invaluable adjunct to the psychotherapeutic process.

“Hold fast the Great Form within/and let the world pass as it may” is a description or an attempt to describe the indescribable. Mystics and seekers throughout time and from diverse cultures have sought to know the answer to “What is the Great Form within.” The Dalai Lama, during a mind-life symposium studying the effects of destructive emotions on brain functioning, was asked about whether every state of mind would have neural correlates. His answer is important, “There is no reason to believe that the very subtlest state—called ‘innate mind,’ the very essential nature of awareness itself, which is its luminous nature—would have neural correlates because it is not physical, not contingent upon the brain.”* Yet, this state, which is not a thing, and “not contingent upon the brain,” can have tremendous influence on our experience. Mind training affects a sense of moment-to-moment calm, a resting in the spaciousness that holds everything. Immediate contact with this spaciousness offers the experience of complete simplicity where nothing is missing and nothing needs to change. This process: just sitting and doing nothing, paradoxically transmutes any pain or suffering into quiet calm.

My client and I are sitting sensing that there is no urgency to do anything. I return to her “mental formula” statement in which she was curious about a formula for existence. In the spirit of contemplative inquiry, I ask her, “Where is your I?” She looks at me without answering and then laughs, nervously. She is noticeably uncomfortable, but she just sits with her discomfort. I ask her where the boundary is between her sense of self and the outside. She closes her eyes, but again remains silent. It’s as if she’s processing that her mind can’t figure out the answer, and I’m with her feeling into the confusion. She closes her eyes again and breathes. She then reflects, without much need to hear an answer, “Is just being aware my I?” This sense of her sitting without a need to identify an “I” with her body or her mind, and allowing for the sense of the inexplicable, relaxes her.

Pure awareness is beyond our ability to understand, to know as a thing. Therefore, unlike the client above, it is possible to become more anxious before we learn to accept the space of not knowing. This is not a problem. In therapy sessions there is a constant reinforcement of noticing the present moment—whatever is being experienced. We also notice that things that activate us have a history and a story associated with them, but we are not interested in participating with the thoughts and the stories as much as we are interested in letting them arise and then letting them go. Our attachment to these stories can create increasing anxiety, but we just sit together and allow an increase in tolerance for the sensations within the body. It is not infeasible that a client might even get angry and say, “This isn’t what I expected. I don’t know what is happening.” So, we allow this and ask if they can notice that they are not their confusion, not their anger. This is very hard, but not impossible, for someone who is not practicing some form of contemplative discipline. Yet, if they can just witness the passing of time and the moment-to-moment shifts they begin to rest in the sense that the ground of their witnessing is not changing. That ground is what we are looking to touch and hold in this process of feeling very identified with the emotion of confusion and anger. Familiarity with this ground and this baseline of neutrality helps when there is a perceived potent assault on our sense of safety.

The challenge in psychotherapy is to blend what is happening in therapy (all the conditions that are being experienced) with the openness of our essential nature, pure awareness. In any moment in time, we feel either contracted or expanded, and whatever arises is used to enhance the experience of effortless being, of freedom and spaciousness in the present moment. The client enters the psychotherapeutic process because he or she is experiencing discomfort and emotional reactivity. The therapist responds from the space of curiosity monitoring the absence or presence of freedom and spaciousness in the present moment. The dance becomes the inquiry between the conditions that a client believes keeps him or her in discomfort, and what is immediately available in the present moment. We use whatever arises to reveal the presence of pure or neutral awareness, and we see how different conditions can be viewed from unconditional presence, the essential nature of pure awareness.

*The Dalai Lama’s quote is from Daniel Goleman’s book Destructive Emotions: How Can We Overcome Them? (New York: Bantam Books, 2003) p. 206

©Copyright 2010 by Linda Jame, LCSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Linda and/or see her GoodTherapy.org Profile

Click here to contact John and/or see his GoodTherapy.org Profile

Exposure types of therapies such as Eye Movement Desensitization and Cognitive Restructuring have the best outcomes in the treatment of Post Traumatic Stress. Exposure therapy might be good with an accident victim who is afraid of driving through an intersection. The therapy is combined with desensitization strategies and relaxation techniques so the person can safely visualize driving successfully through the point of an accident. However, with more complex PTSD cases related to long term abuse or with a person who has long term symptomology, exposure therapy could be dangerous.

I recently began using EMDR after beginning my training in this phenomenal approach. I also utilize ongoing clinical training from two mentors. One has been providing EMDR treatment for 20 plus years; the other specializes in the field of clinical hypnotherapy and the treatment of trauma. It was drilled into my head many years ago to constantly seek clinical training because the lives therapists serve are actually fragile.

So far I have helped a few people along the way. In using any type of new approach my policy is to seek guidance from the experts. EMDR is is no exception. One needs to use caution any time a traumatic memory is explored. With EMDR images and memories emerge. It is like riding on a train gazing out the window as one’s life experiences pass them by. I’ve been a psychotherapist for 20 years and a PTSD survivor as well, so I am very cautious with every person I serve.

EMDR, or Eye Movement Desensitization and Reprocessing, is more than just an approach. It is the belief of myself and others that EMDR is a successful means of treatment for PTSD and for those who are affected by unresolved childhood issues.

Trauma, critical childhood experiences, memories of abuse or neglect, and the associated feelings become stored in the amygdala part of the brain. A scent in the air, the time of year, a simple taste or a sound can bring the experiences to consciousness often in the form of anger or fear! People who have been affected also tend to redefine who they are and what they can do. Irrational thinking errors and beliefs evolve, often affecting self-esteem, level of confidence, and social, vocational and recreational functioning. Examples of irrational beliefs could include, “I’m not important. I’m a failure, I’m defective or I’m worthless.”

Irrational beliefs can also evolve from something a person in authority might say on a continual basis. For example, I was never good at math but my high school algebra teacher made the statement, “I don’t know how someone could be so stupid and still breathe.” Another person I knew was a great baseball player in grade school. He won awards, etc. but then was assigned a coach who decided to single him out. The coach began to make fun of him and was overly critical of his every move. This person quit playing and never picked up a baseball bat again, truly believing he had failed the game. Even though this wasn’t an obvious sign of abuse, it did have a lifelong impact on the person. EMDR and cognitive restructuring helps people challenge irrational thoughts and beliefs to redefine who they are!

Traumatic or abusive events that resurface take over the emotional hemisphere of the brain and shut down the rational or intellectual part of the brain. By following the therapist’s fingers the eyes move back in forth as in REM sleep. During REM sleep the eyes also move back and forth bringing up images or at times unresolved issues from the past. Images or pictures from the past do come up! This becomes complex with abused or long term trauma folks, especially those who may have a tendency to disassociate.

With EMDR both the emotional and the rational hemispheres of the brain are engaged. This is a huge component of its efficacy to help the patient resolve childhood and traumatic issues. This is where the baseball player resolved what the coach had to say and began to play baseball again. This was an easy one. The case below was a little more difficult.

With this person’s permission, I am sharing what recently happened during a session with me. This person is a successful salesperson who is currently going through a divorce after 20 plus years of marriage. The person felt betrayed because their spouse was cheating and was flaunting that it is not against the law to cheat on a spouse. This person works and has always taken great care of the children. Their background included a lot of childhood neglect. Many years ago they evolved irrational beliefs: “Nobody loves me. Everyone else is happy except me. I’m not valued. I’ll never be happy.” I began to see this person for anger control issues. I’ve used hypnotherapy and Brief Cognitive Therapy to address their belief system and try to build up their level of confidence. I’ve also used relaxation exercises to reduce their anger.

Recently, this person presented for a scheduled session almost in a rage and was unable to focus or concentrate on work. An agreement to use EMDR was facilitated. Following the protocol and from earlier sessions an imagined safe place evolved. EMDR therapy began after the person calmed down utilizing some hypnosis techniques focusing on the five different senses of smell, touch, hearing, sight and taste. They were relaxed and experienced a childhood scene with feelings of safety and security. Having the person imagine their own personal safe place is key, as shown below.

Focusing on the scene from their past, EMDR began. After about five minutes feelings of anger began to evolve and the therapist redirected the person to their safe place. A few moments later the tears began and painful images of their childhood surfaced. An image of a forgotten childhood birthday emerged. At this point, the person’s heart rate began to escalate and the EMDR was stopped. The person was led back into hypnotherapy using breathing and progressive muscle relaxation. Through hypnosis the safe place was imagined, heart rate returned to normal, and the person had the feeling of exhaustion. The process of restructuring beliefs into positives such as “My kids value me!” was processed with more EMDR. The disturbing feelings were contained while building on the person’s resources to handle any stress that might come up during the week. This person left my office feeling emotionally drained, with no signs of anger and an irrational belief partially resolved.

The person later that afternoon returned to work and was able to complete all of their work tasks. Two days later, the person is experiencing a continued state of calmness with no signs of distress. We have an agreement that if stress is experienced, they are to call my office at once.

EMDR is not magic. There is a lot of work left to do. Recovering from childhood issues is like peeling an onion, one layer at a time. That afternoon we chipped at just a piece of that layer. EMDR is a gradual safe process that has a proven track record when done according to protocol and with the right therapist who is properly trained in this therapeutic technique. It is not for the novice, nor to be tried on oneself! Whenever any traumatic or childhood memory is explored it needs to happen in a safe place, in a safe way, and with a skilled therapist.

©Copyright 2010 by John Lee, LMHC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact John and/or see his GoodTherapy.org Profile

Click here to contact Chris and/or see his GoodTherapy.org Profile

Core Energetics (CE) was created by John C. Pierrakos in the 1970s. Pierrakos was a student of Wilhelm Reich and worked closely with Alexander Lowen. After jointly creating Bioenergetics, Pierrakos split with Lowen to create his own unique way of working with his patients. Influenced by the work of Carl Jung and his wife, Eva Pierrakos, CE evolved to include not only the roots or Reichian theory, but also an eclectic mix of energy and consciousness theory.

There are three primary tenets to Core Energetics. The first is that humans are inherently a psychosomatic being, that the body and the mind of the individual are inseparable. Second is that the ability to heal, what is necessary to heal, comes from within. Unlike traditional allopathic medicine, where a patient relies on the healing of the physician or medication, in Core Energetics, the belief is that what is required to heal is already present in the person. Third is that “all of existence forms a unity that moves toward creative evolution, both of the whole and of the countless components” (Pierrakos, 1990, p. 12).

In CE, healthy functioning is characterized by balanced flow of energy through the body, emotions, mind, will and the spirit, the five fundamental levels of being. This energy is similar to the chi of Traditional Chinese Medicine, the Indian prana energy and Reichian orgone energy. In fact, Pierrakos was the first Western scientist to bring together energy, spirituality, physics and psychiatry (Chubbuck, 1999).

When energy flows evenly and unobstructed, there is health and optimal functioning. When the energy is weak, or blocked, health is lacking. Such deficiencies can be seen in areas of the body where there is too much or too little energy. Affecting not only the body, energy dysfunctions can also impact the psychological functioning, and result in character structure types found in the work of Reich and Lowen (schizoid, oral, masochistic, psychopathic, and rigid).

One of the most basic principles in CE is that every person has a unique and predictable ability to love, grow and evolve to limitless potential. These abilities form the life force or primal energy found in each of us. The capacity of the individual to be in touch with and to allow this energy to flourish is what determines one’s level of health or suffering. It is through the body, mind and spirit that this energy flows, can be observed, and ultimately accessed in therapy (Chubbuck, 1999).

Another integral concept to CE is the belief that we are made up of layers of energy. At the core is our life force, the energy of life that moves, evolves and creates. As already mentioned, when we are aware of and allow this energy to flow, we are in balance and find health. Surrounding the core is the lower self, formed when we are unable to express negative and/or painful emotion. This defensive layer, the shadow self, serves to protect us from the potential consequences of authentic emotional expression. This layer of unexpressed emotional energy becomes fixed, hardened and literally shapes our physical structure (Chubbuck, 1999).

CE interventions focus on working with energy blocks and deficiencies in the body via physical exercises and breathing techniques. The goals of such interventions include increasing or decreasing energy in various parts of the body, grounding energy, clearing blocked energy. Interventions include hitting pillows, kicking, and role play.

CE also uses specific equipment to work with the body. The roller, for example, is a tool that is used to work directly on the body. Basically a large and thick rolling pin, it is used to smooth out muscles on the feet, torso and large muscles of the legs.

Touch and massage, both by the therapist and by the client, are used extensively in SE, again to work with the body and energy. Locations throughout the body common to blockages, including the eyes, the jaw and the diaphragm are often the focus of this bodywork.

There are four primary stages in CE. The first, penetrating the mask, focuses on increasing the patient’s awareness of their own character structure, and defensive armoring. This is done using extensive physical exercise, which serves to increase a somatic awareness of the self and begin releasing authentic emotionality. “The therapist helps the patient to move from the conscious into the unconscious, and ultimately to reach the core of his being” (Pierrakos, 1990, p. 213).

The second stage, releasing the lower self, is divided into five parts. First, much like penetrating the mask, the therapist and patient continue to increase awareness and knowledge of the “attitude of denial,” the mechanism that is the defensive structure. Second, the meaning of this attitude is uncovered. In short, how does having this specific outlook on life impact other aspects of being? Third, the intent of this attitude, how it is used and why, is uncovered. Fourth, the cause, the original wound, or defensive reaction is revealed. And finally, work to uncover is to uncover what is referred to as the mask, basically the face we have shown the world for much of our lives. Secondly is working with the lower self. Third is bringing the authentic self back online. And finally, in the context of a safe and unconditionally accepting therapeutic container, the negative and painful emotions that have been guarded and held within, are released and allowed to have expression.

Stage three is called centering in the higher self. CE “continues where other therapeutic approaches leave off, after the resolution of the dysfunctions. The third and fourth stages, then, are devoted to evolving the person’s path toward unification with all of existence” (Pierrakos, 1990, p. 222). It stage three, the primary work is to increase trust in living from the authentic self.

The fourth and final stage, uncovering the life plan, is characterized by a meditation process consisting of four focuses. The first focus is on inner truth, which “helps the patient see who he or she can be and accept the effort it will take to evolve” (p. 226). The second focus involves placing the truth uncovered in the first focus on the inner core itself. The third focus is about where life is taking the patient, where they are headed, uncovering the uniqueness of the core. And finally, the fourth focus is about trusting that the world, the universe, can and will hold the evolution of this new, unique core self.

A typical CE session lasts about an hour. The patient might wear tight fitting clothing, or even a bathing suit, to allow the therapist to easily assess and intervene with the body. As already stated, early interventions serve to increase the patient’s awareness of their body and their structure by increasing and working with the energy. This is done with breathing exercises, postures, touch and other physical interventions. Sessions typically include intensive bodywork, movement and touch, in order to directly access and facilitate the release of held energy. It is quite common for such release to result in intense and cathartic emotional expression (Chubbuck, 1999).

One primary intervention common to CE is the use of staccato breathing. In his observation of newborns, Pierrakos noticed that while nursing, babies tend to breathe in short nasal sniffs. He hypothesized that by engaging in this primal, nurturing breathing method, one might reconnect with a lost sense of connection and love. He thus created the staccato breathing technique which served to release multiple muscular blocks as well as optimize the flow of energy through the body, balancing both active and receptive capacities (Wilner, 1999).

There are two ways energy moves through the body. Active energy occurs when we engage with something, when we act on something. It tends to flow posteriorly from bottom to top. Receptive energy, flowing anteriorly, allows us to receive love and engage spiritually. If the posterior flow is stronger, we tend to be less able to be compassionate, and feel things superficially. When the converse is true, we tend to struggle with doing, planning and completing thing (Wilner, 1999).

Common to Reichian and Bioenergetic theory, the body is divided into seven segments which include ocular, oral, throat, chest, diaphragm, abdomen, and pelvis. Staccato breathing simultaneously brings a flow of energy through all seven segments, in a figure eight pattern, crossing at the diaphragm (Wilner, 1999).

Staccato breathing is broken into three stages which include expansion (active), contraction (receptive) and pausing (relaxation). During expansion, the patient lies down on their back with their knees bent. The back is arched as they close their eyes and take in five short, strong breaths through their nose. The patient then holds their breath on a count of three and then exhales. During the exhalation stage, the patient exhales forcefully through the mouth, as they allow their back to relax from the arching. The shoulders are raised and the tummy is tucked, as their body moves into a contracted posture. During the third phase, the body is allowed to relax for several seconds before the entire cycle is repeated (Wilner, 1999).

In conclusion, Core Energetics is a form of somatic psychology that brings together body, mind and spirit. At its core is the premise that all beings are born to give and receive love, and evolve to limitless capacity. Love here is life force, the core, authentic self that was covered over and protected early in our lives. Through the body focused and cathartic interventions found in CE, the shadow, or lower self, which has restricted our movement, physically, emotionally and spiritually, is removed. “When the core, or authentic self, is no longer overshadowed by the destructive characteristics of the mask or lower self, love is free to nourish people and help them transform their lives (Wilner, 1999, p 3).

References:

Chubbuck, P. L. (1999). Core energetics. In Allison, N. (Ed.), The illustrated encyclopedia of body-mind disciplines (pp. 387-390). New York: Rosen Publishing Group.

Pierrakos, J. C. (1990). Core energetics: Developing the capacity to love and heal. Mendocino, CA: LifeRhythm.

Wilner, K. B. (1999). Core energetics: A therapy of bodily energy and consciousness. In D.J. Wiener (Ed.), Beyond talk therapy: Using movement and expressive techniques in clinical practice (pp. 183-203). Washington: American Psychological Association.

©Copyright 2010 by Chris Tickner, MA, MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Chris and/or see his GoodTherapy.org Profile

Click here to contact Michael and/or see his GoodTherapy.org Profile

In Switzerland, Carl Jung told a young American man suffering with alcoholism that as far as medicine and psychiatry were concerned, there was no hope for him. That was in 1931, and this still remains true in 2010. The single alternative left was a religious or spiritual experience — what Jung referred to as “a genuine conversion.” Jung had heard of such experiences helping alcoholics get sober, but admitted that such cases were “comparatively rare.”

In 1934, William D. Silkworth, a prominent physician specializing in alcoholism and drug addiction had a similar slant on the problem. He proclaimed that only a message of “depth and weight” could hold the interest of the addicted person. “In nearly all cases, their ideals must be grounded in a power greater than themselves, if they are to re-create their lives.” Silkworth further stated that, “Unless this person can experience an entire psychic change there is very little hope of his recovery.” Anyone presently familiar with addictions knows that it was out of these messages that the entire Twelve-Step recovery movement was born. Addressing the relief from out-of-control obsessive desires (alcohol, drugs and other addictions) and the need to create substantive lives, the Twelve Steps have helped millions of people throughout the world. It is also clear that while this movement continues its profound and rapid growth, at its core are controversy and mutations of the experience. A 1994 issue of Common Boundary magazine states, “On the eve of the 60th birthday of Alcoholics Anonymous critics are charging that the Twelve Steps are outdated and irrelevant. Others claim they’re the doorway to new forms of spirituality and social action.

Far from outdated and irrelevant I would say the Twelve Steps are dated. For many they are a doorway to new forms of spirituality and social action, but they need to be built upon with all that had been learned in the last seventy-six years. We need to acknowledge the limitations of these steps. Building on my own experience, I am hoping to create a larger view of addictions recovery. I want to build on AA’s original intent to be inclusive and transforming, while integrating with newer, more expanded wisdom on spirituality, diversity and psychology. In doing so, I continue to proclaim our societal needs for the Twelve Steps with nothing less than my respect and loyalty, as the program continues to support so many in a profound, meaningful way.

The purpose of this article is to explain the sense of spirituality that one must bring to the staged model of addictions recovery, as illustrated in the Tree Diagram at the end of this article. My extensive work in this integrative model is fleshed out in my book The Journey Toward Complete Recovery: Reclaiming Your Emotional, Spiritual & Sexual Wholeness. The National Institutes on Health (NIH/NIDA) and The National Association of Addiction Professionals honored the study for Outstanding Leadership in Research in the year 2000. At the awards banquet a NIH senior researcher congratulated me, along with a caveat: Don’t get your hopes up too high. As valid as this research is, it might take a minimum of twenty years before it could reach mainstream acceptance. I was disappointed in hearing that then, but now, ten years later, I understand what I was being prepared for.

To have the capacity for however one defines God, love, or the great, or universal spirit, one must come out of their self-sustaining, ego-driven fear and isolation or conditioned thinking. (Attachment to outmoded, self-harming conditioning is an addiction in itself; all the same healing techniques apply.) One must also admit that they cannot successfully confront their addiction without the help of others. In so doing, the ego, one’s conditioned thinking and its enforcing armor begin to relax, allowing the opportunity for a spiritual conversation. This is the threshold to Stage One recovery. If the person is earnest in their desire for help, and if empathetic help is available, this spiritual, energetic and experiential conversion will begin to take place. The words energetic and experiential are important because this conversion is beyond words, and can take place without any reference to God or spirituality. It does so in groups like AA for Agnostics all the time. It is done through the compassion and understanding of others who allow a person to be just as they are — even when that includes not believing in God or spirituality. The experience is felt as an opening, however slight, to the energy flow within the person and how they’re connecting with the energy in those sharing their recovery process.

When a recovering person has sufficient time adjusting to a life that is not ruled by their primary addiction, a second stage of the process begins. The timing for this emergence varies for each individual. This Stage Two requires a deeper, spiritual experience of the sense of self that is created as part of the process. It is this phase that empowers a deeper realization of self through a merger of Analytic Theory, Humanistic, Transpersonal, Existential, and Somatic Psychologies. Often called the remembering and resolution stage, this is a time when one awakens their unconscious, with the help and support of others, to dissolve existing barriers to fuller self-expression and joy. Similar to addressing the primary addiction, there is often great resistance to this deeper self-discovery. Again, it will be the reaching out for help, and letting go of the self-sustaining ego that will allow one to lean into this work.

Similarly, the empathetic nature of one’s help will significantly impact the process. At this point in the process, many will wonder: Why should I spend time and energy probing my depths? I want to just get on with my life. That is understandable, as it takes courage to confront one’s own barriers of getting needs met, to gradually move further into the remembering and resolution. Once one makes this movement, they will be able to open to new energy and information. AA’s founder, Bill Wilson, wrote, “Sobriety is only a bare beginning; it is only the first gift of the first awakening. If more gifts are to be received, our awakening must go on.” Taking the leap into this kind of work has its rewards, as attested to by many of my clients; some of their remarks follow:

I discovered Stage Two work after my recovery from crystal meth addiction and sexual compulsion. Focalizing in Stage Two was especially effective in healing the traumas and blocks that kept me from living the life I desired. These techniques were graceful, occurring naturally with ease.

Having previously been in therapy, as well as successfully working on my sobriety for over a decade, I thought that I was fairly self-aware, able to work out problems on my own. I had little idea then of the life-changing journey I was about to embark on in Focalizing Stage Two.

Today my life has changed beyond what I thought was possible.

Of the thousands of highly motivated women and men that I have worked with in addictions recovery, they have all expressed the same longings. They want to connect more meaningfully with others. They want consistent loving relationships, and a sustainable loving, sexual relationship. They want to feel less awkward in their presentation of self. They want to have a sense of purpose to separate from obsessive drives. They want to know who they are. Stage Two was developed to begin the process of fulfilling these deep, inner desires.

In my own recovery and struggles to define God, I eventually distilled a technique of personal observation and experience. From this refinement of many years of searching, I was left with two concepts that I continue to juggle with through all the work I presently do. The first is love; the feeling of kindness, compassion and understanding toward others. Many ancient philosophical and religious writings espouse that “God is love,” but it took my own rigorous study to breathe life into those words. The second is that an experience of transcendent energy, spirit or force inspires the disentanglement of my unconscious. As I learned to bring compassion and understanding into my own repressed traumas, conflicts, defenses and secrets, I experienced a deeper well within from which I am able to share an energetic connection.

At one point in my search, M. Scoff Peck became my hero when he wrote in The Road Less Traveled, “If you desire wisdom greater than your own, you can find it inside you. The interface between God and man is at least in part the interface between our unconscious and our conscious. To put it plainly, our unconscious is God.”

Although I have used the word God in my own discoveries, it is important to remember when working with recovering people, that word must often be abandoned for another more practical and meaningful to the individual. For many, having experienced childhoods that were inconsistent, abusive or neglectful, there is a deep sense of having been deserted or betrayed by the concept of God. Assisting people in discovering this deeper sense of self can be best accomplished with words and phrases that describe a feeling. Ones that I have used with a high degree of success are: energy, spirit, the Great Spirit, the universal spirit, connection with self and others, or letting go of willfulness and ego.

These realizations are the spiritual grounding for the self awareness that is required to do this work. Eva Pierrakos, founder of the Pathwork, said, “If you make your commitment to yourself to fully accept everything you now are and to proceed to get to know yourself where you do not yet know yourself, you will find it is the most exciting, significant, and meaningful journey into your own depth. You will have all the help you can possibly need, for no one can undertake this journey alone. The help will be given to you; it will come to you.”

The abstract concept of Serendipity, a motivating goal in the staged model of recovery, is rooted in these ideas. Webster’s defines serendipity as “the gift of finding valuable or agreeable things not sought for.” Carl Jung referred to this phenomenon as synchronicity, while M. Scott Peck called it “being touched by grace.” Eva Pierrakos takes it further. “When your spiritual center begins to manifest, your ego consciousness integrates with it and you begin to be lived through, as it were, by the spirit.”

However one describes serendipity, people in recovery who have reached out of their self-sustaining ego for empathetic help report these occurrences regularly. They will often say “miracles happen,” or “there is no such thing as coincidence.” Simply stated, the minimum spirituality that a person must bring to the staged model of addictions recovery is the willingness to be open and reach out for help. It is in this humility that the determined, willful ego of the addicted person begins to relax and integrate with their energetic, core center. Focalizing and other somatic healing practices bring grace to the Stage Two recovery process by gently introducing our central nervous systems and neurobiology to the experience of wholeness. Another of my clients remarked:

We started out using Focalizing techniques to calm the physical trauma to my central nervous system. The effect was subtle, but clear. I soon began to easily take positive actions that I had previously been too paralyzed to even think of.

As recovery continues, this willingness, humility or surrender will become elusive at times, particularly in Stage Two. When deeper issues, traumas and conflicts get exposed, one must then integrate the determined aspects of the ego defenses with the deeper desire for connection, and continue to open up for help and clarification. This continued reaching out for the wisdom and experience of others will provide necessary spiritual support for working through this staged model. It will deepen one’s sense of self, slowly evaporating the invisible shame that ensconces it, and making it possible to share this deeper self with others.

Through Focalizing and other visualization techniques, I find myself able to finally let go of the mental debris that prevented me from building a more solid foundation. I am now able to make positive, transformative changes to become more of my authentic self.

What truly inspires me to continue this journey is another quote from M. Scott Peck. “I think of addiction as the sacred disease…Very probably, God created alcoholism in order to create AA, and thereby spearhead the community movement which is going to be the salvation not only of alcoholics and addicts, but of us all.”

(Note: Although the above Tree Diagram is a linear presentation it is in fact non-linear, fluid and organic progression. Particularly in Stage Two, where whatever needs to be healed next presents itself in a natural process of resolution.)

©Copyright 2010 by Michael Picucci, PhD, MAC, SEP. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Michael and/or see his GoodTherapy.org Profile

Is it hard for you to say “NO”, even when you want to? Are you afraid to sound mean or selfish if you speak up? Do you ever say, “Everything is OK”, even when it’s not?

If you answered “yes”, to any of these questions, deep down, you may wish that you could speak your truth without fear of turning people off or pushing them away. Sometimes, you may even be confused about exactly what you want. Imagine being able to identify your thoughts, feelings and desires and confidently express them without letting your anxiety run away with you. Speaking your truth in each moment will bring you more of the satisfying connections that you long for with your partner, your friends, and your family members.

The key to achieving high quality intimacy is growing your ability to maintain your sense-of-self when you are emotionally and physically close to another. This means that you have developed the courage to speak your truth without needing the person on the receiving end to accept or validate what you have shared. When you accept and validate your own thoughts, feelings and desires, you are free to stay in connection without having to forfeit your own experience for the needs and wants of another. David Schnarch, my favorite intimacy guru, calls this, “self-validated intimacy”, the ability to hold on to your own truth as you show people who you really are.

On the other hand, when you are dependent on the approval of others to determine what is acceptable to share, you are practicing “other-validated intimacy.” People who practice “other-validated intimacy” give up their sense of individuality in order to feel safe and connected. We all want connection! And other-validated intimacy is one way to create it. But giving up our own needs and wants more often then not, will eventually lead to resentment, anxiety and depression, co-dependency, and dead-end relationships. Self-validators, on the other hand enjoy more freedom, aliveness, and intimacy because they know they don’t have to hide their individuality to stay together.

This reminds me of Sarah, who came to me paralyzed by her fear of having panic attacks in social environments. She was the daughter of divorced parents and raised by a single mother, who managed her sadness and anxiety with frequent and sometimes reckless bouts of alcohol. As a little girl, Sarah really needed a stable mother to look after her. So she made it her mission to keep Mom happy and sober. She learned that, “Mom will be okay, if I am okay” and decided that sharing difficult emotions, saying “no”, or doing anything that might upset Mom was just not worth it.

As an adult, she continued to rank the importance of her thoughts, feelings and desires behind those of others. Placing herself second was second-nature. In our sessions together, Sarah and I discovered that her panic attacks were an unconscious response to her ignoring her own needs. Her psyche was literally screaming for her truth to be known!

With my help, Sarah learned how to manage her anxiety by listening to her panic attacks because they were giving her valuable information. When she noticed her panic escalating, I instructed her to slow down, feel her feet on the ground, notice her breath and turn her attention inside. Then she could notice what was really going on and hear her hearts true desire. At first, the thought of asserting herself produced another rush of panic. She worried, “Will you be okay if I speak my truth?”

With time, Sarah could separate her experience as a little girl from the present moment enough to believe that putting herself first was worth the effort. She stopped needing to be a professional people-pleaser. Now she could navigate a world that used to feel unsafe. She no longer felt overwhelmed and drained at social engagements. She found the courage to stand up to a boss who made her feel underappreciated. She quit her office job and applied to grad school to study her real passion, nutrition and holistic health. She married her long-time boyfriend. And she even began to relate to her mother in new ways, forging a path with her for less hair-pulling and more loving interactions.

When it’s all said and done, being a self-validator is not about shifting from, “what ever you want, dear” to “its-my-way-or-the-highway”. Ideally, you can confidently communicate your unique thoughts, feelings and desires (even if they are different from those around you!) and also express your true interest in connecting with them. Sometimes you can have both (and other times you can’t), but at least you will like and respect yourself for standing up for what you believe in.

©Copyright 2010 by Alissa Sige Weisman, MFTi. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Alissa and/or see her GoodTherapy.org Profile

Click here to contact Peggy and/or see her GoodTherapy.org Profile

** The following article is a continuation from last month’s GoodTherapy.org submission, “The Use of Scaffolding Map in Narrative Therapy” **

In my second meeting with Peter, we met alone for the majority of the time because his father was involved with taking care of the other children in the family. Peter was immediately talkative and engaged in our conversation. I “checked in” with him regarding how he has been feeling about things since our last meeting (which had taken place one and a half weeks prior). Peter identified that he was noticing that he was not feeling angry or sad, and that this was a change for him. I inquired as to what contributed to that change, and he said that he was deciding to “focus on other stuff,” which enabled him to “worry less about things going on around him.” When I asked what “other stuff” he was focusing on, he said that he was focusing on homework, and also on baking. Peter smiled as he told me of his recent success with baking a new type of cookie that he had discovered in a cook book. The fact that he got the idea to bake them, asked to bake them, made them, and that they were enjoyable to others had him feeling “proud of himself.” Through questions, I was able to ascertain that baking these cookies was a new initiative for him. I asked him to give this initiative a name, and he called it being “adventurous.”

Here commenced a reauthoring conversation that centered around Peter’s adventurousness. I spent time asking Peter about both his actions, as well as questions about his identity, as seen through the lens of adventurousness. Peter’s affect was bright and engaged during this conversation. A reauthoring conversation is based on highlighting actual events in a persons life (landscape of action) as well as exploration of the meaning, hopes, values, preferences, learnings, commitments, and importances to that person (the landscape of identity). As I spoke to Peter about adventurousness, my aim was to ground this initiative in Peter’s current and past actions, as well as connect this step to his beliefs about his life, his hopes, and preferences for living. This conversation is summarized in the following letter which I wrote to Peter after we had our reauthoring conversation.

Dear Peter,

Peggy

The purpose of the Reauthoring conversation is to make previously subjugated storylines more present in people’s lives. Often “problem” storylines (in this case – sad, angry, and stressed) have taken over people’s thinking, and life events become interpreted within the context of these problems. Since Reauthoring conversations bring about a new way of looking at lives, often these conversations require some extra “reinforcements.” Because Peter had just discovered this place of “adventurousness” in his life, I chose to send him the therapeutic letter in order to reintroduce and reinforce these ideas with him a few days later.

Also – at the end of our conversation that night, Peter’s father entered the counseling room and I recounted on the developments of adventurousness. By having Peter listen to my “retelling” of his Reauthored story, he was able to listen to the entire plotline from a place of distance, which helped it become more real for him. Additionally, I interviewed his father briefly about what he knew of Peter’s adventurousness, and Peter was able to hear these stories (one about playing soccer on his older brother’s soccer team, and one about feeding alligators in Florida), within the context of him being adventurous. The retelling, the interview with his father, and the letter all serve to bolster and reinforce the strength and power of the developing Reauthored story.

Peter has continued to embrace and explore his adventurousness. One day after our conversation, he asked if he could make chocolate cookies from scratch, and he did. He has expressed that trying new things and being adventurous has him feeling proud of himself and happy. He says that it helps him to feel like he can be “more carefree and less stressed.” His father has also commented that he feels like he has “gotten Peter back,” as they have had the opportunity to have fun together, and be silly and carefree.

©Copyright 2010 by Peggy Gold, MS, NCC, LMHC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Peggy and/or see her GoodTherapy.org Profile

Click here to contact Christopher and/or see his GoodTherapy.org Profile

There is nothing more satisfying for me than hearing, “I have been in therapy for years talking about this and today with you is the first time I felt like someone really believed me.” The client comes to this relief when she senses my intention and ability to hear her story, be emotionally present, and be impacted emotionally by her. Possibly for the first time, she is “seen” without judgment. And I let her know that I appreciate that she is willing to let me in on something that is so personal and sacred.

People occasionally ask me,”How can you stand to listen to problems and complaints all day?” With this attitude my client would never feel emotionally safe and experience me believing her. I tell them “It is not like that at all. I am so grateful that I can be with people who can open up their hearts and let me in. It is an honor for me that they trust me so much.”

With either child or adult trauma, even if she has people that genuinely care about her, she is often left with feelings of loneliness since very few people (therapists included) are able to go to that deep emotional place with her. This is more than understanding details, the listener must obviously demonstrate that he is emotionally and physically impacted by what he is seeing, sensing, and hearing. His eyes could moisten, tears could flow, face may soften, and the body language and voice intonation somehow must genuinely show caring.

This is the power and miracle of Interpersonal Neurobiology (IPNB)–that we can influence each others neurology in a significant way. Unfortunately, our parents did not know how to give us this gift of being seen since they never experienced this themselves. As an IPNB therapist we must first find a way to experience this emotional resonance for ourselves with a partner, therapist, friend, lover, someone. Unless we know this emotionally, not intellectually, then we cannot possibly give it to another or participate in this exchange.

Making the implicit explicit–not simply that the patient exists in the mind and heart of the therapist, but exploring how he exists–gives weight and staying power to the new experience to balance the pervasiveness of the defenses marshaled against the pain and disappointment associated with intimacy. Moreover, such therapeutic work promotes and intensifies, even accelerates, the process that primes the Reflective Self Function (Fosha p. 219). To assist the client in bringing to the surface what is implicit, the unconscious mind, is the therapist’s task. He must enter her world not as an invader but as a trustworthy ally willing to fight the enemy. “The enemy of healing is not only trauma; the even more subversive enemy of healing is detachment, trivialization, stagnation, and the loss of feeling and meaning” (Fosha Trauma/Resilience p. 3).

When the client knows that the therapist is truly present with her in the loneliness, this changes her world, her inner reality. For the first time she is not isolated with the pain. As a result, toward the end of the session when each shares their experience of the session, she is not alone with the joy, relief, and appreciation. An adult client once took me to her “torture chamber,” the place her father raped and threatened her life many times. As a result of that session, the client was later able to take a shower without having a 15 minute panic attack. When she saw how touched I was by her progress and she saw my tears, she believed this had a greater impact on her than the previous “torture chamber” session.

She could see and sense my feelings for her healing and this changed her brain. It reduced her cortisol and adrenaline levels and generated oxytocin. The oxytocin promotes emotional resonance and the resonance generates oxytocin. They feed each other. This exchange is sacred, healing, and spiritual.

References:

Fosha, D, 2000, The Transforming Power of Affect, Basic Books, p. 219

Fosha, D, Trauma Reveals the Roots of Resilincy, Constructivism in the Human Sciences

©Copyright 2010 by Christopher Diggins, MA, LMHC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Christopher and/or see his GoodTherapy.org Profile

Click here to contact Leslie and/or see her GoodTherapy.org Profile

I had been seeing “Nicole” for almost a year. She had made remarkable progress in her efforts to overcome the abuse and neglect of her childhood and wanted to draw on her new-found insights to improve her relationship with her husband. Gradually, she was making connections between the attachment deficits from her family of origin and the “disconnects” within her marriage. But then some things started surfacing: how her husband “Jeff” controlled all the finances and made her ask for money; how he would get sullen and sulky for days when she made plans that didn’t include him; how he would start an argument with her just before she was leaving to go out with her friends, usually ending up with Nicole giving up and staying home; how he made light of her pursuit of a college degree and insisted she take out student loans in her name rather than use his income to pay for her books and tuition.

As a therapist with more than seven years experience working with partner violence perpetrators and victims, I recognized the red flags. As her husband’s controlling ways became more apparent, our work focused on her managing this relationship rather than enhancing it. Not surprisingly for someone raised in an atmosphere of authoritarianism and abuse, Nicole never equated her husband’s “tantrums” or “selfishness” with partner abuse. She did what most victims and perpetrators do — she minimized it, made excuses for the abuser, blamed herself, justified it or just flat out denied it. We explored ways of empowering Nicole to set boundaries, be assertive, expand her social support system (like many abused partners, she had become isolated) and build self-confidence and self-esteem. Leaving Jeff was the last thing she wanted to talk about. There were just enough “honeymoon phases” to allow her to believe that he would change, that it could work, that it would all be OK. And he “talked about” attending couple’s counseling just often enough to keep her hopes alive.

And through all this, Nicole maintained that Jeff had never physically abused her; no, not once had he raised a hand to her. She hated the manipulation and control, and the temper tantrums, but she did not feel physically threatened. She did not need a safety plan, she insisted, and anyway, where could she go? Her parents were as indifferent as ever, her favored sister was off in her own world in happily-ever-after-land and Nicole had no money of her own. Besides that, she feared that she would not be able to afford the vet bills for her beloved dog, Cleo.

Then, the flags started getting redder. It seemed that Jeff had taken to checking her cell phone. His temper tantrums increased and the insults became more biting. As Nicole was getting healthier, Jeff was getting more fearful and controlling.

And then came the day I got the panicked phone call from Nicole. She had to leave, now. Jeff had gotten physical with her the night before when they got into an argument. They were in the car at the time and he began driving recklessly on the rain-slicked road. Nicole was terrified. She was eventually able to jump out of the car at a stoplight but as she tried to run away, Jeff chased her and tackled her to the ground. He started to choke her, but stopped himself, then got into the car and left her outside in the rain. The argument had started when Jeff found a text about him while checking Nicole’s phone.

I helped her make a safety plan over the phone and Nicole got out safely. While Jeff was at work, she stuffed her clothes, schoolbooks and CDs into garbage bags, grabbed Cleo, and went to the home of a classmate. She has been on her own ever since, struggling to live and finish school.

Denouement

Nicole is one of the lucky ones; she got out safely without being stalked or threatened (with physical harm, anyway) and she never had to go to a shelter. Jeff filed for divorce and got a lawyer to help him protect his assets (their home and furnishings, his $100K salary, 401K, and some investment accounts that he tried to hide from Nicole). The only thing Nicole asked for was Cleo, whom Jeff also fought to keep out of Nicole’s reach, though he had never shown much interest in the dog before.

When Nicole and I first sat down together all those months before and began charting a path to wholeness and healing, neither of us would have predicted this outcome. Could I — should I have seen this coming? But then, why had Nicole not mentioned the times Jeff threw things across the room during his temper tantrums? Why didn’t she tell me that he regularly called her “stupid,” “crazy” and “white trash”, or that he coerced (shamed) her into having sex when she did not want to? Was she frightened? Protective? Ashamed?

Perhaps all three apply, but the most significant and surprising thing I have learned in working with individuals caught up in partner violence is that more often than not, they do not recognize abuse for what it is. Their defenses go into overdrive: “He didn’t hit me; he just put his fist through a wall.” “She has a really bad temper when she gets mad.” “Yeah, she hits me all the time — but she’s 5’ 4”, it’s not like she can really hurt me.” “I just grabbed her by her arms to get her attention, you know, to let her know I was serious.” “I warned him not to piss me off.” “If I didn’t control all the money, she’d put us in the poorhouse.” And my personal favorite, “she bruises easily.”

I’ve heard every one of the above statements, and many more, by people who literally do not know that they are in an abusive relationship. Sadly, what they also do not know is:

- It does not matter if there are no physical injuries: abuse is abuse
- Emotional abuse has longer-lasting and more devastating effects than most physical abuse
- Partner abuse is a progressive dis-ease, like alcoholism, and can be fatal
- It undermines self-confidence and self-esteem and makes it harder to make healthy decisions in all areas of their lives
- Their children know what is going on. Even if they’re not there, asleep, at grandma’s, etc., children sense the tension and hostility and begin to equate those feelings with love
- Children who grow up with partner violence are more than twice as likely to abuse or be abused themselves
- Violence can escalate dramatically when a victim leaves or attempts to leave an abusive relationship
- Women and men have been shown to be equally likely to be the initiator of physical violence
- There is a high correlation between controlling behaviors and violence, whether by a male or a female
- Lesbian and gay partners are just as likely to be abusive and violent as their straight counterparts

Because most abused and abusive people don’t know these things, it is important that those of us in the helping professions do. When our clients can put the proper name to their experience, they have taken the first step to safety and healing. Often, we must spend a great deal of time helping our clients see the sad reality of their circumstances before they are able and willing to move forward. It can be frustrating to see our clients return each week with another horrendous story of pain and humiliation, or with bruises and abrasions (or worse), and still not call it what it is. We must have the patience to witness their pain and fear without judgment, without demands or reproaches for “allowing” this to go on. We must acknowledge our own feelings of helplessness in order to better understand their helplessness and despair. And we must be watchful of our own indignation and anger toward the abuser.

In future articles, I will provide other information that may help counselors and therapists conceptualize their cases that include partner abuse so that they can incorporate interventions for it into their treatment plans. Next month: Why do partners abuse each other?

(Some of the above data is from Domestic Violence Resource Center, www.dvrc-or.org)

©Copyright 2010 by Leslie Larson, LPC-S. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Leslie and/or see her GoodTherapy.org Profile

Click here to contact Lynn and/or see her GoodTherapy.org Profile

As David Frawley wrote in Yoga: the Greater Tradition, “Breath and Mind are connected like the two wings of a bird. The breath reflects our thoughts and emotions. . . .fear makes us forget to breathe.”

Emily’s boyfriend dropped her; he told her he wouldn’t ask her out again because she was like a parrot, she always agreed with him. “It’s like you’re not there, Em,” he said. About the same time her favorite teacher told her basically the same thing- she was smart, but didn’t seem to have a mind of her own; the teacher suggested Emily might need help, so Emily decided to see a psychotherapist–me.

Emily told me her story, laughed, said she was silly, and looked half ready to go and half longing to stay. “That’s no reason to see a therapist,” Emily said. She sat rigidly on the edge of her chair, so stiff and straight she looked like was balancing a book on her head. She made none of the little movements people use to get comfortable. In fact, she didn’t move at all. She often held her breath, and breathed mostly from her chest.

I had the strong feeling that I shouldn’t breathe, either, that any move I might make–even something as subtle as a blink, would hurt Emily somehow. She couldn’t tell me how she felt, but she could show me–she couldn’t speak freely or think for herself, and she wasn’t allowed to move a muscle. She was always scared, and her body showed it; she walked stiffly with short mincing steps, as though treading on egg shells; her face was frozen in an expressionless mask; she rarely spoke, and her voice was very soft when she did speak. She was trying to be invisible, even from herself.

For many months I gently listened to the lists Emily made of her days. Emily was passive, and always agreed with me, just as her boyfriend and her teacher said. She was a chameleon- blending into the background to avoid being noticed.

When she was a little girl Emily often woke up from nightmares in the middle of the night; she pulled the covers over her head, making sure they were completely and tightly tucked in, held her breath, and became invisible. Her parents didn’t protect her, and were even abusive sometimes; when she told me about family life she said it was OK, but she spoke like a robot, and looked scared stiff. Emily often felt cold, and I offered her a blanket, something, she said, her parents would never have done- they would have told her she wasn’t cold, just complaining.

Psychotherapy creates a safe space where mind and body can come together and find peace; the therapist uses mirroring, empathic understanding, metaphors, and stories; the therapist’s reactions may be different than expected, creating kinder pathways. I wanted to help Emily write a new story for herself, and I wanted her to relax.

One day I asked Emily if she would like to begin her therapy sessions with a brief centering experience–belly breathing. I showed her how to breathe deeply, filling up her lungs, hoping this would help her inhabit her body and calm down.

Starting our meetings with a breath centering technique brought us closer together. Emily became more attuned to her body’s hints when she was beginning to feel anxious, and was able to enjoy the feeling of slow complete breaths, the energy of the inbreath, and the deep relaxation of the outbreath.

Emily was feeling safer and could breathe easy. She had found her original, primordial breathing rhythm, and experienced peacefulness in a safe place with another person, allowing the deep self to emerge and feel accepted (for more on this, see my article in the psychotherapy issue of Integral Yoga Magazine, Fall 2008.) She was in tune with herself and others, the beginning of mindfulness. Her relief from stress and anxiety, and her growing ability to catch herself tightening up and soothe herself before the anxiety took over, had a profound effect on her experience of being in the world. She felt stronger and more collected, no longer a victim.

Her talk in therapy changed too, now less a recitation of events and more a consideration of their meaning, and why they were significant to her and to others. In short, she was able to reflect on her experience, and hold firm in the face of powerful emotions; as her sense of self became more coherent, she developed qualities of mindfulness. She was less reactive and more spontaneous, and began to see herself as worthwhile and good. Her friends told her she was different, more alive.

©Copyright 2010 by Lynn Somerstein, PhD, RYT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Lynn and/or see her GoodTherapy.org Profile

Click here to contact Lisa and/or see her GoodTherapy.org Profile

We are shaped by our primary relationships not only by experience but how our brains are wired as a result. The exciting latest research in the field of interpersonal neurobiology (Daniel Siegel, MD) has demonstrated that though negative experiences of unmet needs can result in our personal alarm systems (our reptilian brain, or our amygdalla in neuroscience-speak) sounding off inappropriately, the brain can rewire itself with new experiences.

Let’s talk a bit about unmet needs…

In therapy, whether individually or in a couple dynamic, I look for indicators of unmet needs as children. This often shows itself as deep mistrust, fear of abandonment, sensitivity to criticism, poor self esteem and other signs. There is a reason why the person sitting before me looks at the world through this lens. A combination of biology, unmet relational needs and the ensuing wiring of the brain can be a cocktail for a great deal of internal and relational distress.

How does one get to the seed of unmet needs, particularly in many cases when there have been very efficient defense mechanisms in place to protect the person from this emotional reality? The answer is, very cautiously. These types of questions are probably not best suited for the first few sessions of therapy unless the client is well aware of them and brings them forth immediately to look at.

One question that helps to get to this sensitive area is, “What did you need from your dad (or mom) that you didn’t get as a child?” Many people have never pondered this question and why would they? For many, it’s a fairly painful thing to look at. If a safe environment has been created between the four walls of a therapy room, this is a good place to start.

I often have the client do a letter to their mother or father from themselves at a particular age in childhood then process this in session. People often are surprised at how emotional it can be to not only do this letter – but hear themselves read it aloud. If one can start to look at what experiences and core beliefs about themselves, others and the world they have internalized, they are often solidly on the road to healing. The hardest part is often facing what the experiences must have been like for you as little boy or girl, which means breaking through some of your well constructed and useful defensive mechanisms. The problem is what may have been “useful” before is not longer useful as you walk through life.

If you can take a look at and appropriately grieve for your inner child and develop empathy for him/her, you have great hope for getting on the road to the emotional and relationship health you deserve.

©Copyright 2010 by Lisa Brookes Kift, MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Lisa and/or see her GoodTherapy.org Profile

Click here to contact Beth and/or see her GoodTherapy.org Profile

Lucy and Andy, my two cats, have been best buddies ever since we brought Andy home fourteen years ago, when Lucy was one year old. As I write, they are nestled next to each other. Lucy, who has always been very healthy, is starting to show the signs of age: recurrent urinary tract infections, and the beginnings of kidney failure. As a hospice bereavement counselor, I support family members through their anticipatory grief, and their grief after the death of their loved one. Is Andy starting to prepare for Lucy’s demise? How will she react after Lucy dies? How can I support her in the process? I know plenty about supporting humans through their journey of grief — how do I do that with my animal partners?

Many have observed behavioral changes in their pets after their animal and human companions die. They may search for their friend, stare out the window, seemingly in hopes that their friend will come back, stop eating, cry or seem depressed, clingy or withdrawn.

Some researchers believe that a cat or dog’s concept of death is similar to that of a young child. Young children do not have the cognitive development to understand the finality of death, and grief counselors urge parents to talk honestly about death, in as much detail as a child can understand and tolerate — we cannot do that with our pets. Pets can experience absence of what they became used to with their animal companions — their warmth when cuddling, their heartbeat, eating side by side. Some behaviorists believe it is helpful to show surviving pets the bodies of their deceased buddies. Indeed, it has been observed that a cat may stop searching for his or her playmate once shown the corpse of his dead friend. If that is not possible, searching behaviors may continue until the surviving cat realizes in some way that his or her friend is not coming back.

So, how do we support our grieving animal friends? As a grief counselor, I always keep in mind Maslow’s hierarchy of needs, and it is therefore important to start with the physical. With humans, I always ask if they are eating and sleeping well and getting exercise, using psychoeducation to explain that grief is stressful in all domains — physical, emotional, social and spiritual — and that if the bereaved does not take care of the physical component, he or she will not be able to move forward in a healthy way on the journey of grief. Obviously, we cannot explain this to our animal companions. Instead, look for eating and sleeping changes. Not eating can be very dangerous in animals, and can lead to liver failure and death. Hand feeding may be necessary in this case, and the physical closeness involved in hand feeding can be soothing and aid in healing. It is also important to observe if the animal is urinating normally, as urinary tract infections can occur in times of stress.

Emotional support is also important in the healing of grief. I have observed time and time again how important touch is in working therapeutically with those who are dealing with loss. When I comfort a grieving spouse, a hospice patient who is scared and confused in dementia, and others who are experiencing the pain of loss, the touch of a hand or a hug is often far more healing than words. It is the same with our pets — massage them and talk to them in comforting tones. Continue to observe their behavior, and if they seem fearful, depressed or anxious, spend as much time as you can with them, talking to them in a soothing way and petting them so that they learn that they are safe.

Our pets are very sensitive to changes in their human companions’ emotions, and may become anxious. Therefore, it is important for us to take care of ourselves, and get the support we need, whether from friends, a grief counselor or a support group, so that we can best support our pets.

©Copyright 2010 by Beth S. Patterson, MA. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Beth and/or see her GoodTherapy.org Profile

Click here to contact Kalila and/or see her GoodTherapy.org Profile

Over the past decade, as I began to practice spiritual psychotherapy as well as more traditional psychotherapy, I have worked with a number of clients who have expressed difficulties with prayer. Some don’t know whom to pray to; others don’t know how; and others report that they have tried it and their prayers were rarely if ever answered.

I recently read The Private Patient (Alfred A. Knopf, New York 2008) by British mystery writer P.D. James in which she describes a character seeking help with a difficult decision. “The cross was directly in Marcus Westhall’s sightline, and sometimes for long periods of silence he would fix his gaze on it as if expecting from it some mysterious power, an aid to resolution, a grace which he realized would always be withheld…For him it served as an aid to concentration, the focus of the thoughts which crept and rose and whirled in his mind like brown brittle leaves in a gusting wind..He had entered quietly and, seating himself as usual on the back wooden bench, gazed fixedly at the cross, but not in prayer, since he had no idea how to begin praying or with whom precisely he would be attempting to communicate. He sometimes wondered what it would be like to find that secret door said to be open to the lightest touch, and to feel this burden of guilt and indecision fall from his shoulders. But he knew that one dimension of human experience was as closed to him as was music to the tone deaf.” (Pp.58 – 59).

The “…secret door said to be open to the lightest touch” is a beautiful summation of my personal assessment of and experience with the power of prayer.

For those patients who are part of a specific religious tradition and have the tools of their faith with which to communicate with the divine, it is often a matter of taking the time out to pray and learning both how to frame their prayers and how to listen. This is more subtle than it sounds. All too often I find that people think that the only purpose of prayer is to ask for something from God, usually something very concrete, i.e., money, a new job, a partner, relief from pain, and so on.

To those individuals I suggest reframing the request and instead, asking for help acquiring the tools to get that for oneself. Then I talk about listening. Once again, all too often, people are better at asking than listening. Their wish is that they pray and the wish is granted (kind of like the fairy godmother concept). However, rarely do they take the time to sit quietly after prayer to allow the answer to come. I find people are impatient and forget the cardinal rule (no pun intended) of prayer, which is that God answers in God’s time and not ours.

For those who are on a spiritual path not connected to any particular religion, I encourage them to keep it simple. I borrow from the not simple at all wisdom of the 12 Steps of Alcoholics Anonymous, particularly the 11th Step. “Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God’s will for us and the power to carry that out.”

As you take a moment to ponder the meaning of that step, I’ll give you my interpretation. I believe the step is emphasizing the importance of being on a spiritual path each and every moment; to do it consciously and with intention. I also believe that the step is recommending seeking knowledge rather than specific things. We are encouraged to seek the answer to the basic question of what God wants for us. Everything else is irrelevant, including what we want. (You know the old saying “…be careful what you wish for”). This is because we often lack the wisdom or perspective to know what is truly right for us. Once we understand what God wants for us, we need to go about achieving it and that’s where the second part of the step comes in – the power to carry out God’s wishes. This is where the divine and the human intersect. This is where our own efforts to create our lives play a significant role.

When all of our actions and behaviors and choices are divinely guided, it’s then we can move mountains and find the joy and satisfaction we all seek.

©Copyright 2010 by Kalila Borghini, LCSW and Ordained Yoruba Priest. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Kalila and/or see her GoodTherapy.org Profile